Perceptions of intersectional stigma among diverse women living with HIV in the United States

• Published in: Social science & medicine (1982) Vol. 208; pp. 9 - 17
• Main Authors: 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, Tracey E., Johnson, Mallory O., Weiser, Sheri D., Turan, Janet M.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-07-2018; Pergamon Press Inc
• Subjects: Acquired immune deficiency syndrome; Adult; Aged; AIDS; Discrimination; Female; Health care access; Health disparities; Health planning; Health services; Healthcare Disparities; HIV; HIV Infections - epidemiology; HIV Infections - psychology; Human immunodeficiency virus; Humans; Imprisonment; Income; Income - statistics & numerical data; Intersectionality; Interviews; Life experiences; Marginality; Middle Aged; Perception; Perceptions; Prevention programs; Preventive medicine; Public health; Qualitative Research; Race; Racial inequality; Racism; Racism - psychology; Sensory perception; Sexism; Sexism - psychology; Social interaction; Social Marginalization - psychology; Social processes; Social Stigma; Socioeconomic factors; Stigma; United States; United States - epidemiology; Uptake; Well being; Women; United States; Women; Qualitative research; Discrimination; HIV; Stigma; United States; Intersectionality; Health disparities
• ISSN: 0277-9536; 1873-5347; 1873-5347
• DOI: 10.1016/j.socscimed.2018.05.001

Attitudes and behavior that devalue individuals based upon their HIV status (HIV-related stigma) are barriers to HIV prevention, treatment, and wellbeing among women living with HIV. Other coexisting forms of stigma (e.g., racism, sexism) may worsen the effects of HIV-related stigma, and may contribute to persistent racial and gendered disparities in HIV prevention and treatment. Few studies examine perceptions of intersectional stigma among women living with HIV. From June to December 2015, we conducted 76 qualitative interviews with diverse women living with HIV from varied socioeconomic backgrounds enrolled in the Women's Interagency HIV Study (WIHS) in Birmingham, Alabama; Jackson, Mississippi; Atlanta, Georgia; and San Francisco, California. Interview guides facilitated discussions around stigma and discrimination involving multiple interrelated identities. Interviews were audio-recorded, transcribed verbatim, and coded using thematic analysis. Interviewees shared perceptions of various forms of stigma and discrimination, most commonly related to their gender, race, and income level, but also incarceration histories and weight. Women perceived these interrelated forms of social marginalization as coming from multiple sources: their communities, interpersonal interactions, and within systems and structures. Our findings highlight the complexity of social processes of marginalization, which profoundly shape life experiences, opportunities, and healthcare access and uptake among women living with HIV. This study highlights the need for public health strategies to consider community, interpersonal, and structural dimensions across intersecting, interdependent identities to promote the wellbeing among women living with HIV and to reduce social structural and health disparities.
•Focus on the clinical implications of HIV-positive women's unique social position.•Imparts rich, multi-dimensional understanding of stigmas among U.S. women with HIV.•Expands lens of intersectional stigma to types less examined in this population.