A Longitudinal Study to understand Sexual Health and Prevention Among Women in Alabama


Pre-exposure prophylaxis (PrEP) is an important biomedical HIV prevention tool and may particularly benefit Black, cis and trans-gender women, who are at increased risk for HIV and STIs. The purpose of this study is to use a population-based approach to create a cohort of cis and trans gender women at risk for acquisition to better understand the factors associated with the risk of STI and HIV diagnosis and predictors of PrEP use.

Download Study Summary


Despite the availability of effective HIV prevention tools such as pre-exposure prophylaxis (PrEP), significant disparity remains among communities of color, particularly among women in the Deep South where the rate of HIV diagnosis is fourteen-times higher for Black women compared to White women. PrEP utilization remains low among women in the Deep South with estimates of <7% eligible women receiving PrEP in Alabama.

Moreover, algorithms to determine PrEP eligibility demonstrate poor predictive power for women. The proposal takes advantage of a dynamic and innovative collaboration of experienced HIV-prevention investigators from the University of Alabama-Birmingham, Florida State University, Centers for AIDS Research, the Alabama Department of Public Health (ADPH), and Social Scientific Systems.

This novel research proposal utilizes a population-based approach to establish a geographically representative cohort of cisgender and transgender women (‘Camellia Cohort’) more likely to receive an HIV diagnosis in the future, based on recent gonorrhea or syphilis diagnosis, across the state of Alabama (AL), highlighted as a geographic hotspot by the federal Ending the HIV Epidemic strategy, to better understand factors associated with risk of STI and HIV diagnosis and predictors for PrEP use.

Study Description

The aims of this proposal are to:


Refine the HealthMpowerment (HMP) digital platform, previously utilized to deliver evidence-based interventions to improve HIV and prevention outcomes among Black men who have sex with men and transgender women, to include key elements that optimally engage and retain a cohort of women at-risk for HIV in AL; this will be achieved via stakeholder engaged research with self-identified women on PrEP and PrEP care team members using nominal group techniques.


Recruit and retain a geographically-diverse and rurally-enhanced cohort of 800 women ages 18-44, with recent positive gonorrhea or syphilis testing who do not have STIs or HIV at enrollment, to participate in the Camellia digital cohort utilizing a geographically diverse sampling framework using public and commercially available annual county-level HIV and STI testing data.


Evaluate predictors, mediators and moderators for STI/HIV incidence and PrEP use and adherence in the Camellia Cohort by collecting demographic, behavioral, and community level assessments via the HMP digital platform and HIV/STI testing through ADPH’s home testing program at regular intervals.

App Highlights

The Camellia app, is a digital app designed specifically for women that provides information and resources on women’s health. User will be able to track their medications, complete informative quizzes and assessments, set health goals, track behaviors (e.g., smoking, alcohol, mood, sex), and find additional resources based off your location or services needed for sexual health.

Screenshots of the app coming soon!

What’s Next

Findings in this study will guide future intervention development.

mHealth Development
Risk Reduction Research