New project brings revolutionary HIV prevention program to the South

More than half of new HIV diagnoses among women in the United States are among Black women. That number is even higher in the South, where about two-thirds of new HIV diagnoses among women are among Black women. Nationally, the HIV diagnosis rate among Black women is about 12 times the rate among White women. The disparity is even greater among Black women under community supervision, such as probation or parole. Some studies have found that as many as 17% of women under community supervision are living with HIV, compared to about 0.2% of women nationally. Karen A. Johnson, an OIBR affiliate and associate professor in the University of Georgia School of Social Work, is developing targeted interventions to address this critical problem.

Johnson and her team have secured a five-year, $2.8 million grant from NIH’s National Institute on Drug Abuse. This major award will support Empowering African American Women on the Road to Health (E-WORTH) South, an intervention designed to prevent HIV and STI infections.

E-WORTH South, based on the WORTH (Women on the Road to Health) and E-WORTH interventions, presents a hybrid approach to HIV prevention. WORTH focuses on women in community supervision programs who engage in behaviors linked to HIV and STI transmission, such as drug use. E-WORTH is an adaptation of WORTH and is tailored to Black women who are under supervision. It is the only intervention for this population included in the CDC’s Compendium of Evidence-Based Interventions and Best Practices for HIV Prevention, and E-WORTH South will bring it to Alabama.

Nabila El-Bassel, the creator of the WORTH intervention, is a professor of social work at Columbia University and Johnson’s mentor. As a doctoral student, Johnson served as Project Director, and later, co-investigator on E-WORTH. Her primary responsibility was leading the development of the intervention for African American women, including several of the stories and videos featured in E-WORTH’s digital modules. Coming from a difficult childhood home herself, the work Johnson did for the program resonated with her.

“When I had the opportunity to move from New York to the South, it was the only thing on my mind,” Johnson said. “I’ve got to bring this work to the South.”

Adapted program touches on distrust toward doctors, religion, lack of transportation

But Johnson knew they could not implement the exact intervention used in New York. She instead worked with southern Black women with lived experiences of community supervision for years to uncover what unique challenges they face.

A recurring theme was a lack of trust in the healthcare system. Many Black women have experienced poor treatment from healthcare professionals or know about someone who did. There are fewer health care providers in the South compared to the Northeast, so switching doctors is not always an option. This can lead many women to stop going to the doctor entirely.

“Women in the South often find out that they are living with HIV when it’s progressed to the stage of AIDS because they’re not in care as much,” Johnson said. “So, we’re trying to get them to the doctor and make sure they’re going regularly.”

Religious participation also has a greater presence in the South. While this can be a positive part of women’s lives, it can also lead to shame and barriers to care when religiosity intertwines with healthcare. Johnson recalled when she spoke to a woman who sought preventative care for HIV after being sexually assaulted. She faced judgment from each system of care she contacted for having sex without a condom, never receiving the treatment she needed. When relaying this story, the young woman “cried like she was three years old,” Johnson said.

Furthermore, while New York City has mass transportation that runs 24/7, many of the women Johnson spoke to lacked access to reliable transportation. They often struggled to reach healthcare clinics and probation or parole offices, and in some cases, were pressured into sex in exchange for rides.

“So, the women were stuck between ‘Do I say no and get violated for probation and go back to incarceration? Or do I say yes, even though I don’t want to?’” Johnson said.

All of these pain points were incorporated into E-WORTH South’s activities.

A hybrid approach to HIV education and prevention

In Johnson’s project, women will be randomized into two groups, with one participating in E-WORTH South while the other engages with standard care. Each E-WORTH South group session “begins as a group and ends as a group,” Johnson said. There will be five weekly meetings with five to six women in each session. The first of the five sessions is an individual session. A live facilitator will talk to the participants and guide activities on topics such as provider trust, self-advocacy, problem-solving, and building peer support.

Participants will also watch videos and answer questions individually. These videos feature female characters describing the challenges they face and how they handled them. The goal of these videos is to help participants identify with the characters and apply what they’ve learned to their own lives through homework and group activities.

All participants will be surveyed before the program and again at three months, six months, and twelve months to gauge their knowledge and behavior patterns. Both groups will receive no-cost HIV and STI testing, treatment, and access to medication such as pre-exposure prophylaxis (PrEP) that can prevent HIV transmission.

Increasing knowledge, protecting health

E-WORTH has already seen success. Among 352 Black women under community supervision in New York City, E-WORTH participants had 54% lower odds of STI infection, 38% fewer condomless sex acts, and greater PrEP awareness through over 12 months of follow-up. Johnson is hopeful that E-WORTH South will make a big difference for women in Alabama and, eventually, the rest of the South.

“There’s this knowledge gap, and I hope the study will close it. Some women in this part of the nation don’t even know exactly how HIV is transmitted,” Johnson said. “We’re trying to get rid of HIV. And for Black women, we’re trying to decrease that disproportionate rate of transmission.”

Written by: Sydney Barrilleaux

November 5, 2026