Background
Nearly 25% of people living with HIV in the US are women, most of whom are racial/ethnic minorities living in the south. In 2022, people assigned female sex at birth accounted for 18% of the almost 38,000 incident HIV diagnoses. Of those, Black/African Americans age >=13 accounted for 50%, and 20% were Hispanic/Latina. Minority women and women with HIV (WWH) commonly face unplanned pregnancies, adverse pregnancy and long-term clinical outcomes, poor retention in care and ART adherence, and higher mortality compared with men, white women, and older women. Understanding the effects of HIV among minority women of reproductive age is vital.
Methods
The Study of Treatment and Reproductive outcomes (STAR) is a cohort of women ages 18-45 living with and without HIV in Miami FL, Atlanta GA, Birmingham AL/Jackson MS, Chapel Hill NC and Washington DC. Structured interviews are conducted in person at baseline, six, 12, and 18 months, and by phone semiannually thereafter with additional visits for pregnancy and postpartum. Major aims include assessments of mental and oral health on HIV and overall health outcomes, particularly during pregnancy and postpartum.
Results
Among 891 women enrolled between March 1, 2021 and April 30, 2024, 526 were WWH (of whom 65 (12%) were pregnant) and 365 were women without HIV (WWoH; 32 (9%) were pregnant). Median age was lowest among pregnant WWH (30 years) and highest among non-pregnant WWH (38 years). Most STAR participants are Black/African American (76%), non-Latina (89%), attended or completed college (56%), never married (54%), have monthly household income <=$1,000 (30%), and had >=3 sex partners in the past year (59%). The majority (98%) of WWH were using ART at baseline. Only 5% of WWoH had used PrEP in the past year. The majority of pregnant women reported alcohol use in the past year (66%), though fewer compared to non-pregnant women (77%). Non-pregnant WWH had highest prevalence of depressive symptoms as assessed via CES-D; (39%) scored >=16 and 28% scored >=21. Almost half (48%) of the cohort had not seen a dentist in the past year and over half (52%) rated the condition of their mouth and teeth as fair or poor.
Conclusions
Barriers to healthcare access, such as mental health challenges and substance use, continue to contribute to higher HIV prevalence among women in the southern US. STAR provides critical insights into the intersection of HIV, reproductive health, and social determinants of health among women of reproductive age in the Southern U.S.