Date of Award


Degree Name

Doctor of Philosophy


Interdisciplinary Health Sciences


Thenral Mangadu


Purpose: To explore and assess awareness of and attitudes toward "undetectable equals untransmittable" (U=U) and associations with social-ecological factors among minority women. Population: Ethnic minority women 18 years and older residing in the El Paso, TX, US - Juarez, Mexico border region. Methods: A cross-sectional convergent parallel mixed methods study using in-depth interviews and a survey instrument was conducted among a purposive sample. Thematic analysis was done on qualitative data, and descriptive, bivariate and binary logistic regression analyses were done on quantitative data. Results: The majority of the participants (66.7% interviewees and 50.7% survey) were Hispanic, in their early-mid thirties, and had a substance use disorder (SUD). The interviewees' awareness of U equals U was low (23.8%) but high among survey participants (69.2%). Five major themes related to U equals U unawareness, awareness, discrepant beliefs and behaviors, positive attitudes, and stigma and discrimination resulted from interviews. Statistically significant odds of 1) believing in the accuracy of U equals U was found with HIV test, perceived HIV transmission risk with U = U, belief in HIV treatment as prevention (TasP), and community trust in U equals U; 2) perceiving no risk of HIV transmission with U = U was found with alcohol SUD, belief in the accuracy of U = U, and belief in the efficacy of HIV treatment among community members of same cultural background; and 3) engaging in condomless sex with U equals U was found with beliefs in TasP and whether people got along in their neighborhood. Conclusion: Both types of data showed low levels of belief in U equals U, high perceptions of HIV transmission risk, and strong unwillingness to engage in condomless sex with U equals U among racial/ethnic minority women in the border region. An integrated HIV testing service with education about TasP and U = U may increase this population's acceptance and trust in the efficacy of U = U.




Received from ProQuest

File Size

358 p.

File Format


Rights Holder

Roberta Marie Thimbriel