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The Influence of Housing Status and Food Insecurity on a Behavioral HIV/STI Prevention Intervention for Black Women under Community Supervision in New York City: A Moderation Analysis

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Abstract

Black women in community supervision programs (CSPs) are disproportionately affected by HIV and other sexually transmitted infections (STIs). A randomized controlled trial of a group intervention titled Empowering African-American Women on the Road to Health (E-WORTH) demonstrated effectiveness in reducing sexual risk behaviors and STI incidence among Black women in CSPs. This secondary analysis aimed to assess the moderating effects of housing status and food security on E-WORTH effectiveness in reducing sexual risk behaviors and cumulative incidence of STIs over a 12-month period which were found significant in the original trial among a sample of 351 Black women in CSPs in New York City who use drugs and/or engage in binge drinking who reported engaging in HIV risk behaviors or testing positive for HIV. We examined the moderating effects of housing stability, housing independence, and food insecurity on reducing cumulative STI incidence and number of unprotected sex acts using mixed-effects negative binomial regression and logistic regression models that controlled for age, high school education, employment status, and marital status. Findings indicate that the intervention effect was moderated by housing stability, but not housing independence or food security. Compared to the control group, E-WORTH participants who were housing insecure had 63% fewer acts of condomless sex. Our findings highlight the importance of interventions designed for women in CSPs that account for upstream determinants of health and include service linkages to basic needs provisions. Further research is needed to unpack the cumulative impacts of multiple experiences of poverty faced by this population.

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Funding

This research was supported by a grant from the National Institute on Drug Abuse of the National Institutes of Health under Award Number R01DA038122. One of the authors, Nishita Dsouza, is also supported by the National Institute on Drug Abuse of the National Institutes of Health under Award Number T32DA037801.

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Authors and Affiliations

  1. Social Intervention Group, Columbia School of Social Work, New York, NY, USA

    Nishita Dsouza, Louisa Gilbert, Mary Russo, Mingway Chang, Anindita Dasgupta, Elwin Wu, Nabila El-Bassel & Dawn Goddard-Eckrich

  2. University of Alabama Birmingham, Birmingham, AL, USA

    Karen Johnson

  3. City University of New York, New York, NY, USA

    Nasim Sabounchi

  4. Albert Einstein College of Medicine, New York, NY, USA

    David Lounsbury

Authors
  1. Nishita Dsouza
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  2. Louisa Gilbert
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Correspondence to Nishita Dsouza.

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Ethics Approval and Consent to Participate

All procedures performed were in accordance with the ethical standards of the Columbia University Institutional Review Board (IRB). The procedures used in this study adhere to the tenets of the Declaration of Helsinki. Informed consent was obtained from all individual participants included in the study.

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NCT01690494

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Dsouza, N., Gilbert, L., Russo, M. et al. The Influence of Housing Status and Food Insecurity on a Behavioral HIV/STI Prevention Intervention for Black Women under Community Supervision in New York City: A Moderation Analysis. AIDS Behav (2024). https://doi.org/10.1007/s10461-024-04403-1

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