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

Payton-Harmon, Angel (2016)

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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

Table of Contents List of Tables 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 Lists of Tables Table 1 Initial Codes 28 Table 2 Participants’ Demographics 30 Table 3 Clinical Demographics 32 Table 4 HIV Knowledge Questionnaire 33 Table 5 Depression Data 34

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