Incentives for HIV Testing in Women

African American and Latina women, as well as women living in poverty, are at
disproportionate risk for contracting HIV (CDC, 2018). Prevalence is increased further in
these women if they have other risk factors for HIV, including substance use, history of
intimate partner violence, and homelessness. Despite the relatively high prevalence rates in
these populations, many women with these characteristics have never been tested for HIV (CDC,
2016a). Knowledge of one's HIV status is crucial for rapid access to treatment and reducing
the spread of HIV. Thus, effective interventions for enhancing testing in these women are an
imminent need.

This project will evaluate a systems approach for enhancing HIV testing in high risk women.
The investigators will train ~50 staff from multiple community agencies that provide services
to high risk women to encourage HIV testing and deliver reinforcement for testing. After
staff training, 334 women recruited at these community agencies will be randomized to
standard care referral procedures plus HIV risk reduction education or the same plus
reinforcement, in which they can receive monetary compensation for completing HIV testing at
study initiation and for repeat testing 6 and 12 months later.

This project evaluates new models to promote HIV testing. It institutes trainings and
provides direct resources for integrating reinforcement-based HIV testing referral procedures
to women accessing services at substance abuse treatment clinics, Federally Qualified Heath
Centers, domestic violence agencies, and homeless shelters. Trainings address systemic and
structural issues and provide concrete methods and resources to enhance testing (i.e.,
reinforcers).