# A Harm Reduction Approach to Addressing the HIV, STIs, and Substance Use Syndemic among People Engaging in Sex Work in Alabama

> **NIH NIH P30** · UNIVERSITY OF ALABAMA AT BIRMINGHAM · 2023 · $213,601

## Abstract

PROJECT SUMMARY
Despite the availability of biomedical prevention tools to end the HIV epidemic, incidence of HIV and other STIs
in Alabama remain high, while uptake of prevention such as PrEP remains low. Further, opioid prescribing,
use, and overdose-related death are also disproportionately high in Alabama, with an increasing impact on
Black individuals. Converging risk related to HIV, STIs, and drug use can be attributed in part to socioeconomic
inequalities in the Deep South which may drive sex work. Recent evidence suggests individuals engaged in
sex work report higher rates of diverse drug use and increased vulnerability to HIV and other STIs compared to
other individuals in Alabama. Sex workers and people who use drugs represent vulnerable groups who face
unique barriers to HIV prevention including PrEP. However, HIV services for sex workers in Alabama are
limited, and no evidence-based interventions in the CDC’s Compendium have been tailored for sex workers.
Through community-academic partnership, this project will use syndemic theory to directly address the needs
of a severely underserved population through development of a PrEP intervention for people engaging in sex
work in Alabama. The Specific Aims are to: (1) Develop a harm reduction intervention that responds to
syndemic drug use, HIV, and STIs for people engaged in sex work, [Year 1] and (2) Pilot and evaluate the
acceptability, appropriateness, and feasibility of the intervention to increase PrEP uptake among people
engaged in sex work [Year 2]. Within Aim 1, we will leverage existing quantitative data to identify intervenable
Outer Setting characteristics (patient needs and resources) and collect de novo qualitative data to further
characterize sex work, contextualize the needs and resources of individuals engaged in sex work, and
characterize the processes and resources of Birmingham AIDS Outreach (BAO) to inform intervention
approaches. Under Aim 2, pending CFAR renewal, we will pilot the intervention at BAO with 40 individuals
engaging in sex work, and will evaluate the intervention’s acceptability, appropriateness, and feasibility from a
participant and provider perspective. We will assess clinical outcomes and preliminary effects on PrEP use and
uptake of harm reduction strategies (use of condoms and sterile syringes). This work will be guided by the
Consolidated Framework for Implementation Research (CFIR), RE-AIM framework, and ERIC strategies. The
project will result in formation of a Health Equity Research Assembly, development of a novel harm reduction
intervention for people engaged in sex work, and, if Year 2 is awarded, pilot data to inform a subsequent R-
level proposal.

## Key facts

- **NIH application ID:** 10814069
- **Project number:** 3P30AI027767-35S1
- **Recipient organization:** UNIVERSITY OF ALABAMA AT BIRMINGHAM
- **Principal Investigator:** Renee A. Heffron
- **Activity code:** P30 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2023
- **Award amount:** $213,601
- **Award type:** 3
- **Project period:** 1997-03-01 → 2024-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10814069

## Citation

> US National Institutes of Health, RePORTER application 10814069, A Harm Reduction Approach to Addressing the HIV, STIs, and Substance Use Syndemic among People Engaging in Sex Work in Alabama (3P30AI027767-35S1). Retrieved via AI Analytics 2026-05-28 from https://api.ai-analytics.org/grant/nih/10814069. Licensed CC0.

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