Effects of an HIV Peer Navigation Intervention for Women Living with HIV: A Brief Report A brief report

Main Article Content

Lianne A Urada Macy McClung Rhea Van Brocklin Jill Blumenthal


Background: Peer navigation is an evidence-based model for engaging and retaining women living with HIV in medical care. Participants of an adapted Lotus peer navigation group intervention were hypothesized to have more self-perceived HIV self-care and advocacy behaviors following their participation than non-Lotus participants at an agency serving cisgender women and their families affected by HIV in San Diego, California.

Methods: The peer navigation intervention, Lotus, was adapted to include new modules on substance use, human trafficking, and intimate partner violence and piloted to compare its overall effects with a comparison group (2018-2019). Ninety-five cisgender women living with HIV (WLWH) completed posttest surveys measuring their perceived changes in peer advocacy and self-advocacy following their participation in a pilot of an adapted Lotus. Participants of the four-session Lotus group intervention (n=34) were compared to non-Lotus participants who engaged in other types of group activities at the agency (n=61). The Lotus group participants included a cohort of cisgender women > 50 years old, English and Spanish speaking women, and a mixed age and race/ethnicity group. All clients of Christie’s Place, an organization for women living with HIV in San Diego, were eligible if they were not actively using illicit substances substances in the past year. Cross-sectional bivariate analyses were run to determine differences between intervention and comparison groups. The groups were not randomized.

Results: Among 95 participants, 17% were White, 14% Black/African American, 44% Hispanic/Latino, and 25% Other/Mixed race/ethnicity with median age 51 years (IQR: 45-60). Eleven Latina, 9 White, 6 Black/African American, and 8 Other/Mixed individuals participated in Lotus. In bivariate analyses, Lotus WLWH living with HIV at posttest took their HIV medications correctly (p=0.040) and attended their healthcare/other service appointments as advised/scheduled 3 times more often than non-Lotus WLWH (p=0.014). They advocated for themselves within medical and social service settings 6 times more often (p<0.001) and talked openly with their doctor 4 times more often (p=0.028). They were also twice as likely to talk more often with their partner about safer sex (p=0.022) and PrEP (p=0.037) and a peer about safer sex (p=0.001). They were 3 times more likely to help a peer understand how HIV medications can improve their health (p=0.001). Medical records showed all Lotus intervention participants as virally suppressed one year after their participation.

Conclusions: Participants of an HIV peer navigation intervention experienced significant changes in self-reported self-advocacy outcomes. Peer navigation training interventions remain critical for medication adherence and self-advocacy among cisgender WLWH.

Article Details

How to Cite
URADA, Lianne A et al. Effects of an HIV Peer Navigation Intervention for Women Living with HIV: A Brief Report. Medical Research Archives, [S.l.], v. 10, n. 6, july 2022. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/2835>. Date accessed: 20 apr. 2024. doi: https://doi.org/10.18103/mra.v10i6.2835.
Case Reports


