Barriers to self-care in a cohort of low-income white women living with HIV/AIDS.

In this cohort of 12 low-income White women with HIV disease, five conditions at diagnosis emerged as barriers to self-care: (a) health care provider (HCP) failure to mobilize resources, (b) HCP devaluing of women, (c) social devaluing, (d) economic problems, and (e) legal problems. The core category, disconnection from self-care, linked the five barriers. The self-care barriers were shaped by complex intra- and interpersonal relationships. Motivation to engage in self-care was promoted by relationships that valued women's health. Relational dialogue within a partnership provided the model for HCP relationships that encouraged women to build knowledge and skills for self-care. At diagnosis, HCP interactions were critical in the HIV-disease trajectory because HCPs held knowledge and power to mobilize needed resources, as well as the power to offer (or withhold) the caring and compassion that encouraged women to engage in self-care.