Date of Award

January 2021

Document Type


Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Trace Kershaw


Studies involving women or women with SUDs for PrEP are limited even though in many areas of the world women remain at high-risk for HIV acquisition. This study is to evaluate the impact of accuracy of HIV risk perception on HIV risk behaviors changes over time among women with substance use disorders in treatment, including sexual and injecting risk behaviors. This is a secondary analysis based on a preference controlled un-blinded study. This study enrolled 165 cis- or trans-female volunteers ≥18 years old who were self-reported HIV-uninfected, had diagnosed SUDs, and were presenting for or currently enrolled in drug treatment. 50.6% of participants (N=83) were categorized as underestimating their HIV risk while 49.4% (N=81) were categorized as accurately/over-estimating their HIV risk at baseline. We observed a positive association between underestimating HIV risk at baseline and reduction of HIV risk behaviors over time. Though women who underestimated their HIV risk did reduce their HIV risk behaviors to some extent over time, their HIV risk was still higher than women who accurately or overestimated HIV risk at each subsequent visit. Some high-risk behaviors persisted. The greatest impact of underestimating personal HIV risk on the self-reported HIV risk behaviors was initially after baseline with reduced behavioral change over time, indicating this impact on the change of HIV risk behaviors may be short-lived and fade away if no other intervention is delivered. Though there was a sharp decrease in condomless sex over time among the “underestimate” group, the proportion was above 50% throughout the period of observation, which may be attributed to other determinants that affect women’s decisions of whether to use condom, such as inability to negotiate with sexual partners. Studies collecting more detailed HIV risk behaviors information and considering about other confounders, such as IPV, are needed to research the intensity and duration of the effect of underestimating HIV risk on behavior changes.


This thesis is restricted to Yale network users only. It will be made publicly available on 06/01/2022