HIV Positive Women of Color in Urban Areas of South Carolina Who Are Not in Care Open Access

Abstract

Women of color living continue to be greatly impacted with HIV/AIDS compared to their white counterparts. HIV/AIDS is the 4th leading cause of death among African American women ages 35 to 44 years old. According to the treatment cascade, many people living with HIV/AIDS are aware of their status but are not actively engaged in HIV care. The state of South Carolina ranks 10th in the number of HIV/AIDS cases in the United States. According to the state’s Division of Surveillance and Technical Support, there were just over 3800 African-American women living with HIV/AIDS at the end of 2014. The rates of HIV/AIDS among women of color are far greater than those of their white counterparts (742). The state’s Epidemiological Profile also surprisingly shows there are more people not in care who reside in urban areas of South Carolina than those living in rural areas. The study explored social determinants impacting the decision of urban women of color living with HIV/AIDS to not seek HIV medical care. The study participants were engaged in an in-depth interview to discuss their perceived stigma in healthcare settings, the impact of a lack of social and family support as well as depression.

Table of Contents

CHAPTER I. INTRODUCTION 1

Purpose Statement 3

Research Questions 3

Significance Statement 4

Definition of Terms 5

CHAPTER II. REVIEW OF LITERATURE 6

Women of Color Living with HIV Who Are Not In Care 6

Factors Impacting Engagement in HIV Care for Women of Color 8

Clinic Environment 10

Knowledge and Literacy 11

HIV-related Stigma 12

Medical Mistrust 13

Family and Social Support 15

Depression 18

Religion and Spirituality 20

Summary 23

CHAPTER III. METHODOLOGY 24

Population and Sample 24

Recruitment 25

Instruments 25

Procedures 26

Data Analysis Methodology 27

CHAPTER IV. RESULTS 29

Key Findings 29

Demographics and Clinical Characteristics of Participants 29

HIV Knowledge 33

Depression 33

In-depth Interviews 35

Patient/Provider Relationship 35

Conspiracy 36 HIV-related Stigma 37

Family and Social Support 38

Religion and Spirituality 38

Inductive Findings 39

CHAPTER V. CONCLUSION 40

Discussion 40

HIV-related Stigma 40

Family and Social Support 41

Depression 42

Limitations 43

Recommendations and Public Health Implications 44

Conclusion 45

REFERENCES 47

APPENDICES 63

HIV Knowledge Questionnaire 63

CES-D Scale 65

In-depth Interview Question Guide 68

About this Master's Thesis

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• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Executive Masters of Public Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	HIV women african american
Committee Chair / Thesis Advisor	Gaydos, Laurie, Emory University
Committee Members	Dixon, Terry, Medical University of South Carolina
Partnering Agencies	University, college or educational institution (other than Emory)

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