Structural Barriers to HIV Prevention and Services: Perspectives of African American Women in Low-Income Communities.

BACKGROUND: African American women are at a disproportionate HIV risk compared with other U.S. women. Studies show that complex structural and social determinants, rather than individual behaviors, place African American women at greater risk of HIV infection; however, little is known about women's views of what puts them at risk. AIMS: This study sought to comprehend the perceptions of African American women living in low-income housing regarding the factors that influence both their personal sexual health behaviors and use of HIV prevention services. METHODS: We conducted seven focus groups with 48 African American women from 10 public housing communities in a small city in the southeastern United States. We analyzed the focus group transcripts using thematic data analysis to identify salient themes and points of interest related to the study aim. RESULTS: Women identified factors related to the health care system (trustworthiness of the health care system), the external environment (racism, classism, patriarchal structures, and violence/crime), as well as predisposing (health beliefs, stigma, and gender norms), enabling (agency to negotiate gendered power), and need (perceived HIV risk and perceptions of partner characteristics) features of individuals in the population. CONCLUSION: African American women living in public housing are especially vulnerable to HIV infection due to intersectional discrimination based on racism, classism, gender power dynamics, and community conditions. Our findings confirm the need to develop HIV intervention programming addressing intersectional identities of those making up the communities they plan to address, and being informed by those living in the communities they plan to act on.

How Perceived Structural Racism and Discrimination and Medical Mistrust in the Health System Influences Participation in HIV Health Services for Black Women Living in the United States South: A Qualitative, Descriptive Study.

There are racial and geographic disparities for HIV in the United States; Black women have nearly 20 times the risk of White women in being infected with HIV, and lifetime HIV risk is greatest for people living in the southern United States. These disparities, layered with the structural racism and discrimination that is more prominent in the south, is a public health issue. The purpose of this article is to share Black women's perspectives of how perceived structural racism and discrimination, and medical mistrust in the health care system contribute to their participation in health services. In this formative study, we conducted seven focus groups among women living in 10 low-income housing communities. Results indicate that there are barriers to the utilization of health services that are grounded in personal experiences and historical mistrust for the health care system. Understanding these barriers is critical to combating the HIV epidemic for this population.