Mentored Scientist Award

Despite progress toward the UNAIDS targets, substantial gaps persist in the HIV care cascade, especially for adolescent girls and young women in sub-Saharan Africa (SSA), who experience disproportionately high HIV prevalence. Further, our parent data in Uganda demonstrates a higher baseline HIV prevalence (10.7%) among our larger fistula study cohort as compared to the national average (7.2%). Women face structural and social factors that increase their risk of both HIV and maternal morbidities. These factors include a lack of access to quality emergency obstetric care, which can lead to traumatic conditions like obstetric fistula and often results in stillbirth. HIV and obstetric fistula independently result in significant physical, psychosocial, and economic consequences. The complex interplay between these two stigmatized conditions is poorly understood, yet this intersection may have significant consequences for experiences, care-seeking, and management of both conditions. To address this evidence gap, this study has two aims; i) To explore how HIV influences women's experiences with fistula and their related healthcare-seeking behaviors; and ii) To characterize system-level barriers and facilitators to care. Nesting a qualitative study with a fistula cohort (R01HD101570), we will conduct in-depth interviews with 30 purposively selected women, varying in care engagement and adherence, to gain a nuanced understanding of their experiences with HIV and fistula. IDIs will be conducted with 10-15 providers to provide a healthcare system perspective on HIV and fistula care-seeking behaviors and inform interventions for HIV care engagement. The interview guide will be informed by literature on stigma, health-seeking behavior, and intersectionality, ensuring the qualitative data collection is theoretically grounded to address key questions. By examining the unique vulnerabilities and lived experiences of women with co-morbid HIV and fistula, we aim to inform the development of integrated, patient-centered care models that improve the overall health for women living with HIV and fistula.