African American women's experience of infection with HIV in the rural southeastern United States

Individual, Social, and Structural Vulnerability for Black Women in the South: Implications for PrEP

Pre-exposure prophylaxis (PrEP) is an effective biomedical HIV prevention option, yet adoption among Black women, who are disproportionately impacted by HIV, is low. A nuanced understanding of the multi-level factors that contribute to elevated risk is necessary to better contextualize PrEP uptake. Qualitative data from Black women residing in the Southern U.S. who self-screened as HIV-negative, were collected via four focus groups (N = 27) to understand influences on HIV vulnerability and the potential role of PrEP in mitigating risk. Content analysis of transcribed data yielded multiple themes addressing: the pervasiveness of sexual partner sharing; lack of transparency regarding HIV status, disclosure, and testing; and social/cultural influences on HIV risk. Experiences with the health care system and providers were of particular concern. Findings demonstrate support for PrEP in this population and contribute to our understanding of individual, social, and structural factors to better inform PrEP promotion.

Circumstances Surrounding High-risk Sexual Experiences Among Primary Care Patients Living With and Without HIV

INTRODUCTION

Rates of sexually transmitted infection (STI) are rising in the USA, yet STI risk remains under-addressed by providers, even in HIV care, and with high-risk patients. We interviewed primary care patients living with and without HIV regarding circumstances surrounding sexual risk behavior to identify opportunities for providers to address and reduce STI risk.

METHODS

We conducted semi-structured 1:1 interviews with patients living with and without HIV reporting ≥ 1 sex partner and varying STI exposure risk in the past 12 months from four geographically diverse US HIV and primary care clinics. We audio-recorded, transcribed, and coded interviews by circumstance type, using double-coding to ensure inter-coder reliability. We used Fisher's exact and T tests to determine associations with demographic/risk factors.

RESULTS

Patients (n = 91) identified a mean of 3 of 11 circumstances. These included substance use (54%), desire for physical/emotional intimacy (48%), lack of HIV/STI status disclosure (44%), psychological drivers (i.e., coping, depression; 38%), personal dislike of condoms (22%), partner condom dislike/refusal (19%), receiving payment for sex (13%), and condom unavailability (9%). Higher proportions of those who were high STI-exposure risk patients, defined as those with ≥ 2 sex partners in the past 3 months reporting never or sometimes using condoms, reported disliking condoms (p = .006); higher proportions of the high-risk and moderate-risk (≥ 2 partners and condom use "most of the time") groups reported substance use as a circumstance (p = .04).

CONCLUSION

Circumstances surrounding perceived STI exposure risk were diverse, often overlapping, and dependent on internal, environmental, and partner-related factors and inadequate communication. Meaningful care-based interventions regarding HIV/STI transmission behavior must address the diversity and interplay of these factors.

Women's decision-making about self-protection during sexual activity in the deep south of the USA: a grounded theory study

Many women continue to become infected with HIV, particularly in the Southeastern USA, despite widespread knowledge about methods to prevent its sexual transmission. This grounded theory investigation examined the decision-making process women use to guide their use or non-use of self-protective measures when engaging in sexual activity. Participants included women in the Mississippi cohort of the Women's Interagency HIV Study who were infected with or at high risk for HIV. Theoretical sampling was used to recruit a sample of 20 primarily African American women aged between 26 and 56 years, living in rural and urban areas. Data were analysed using constant comparative method to generate a theory of the process that guided women's self-protective decisions. Three key themes were identified: (1) sexual silence, an overall context of silence around sexuality in their communities and relationships; (2) the importance of relationships with male partners, including concepts of 'love and trust', 'filling the void' and 'don't rock the boat'; and (3) perceptions of risk, including 'it never crossed my mind', 'it couldn't happen to me' and 'assumptions about HIV'. These themes impacted on women's understandings of HIV-related risk, making it difficult to put self-protection above other interests and diminishing their motivation to protect themselves.

Influences of Social Determinants of Health on African Americans Living With HIV in the Rural Southeast: A Qualitative Meta-synthesis

Social determinants of health influence health outcomes and contribute to health disparities in diverse populations. A meta-synthesis was conducted to provide emic perspectives of the experiences of African Americans living with HIV in the rural southeastern United States. Analysis of qualitative literature revealed patterns among social determinants of health as upstream factors contributing to health care barriers, poor health outcomes, decreased quality of life, and health disparities. The purpose of our meta-synthesis was the illumination and synthesis of themes describing characteristics of social determinants of health in selected qualitative articles. The nine themes that emerged included living in poverty, enduring unemployment, missing work, lacking transportation, sustaining stress, feeling socially excluded, needing social support, battling substance use, and lacking adequate health care.

Health-seeking behaviors among HIV-negative, high-risk black women living in an urban southern city

This study explores the HIV health information-seeking behavior among Black women living in a southern urban city in the United States. Interviews were conducted with 50 Black women to explore their HIV health-seeking behavior, self-efficacy, and locus of control. Results indicate that despite the multiple HIV risk factors faced by the women a majority of them did not seek out HIV health information. Policy implications for HIV prevention education are discussed.

Down low sex, older African American women, and HIV infection

The phenomenon of down low sex, wherein men involved in monogamous relationships with women seek extrarelationship sexual relations with men, has gained recognition in recent years. This study addressed the issue of down low sex in a group of African American women whose long-term sexual partners had become infected with HIV during extramarital sexual encounters with men. A grounded theory methodology was used to explore the experiences of 11 women in individual interviews that were sensitive to the intimate nature of their experiences. Themes shown in the data focused on (a) being betrayed and losing trust; (b) reflecting upon the features of the past relationship; (c) seeking the positive aspects of the past relationship; (d) being ashamed before God, community, and family; and (e) assuming the caregiver role and sharing the burden of illness. The study identified the strong influence of positive long-term relationships on life decisions of women following a diagnosis of HIV, despite the extrarelationship sexual activities of their partners.