Social Determinants of Health for African American HIV-infected Mothers

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DESCRIPTION (provided by applicant): Significance: The vulnerability of African American HIV-infected mothers functions at the intersection of gender-, race-, and class-inequality; HIV-related stigma; and motherhood, requiring multidimensional and transdisciplinary approaches to address the complex social and economic conditions of their lives, collectively known as the social determinants of health. African American (AA) women suffer significantly higher HIV infection rates and tend to die earlier from their infection than their White counterparts. Poverty is a significant precipitating factor for HIV infection and AA women are disproportionately poorer than other subpopulations in the US. HIV-related stigma is linked to poorer mental and physical health outcomes across a broad range of demographic profiles. Being a mother adds an extra layer of social complexity to the lives of HIV-infected women. This descriptive study of AA HIV-infected mothers' unique social location and the intersection of the social determinants of health they experience is an essential step in understanding and addressing the disparity in their health outcomes. Purpose: This study aims to describe the intersection of gender-, race-, and class-inequality; HIV-related stigma; and motherhood specific to AA HIV-infected mothers and to describe how their unique social identity influences their health-related experiences. Methods: In this qualitative descriptive study I will identify 20-30 AA HIV-infected mothers and use participant- initiated photography in conjunction with in-depth qualitative interviewing to explore the intersection of the social determinants of health they experience. Participants will be recruited from the Infectious Diseases Clinics at Duke University Medical Center; the Durham County Health Department Early Intervention Clinic; the Wake County Health Department; the Infectious Diseases Clinic at the University of North Carolina Hospitals; and the Alliance of AIDS Services - Carolinas, Inc., using provider referral and recruitment flyers for self- referral. Summary: This study will help to generate hypotheses about how the described intersection operates to shape health behaviors and produce health outcomes for AA HIV-infected mothers and will identify what aspects of the problem might be measured, are amenable to change, and can be meaningfully addressed by intervention.