1. The White House. 2021. National HIV/AIDS Strategy for the United States 2022–2025. Washington, DC.
2. Centers for Disease Control and Prevention. Estimated HIV incidence and prevalence in the United States, 2015–2019. HIV Surveillance Supplemental Report 2021;26(No. 1). http://www.cdc.gov/ hiv/library/reports/hiv-surveillance.html. Published May 2021. Accessed 4 May 2022.
3. Meacham MC, Bahorik AL, Shumway M, Marquez C, Riley ED. Condomless Sex and Psychiatric Comorbidity in the Context of Constrained Survival Choices: A Longitudinal Study Among Homeless and Unstably Housed Women. AIDS and behavior. 2019; 23(3): 802–812. https://doi.org/10.1007/s10461-018-2280-5
4. Sadang KG, Miller D, Veloso D, Lin J, McFarland W. Unmet Health and Social Welfare Needs of Women Who Inject Drugs in San Francisco. Journal of health care for the poor and underserved. 2021; 32(1): 204–219. https://doi.org/10.1353/hpu.2021.0019
5. Harris T, Rice E, Rhoades H, Winetrobe H, Wenzel S. Gender Differences in the Path From Sexual Victimization to HIV Risk Behavior Among Homeless Youth. Journal of child sexual abuse. 2017; 26(3): 334-351. https://doi.org/10.1080/10538712.2017.1287146
6. County of San Diego, HIV Epidemiology Unit, October 2019. https://www.sandiegocounty.gov/hhsa/programs/phs/hiv_aids_epidemiology_unit/reports_and_statistics.html Accessed 4 May 2022.
7. McCree DH, Koenig LJ, Basile KC, Fowler D, Green Y. Addressing the Intersection of HIV and Intimate Partner Violence Among Women with or at Risk for HIV in the United States. J Womens Health (Larchmt). 2015 May;24(5):331-5. doi: 10.1089/jwh.2015.5301. PMID: 25973798.
8. Marshall KJ, Fowler DN, Walters ML, Doreson AB. Interventions that Address Intimate Partner Violence and HIV Among Women: A Systematic Review. AIDS Behav. 2018;22(10):3244-3263. doi:10.1007/s10461-017-2020-2
9. Saxena A, Deschamps MM, Dorvil N, et al. Association between intimate partner violence and HIV status among Haitian Women. Glob Public Health. 2019;14(11):1557-1568. doi:10.1080/17441692.2019.1602156
10. Urada LA, Smith LR, Yore J, Triplett DP, Hucks-Ortiz C, Raj A. Sex Trade and Health Care Utilization Among People Living with HIV/AIDS. AIDS Behav. 2018;22(8):2553-2563. doi:10.1007/s10461-018-2131-4
11. Ramsey SE, Ames EG, Uber J, Habib S, Hunt L, Brinkley-Rubinstein L, Teitelman AM, Clarke J, Kaplan C, Phillips NJ, Murphy M. Linking Women Experiencing Incarceration to Community-Based HIV Pre-Exposure Prophylaxis Care: A Qualitative Study. AIDS education and prevention: official publication of the International Society for AIDS Education, 2021; 33(3):216–233. https://doi.org/10.1521/aeap.2021.33.3.216
12. Toth M, Messer LC, Quinlivan EB. Barriers to HIV care for women of color living in the Southeastern US are associated with physical symptoms, social environment, and self-determination. AIDS Patient Care STDS. 2013;27(11):613-620. doi:10.1089/apc.2013.0030
13. Berg RC, Page S, Øgård-Repål A. The effectiveness of peer-support for people living with HIV: A systematic review and meta-analysis. PLoS One. 2021;16(6):e0252623. Published 2021 Jun 17. doi:10.1371/journal.pone.0252623
14. DeMarco RF, Chan K. The Sistah Powah structured writing intervention: a feasibility study for aging, low-income, HIV-positive Black women. Am J Health Promot. 2013 Nov-Dec;28(2):108-18. doi: 10.4278/ajhp.120227-QUAN-115. Epub 2013 Apr 26. PMID: 23621624.
15. Boyd MR, Moneyham L, Murdaugh C, Phillips KD, Tavakoli A, Jackwon K, Jackson N, Vyavaharkar M. A peer-based substance abuse intervention for HIV+ rural women: a pilot study. Arch Psychiatr Nurs. 2005 Feb;19(1):10-7. doi: 10.1016/j.apnu.2004.11.002. PMID: 15765367.
16. Blackstock OJ, Platt J, Golub SA, et al. A Pilot Study to Evaluate a Novel Pre-exposure Prophylaxis Peer Outreach and Navigation Intervention for Women at High Risk for HIV Infection. AIDS Behav. 2021;25(5):1411-1422. doi:10.1007/s10461-020-02979-y
17. Urada LA, Gaeta-Rivera A, Kim J, Gonzalez-Zuniga PE, Brouwer KC. Mujeres Unidas: Addressing Substance Use, Violence, and HIV Risk through Asset-Based Community Development for Women in the Sex Trade. Int J Environ Res Public Health. 2021;18(8):3884. Published 2021 Apr 7. doi:10.3390/ijerph18083884
18. Urada LA, Simmons J, Wong B, et al. A human rights-focused HIV intervention for sex workers in Metro Manila, Philippines: evaluation of effects in a quantitative pilot study. Int J Public Health. 2016;61(8):945-957. doi:10.1007/s00038-016-0875-z
19. HIV/AIDS Bureau, Special Projects of National Significance Program. Implementation guide: enhancing access to HIV care for women of color. Rockville, MD: U.S. Department of Health and Human Services, Health Resources and Services Administration; 2014.
20. Bandura A. Social cognitive theory of self-regulation. Organizational Behavior and Human Decision Processes. 1991; 50(2): 248-287, ISSN 0749-5978, https://doi.org/10.1016/0749-5978(91)90022-L.
21. Ajzen, I. The Theory of Planned Behavior. Organizational Behavior and Human Decision Processes. 1991; 50:179-211.