Background
Black women in the U.S. are disproportionately impacted by STIs/HIV, largely due to political, social, and structural determinants of health. Despite these glaring disparities, sexual reproductive health (SRH) services continue to be fragmented and challenging to access. This study examines the relationship between family planning service (FPS) use and engagement in STI/HIV testing among cisgender Black women in Maryland, an Ending the HIV Epidemic (EHE) priority jurisdiction.
Methods
The SHINE Black Women Study used a concurrent mixed methods approach, collecting data from Black cisgender women through an online survey. FPS use was measured by asking participants, “Have you accessed or used any family planning services (including birth control, abortion, fertility services) in the last three years?” PrEP eligibility was determined using CDC criteria, including condomless sex, partners, recent STI history, and substance use during sex. We ran crude and adjusted models to assess the associations between FPS use and the odds of receiving an HIV or STI test, while adjusting for other confounders.
Results
Among 158 participants, 140(88.6%) of the sample met PrEP eligibility criteria, indicating HIV risk. Notably, 80(50.6%) reported sex under alcohol influence and 45(28.5%) under drug influence. Most, 103(65.2%) accessed FPS and they were more likely to have been screened for STIs(77.7% vs. 60.0%, p = 0.019) and HIV(67.9% vs. 50.9%, p = 0.035). Bivariate analysis showed a significant association between FPS use and STI screening(OR = 2.32, 95% CI: 1.14, 4.72, p=0.020) and HIV testing(OR = 2.05, 95% CI: 1.05, 4.00, p=0.037). Factors significantly associated with increased STI screening were having private insurance coverage(OR = 4.45, 95% CI: 1.60, 12.34, p=0.004) & HIV risk score(OR = 1.06, 95% CI: 1.02, 1.11, p= 0.003). Factors significantly associated with HIV screening were having a college degree(OR = 0.39, 95% CI: 0.16, 0.95, p= 0.039) & HIV risk score(OR = 1.04, 95% CI: 1.00, 1.08, p= 0.030).
Conclusions
Black women who use FPS are more likely to utilize STI and HIV testing, highlighting a potential intervention point for PrEP and STI/HIV prevention. While FPS are vital touchpoints, broader structural factors play a significant role in HIV/STI screening, understanding underlying factors that strengthen or weaken this relationship is vital. Integrating STI/HIV testing into FPS could reduce SRH disparities, support EHE goals, and ensure that Black women are not excluded from EHE efforts.