Courtney Caiola1, Julie Barroso, Sharron L Docherty. 1. Courtney Caiola, PhD, MPH, RN, was a Doctoral Student, Duke University School of Nursing, at the time the research was completed. She is now Assistant Professor, Family and Community Nursing, School of Nursing, University of North Carolina at Greensboro. Julie Barroso, PhD, ANP-BC, RN, FAAN, is Professor and Chair, Department of Nursing, Medical University of South Carolina, St. Charleston. Sharron L. Docherty, PhD, PNP-BC, FAAN, is Associate Professor, Duke University School of Nursing, Durham, North Carolina.
Abstract
BACKGROUND: The disparate health outcomes of African American mothers living with HIV are considerable. Multidimensional approaches are needed to address the complex social and economic conditions of their lives, collectively known as the social determinants of health. OBJECTIVES: The purpose of this study was to explore the social determinants of health for African American mothers living with HIV by examining how mothers describe their social location at the intersection of gender, race, and class inequality; HIV-related stigma; and motherhood. How they frame the impact of their social location on their health experiences is explored. METHODS: This exploratory study included in-depth, semistructured interviews with 18 African American mothers living with HIV at three time points. We used an intersectional framework and frame analysis to explore the meaning of these constructs for participants. RESULTS: Findings from 48 interviews include a description of the intersecting social determinants functioning as systems of inequality and the heterogeneous social locations. Three frames of social location were used to organize and explain how African American mothers living with HIV may understand their social determinants of health: (a) an emancipatory frame, marked by attempts to transcend the negative social connotations associated with HIV and socially constructed identities of race, gender, and class; (b) a maternal frame, marked by a desire to maintain a positive maternal identity and maternal-child relations; and (c) an internalized frame, marked by an emphasis on the deleterious and stigmatizing effects of HIV, racial, gender, and class inequality. DISCUSSION: The findings offer knowledge about the heterogeneity in how demographically similar individuals frame their social location as well as how the intersections of social determinants influence participant's health experiences. Potential health implications and interventions are suggested for the three frames of social location used to describe intersecting social determinants of health. The study offers an analytic approach for capturing the complexity inherent in intersectional methodologies examining the role of social determinants in producing health inequities.
BACKGROUND: The disparate health outcomes of African American mothers living with HIV are considerable. Multidimensional approaches are needed to address the complex social and economic conditions of their lives, collectively known as the social determinants of health. OBJECTIVES: The purpose of this study was to explore the social determinants of health for African American mothers living with HIV by examining how mothers describe their social location at the intersection of gender, race, and class inequality; HIV-related stigma; and motherhood. How they frame the impact of their social location on their health experiences is explored. METHODS: This exploratory study included in-depth, semistructured interviews with 18 African American mothers living with HIV at three time points. We used an intersectional framework and frame analysis to explore the meaning of these constructs for participants. RESULTS: Findings from 48 interviews include a description of the intersecting social determinants functioning as systems of inequality and the heterogeneous social locations. Three frames of social location were used to organize and explain how African American mothers living with HIV may understand their social determinants of health: (a) an emancipatory frame, marked by attempts to transcend the negative social connotations associated with HIV and socially constructed identities of race, gender, and class; (b) a maternal frame, marked by a desire to maintain a positive maternal identity and maternal-child relations; and (c) an internalized frame, marked by an emphasis on the deleterious and stigmatizing effects of HIV, racial, gender, and class inequality. DISCUSSION: The findings offer knowledge about the heterogeneity in how demographically similar individuals frame their social location as well as how the intersections of social determinants influence participant's health experiences. Potential health implications and interventions are suggested for the three frames of social location used to describe intersecting social determinants of health. The study offers an analytic approach for capturing the complexity inherent in intersectional methodologies examining the role of social determinants in producing health inequities.
Authors: Amie L Meditz; Samantha MaWhinney; Amanda Allshouse; William Feser; Martin Markowitz; Susan Little; Richard Hecht; Eric S Daar; Ann C Collier; Joseph Margolick; J Michael Kilby; Jean-Pierre Routy; Brian Conway; John Kaldor; Jay Levy; Robert Schooley; David A Cooper; Marcus Altfeld; Douglas Richman; Elizabeth Connick Journal: J Infect Dis Date: 2011-01-18 Impact factor: 5.226
Authors: Sandra D Lane; Robert A Rubinstein; Robert H Keefe; Noah Webster; Donald A Cibula; Alan Rosenthal; Jesse Dowdell Journal: J Health Care Poor Underserved Date: 2004-08
Authors: Elizabeth Corwin; Nancy S Redeker; Therese S Richmond; Sharron L Docherty; Rita H Pickler Journal: Nurs Outlook Date: 2019-05-28 Impact factor: 3.250
Authors: Deanna R Befus; Sharon Hull; Justine Strand de Oliveira; Gillian Sanders Schmidler; Morris Weinberger; Remy R Coeytaux Journal: Glob Adv Health Med Date: 2019-06-13