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Social Location and Decision-Making Among Women Living with HIV in the Southern United States: An Intersectional Approach

Author

Listed:
  • Courtney Caiola

    (College of Nursing, East Carolina University, Greenville, NC 27858, USA)

  • Marianne R. Choufani

    (College of Nursing, East Carolina University, Greenville, NC 27858, USA)

  • Juliette André

    (School of Nursing, Vanderbilt University, Nashville, TN 62374, USA)

  • Sadie B. Sommer

    (School of Nursing, Vanderbilt University, Nashville, TN 62374, USA)

  • Alexander M. Schoemann

    (Department of Psychology, East Carolina University, Greenville, NC 27858, USA)

  • Sarah B. Bass

    (Department of Social and Behavioral Sciences, Temple University, Philadelphia, PA 19122, USA)

  • Julie Barroso

    (School of Nursing, Vanderbilt University, Nashville, TN 62374, USA)

Abstract

HIV care engagement and antiretroviral therapy (ART) adherence interventions aimed at decreasing viral suppression disparities for women living with HIV (WLWH) in the Southern United States (i.e., the South) are few and seldom consider diverse social locations. These refer broadly and dynamically to contextual factors and the position people occupy in a social hierarchy based on intersecting systems of oppression and social determinants of health like gender, race/ethnic, and class inequities; geographic location; and HIV-related stigma. Using an intersectional approach, we conducted in-depth interviews and used a phased approach to directed content analysis to describe women’s perceptions of their social location and how it impacts their decision-making about HIV care engagement and ART adherence. Participants were recruited to participate from a broad geographic area and represented the diverse social locations occupied by WLWH in the South. Findings from 40 in-depth interviews include descriptions of how geographic context impacts HIV care engagement and medication adherence through access to care, quality of care, and the place-based context of day-to-day experiences of living with HIV. Participants spoke of multilevel power relationships based on their gender and racial identities, and how social determinants and intersecting identities occur simultaneously and vary as a function of one another to impact health and HIV care decision-making. The findings offer a nuanced understanding of how WLWH perceive their contextually specific social locations and make critical decisions about their HIV care engagement and medication adherence.

Suggested Citation

  • Courtney Caiola & Marianne R. Choufani & Juliette André & Sadie B. Sommer & Alexander M. Schoemann & Sarah B. Bass & Julie Barroso, 2024. "Social Location and Decision-Making Among Women Living with HIV in the Southern United States: An Intersectional Approach," IJERPH, MDPI, vol. 21(12), pages 1-16, November.
  • Handle: RePEc:gam:jijerp:v:21:y:2024:i:12:p:1575-:d:1530391
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    References listed on IDEAS

    as
    1. Metzl, Jonathan M. & Hansen, Helena, 2014. "Structural competency: Theorizing a new medical engagement with stigma and inequality," Social Science & Medicine, Elsevier, vol. 103(C), pages 126-133.
    2. Turan, B. & Hatcher, A.M. & Weiser, S.D. & Johnson, M.O. & Rice, W.S. & Turan, J.M., 2017. "Framing mechanisms linking HIV-related stigma, adherence to treatment, and health outcomes," American Journal of Public Health, American Public Health Association, vol. 107(6), pages 863-869.
    3. repec:aph:ajpbhl:10.2105/ajph.2017.303744_4 is not listed on IDEAS
    4. Rice, Whitney S. & Logie, Carmen H. & Napoles, Tessa M. & Walcott, Melonie & Batchelder, Abigail W. & Kempf, Mirjam-Colette & Wingood, Gina M. & Konkle-Parker, Deborah J. & Turan, Bulent & Wilson, Tra, 2018. "Perceptions of intersectional stigma among diverse women living with HIV in the United States," Social Science & Medicine, Elsevier, vol. 208(C), pages 9-17.
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