A Multilevel Understanding of HIV/AIDS Disease Burden among African American Women

Brawner, Bridgette M.

doi:10.1111/1552-6909.12480

Cited by 15 publications

(27 citation statements)

References 48 publications

(50 reference statements)

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“…This will be particularly important in highly affected communities. Given that HIV risk increases with an individual’s probability of being exposed to an HIV-positive sexual partner (Friedman, Cooper, & Osborne, 2009); individuals in higher prevalence communities will have greater geobehavioral vulnerability to HIV and, thus, require concerted prevention efforts (Brawner, 2014). GIS mapping of census tract-level data can be used to identify areas in need of intervention (e.g., high HIV incidence and concentrated disadvantage), while ethnographic methodologies can be used to engage community residents and design sustainable strategies.…”

Section: Discussionmentioning

confidence: 99%

“…An ecological conceptual model (Bronfenbrenner, 1986) guided the study (see Brawner, 2014 for an illustration of the model and additional details). Four major pathways are posited:

It is presumed that multilevel factors, such as mental health, social capital, and poverty, interact to influence community-level indicators of HIV transmission (e.g., HIV incidence rates).

These same multilevel interactions are purported to also influence behaviors that transmit HIV (e.g., multiple sexual partners).

The association between behaviors that transmit HIV and subsequent HIV risk is thought to be mediated by community-level indicators of HIV transmission in different geographical locations (e.g., community viral load).

The end result of HIV risk, referred to as “geobehavioral vulnerability to HIV”—the probability of HIV acquisition based on what you do, where you do it, and who you do it with—is the manifestation of multilevel interactions that create and sustain the risk context in certain populations and geosocial spaces (Brawner, 2014).

…”

Section: Guiding Conceptual Modelmentioning

confidence: 99%

“…The end result of HIV risk, referred to as “geobehavioral vulnerability to HIV”—the probability of HIV acquisition based on what you do, where you do it, and who you do it with—is the manifestation of multilevel interactions that create and sustain the risk context in certain populations and geosocial spaces (Brawner, 2014). …”

Section: Guiding Conceptual Modelmentioning

confidence: 99%

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Multilevel Drivers of Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome Among Black Philadelphians

et al. 2015

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Background Unequal HIV/AIDS distribution is influenced by certain social and structural contexts that facilitate HIV transmission and concentrate HIV in disease epicenters. Thus, one of the first steps in designing effective community-level HIV/AIDS initiatives is to disentangle the influence of individual, social, and structural factors on HIV risk. Combining ethnographic methodology with geographic information systems (GIS) mapping can allow for a complex exploration of multilevel factors within communities that facilitate HIV transmission in highly affected areas. Objectives We present the formative comparative community-based case study findings of an investigation of individual-, social- , and structural-level factors that contribute to the HIV/AIDS epidemic among Black Philadelphians. Methods Communities were defined using census tracts. The methodology included ethnographic and GIS mapping, observation, informal conversations with residents and business owners, and secondary analyses of census tract-level data in four Philadelphia neighborhoods. Results Factors such as overcrowding, disadvantage, permeability in community boundaries, and availability and accessibility of health-related resources varied significantly. Further, HIV/AIDS trended with social and structural inequities above and beyond the community’s racial composition. Discussion This study was a first step to disentangle relationships between community-level factors and potential risk for HIV in an HIV epicenter. The findings also highlight stark sociodemographic differences within and across racial groups, and further substantiate the need for comprehensive, community-level HIV prevention interventions. These findings from targeted United States urban communities have potential applicability for examining the distribution of HIV/AIDS in broader national and international geosocial contexts.

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Section: Discussionmentioning

confidence: 99%

“…An ecological conceptual model (Bronfenbrenner, 1986) guided the study (see Brawner, 2014 for an illustration of the model and additional details). Four major pathways are posited:

It is presumed that multilevel factors, such as mental health, social capital, and poverty, interact to influence community-level indicators of HIV transmission (e.g., HIV incidence rates).

These same multilevel interactions are purported to also influence behaviors that transmit HIV (e.g., multiple sexual partners).

…”

Section: Guiding Conceptual Modelmentioning

confidence: 99%

Section: Guiding Conceptual Modelmentioning

confidence: 99%

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Multilevel Drivers of Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome Among Black Philadelphians

et al. 2015

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“…These racial disparities in HIV-related health access and outcomes have persisted due to poverty, stigma, discrimination, residential segregation, and lack of access to care (Buot et al 2014; Earnshaw et al 2013). Midlife and older Black women, in particular, face a host of co-occurring social and psychological vulnerabilities that increase their risk of acquiring HIV and reduce their ability to be engaged in HIV care continuum (Brawner 2014; Davis and Tucker-Brown 2013; Sharpe et al 2012). …”

Section: Introductionmentioning

confidence: 99%

Intersectional stigma among midlife and older Black women living with HIV

Sangaramoorthy

Jamison

Dyer

2017

Culture, Health & Sexuality

101

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HIV-related stigma is a barrier to the prevention and treatment of HIV. For midlife and older Black women, the nature and intensity of HIV-related stigma may be compounded by their multiple marginalised social status based on gender, race, and age. We examined the perceptions and experiences of HIV-related stigma among midlife and older Black women living in Prince George’s County, Maryland, USA. Between 2014–2015, we conducted semi-structured interviews with a sample of 35 midlife and older Black women living with HIV. Using a modified grounded theory approach, we explored emergent themes related to the manifestation and experience of intersectional stigma and changes in stigma experience over time. Our findings suggest that intersectional stigma is a central feature in midlife and older Black women’s lives, with women reporting experiences of intersectional stigma at the interpersonal/familial, community, and institutional/structural levels. Although women acknowledged gradual acceptance of their HIV-positive status over time, they continued to experience negative responses related to gender, race, age, and disease. Our findings indicate that a more robust understanding of the impact of HIV-related stigma requires work to consider the complex manifestations of intersectional stigma among an increasingly aging population of Black women in the USA.

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“…Further, the sexual risk behaviors of African American young men and women, and the prevalence of other STIs among African American women, contribute to African American women’s elevated risk, as well (Adimora, Schoenbach, & Floris-Moore, 2009; Paxton, Williams, Bolden, Guzman, & Harawa, 2013; Perkins, Voisin, & Stennis, 2013; Pflieger, Cook, Niccolai, & Connell, 2013; Raiford, Seth, & DiClemente, 2013; Stockman et al., 2013; Wingood & DiClemente, 2000). As Brawner states in an article exploring the multiple levels of HIV/AIDS disease burden among African American women, “…some African American women have minimal room for error because of the sheer concentration of HIV in their geographical and social environments” (Brawner, 2014, p. 634). Thus, African American adolescent women may be at elevated risk for acquiring HIV even when they do not personally exhibit high risk sexual behaviors (Adimora et al, 2006).…”

Section: Introductionmentioning

confidence: 99%

HIV Risk-Reduction Prevention Interventions Targeting African American Adolescent Women

Hendrick

Canfield

2016

Adolescent Res Rev

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African American young women are overwhelmingly disproportionately burdened by HIV/AIDS in the United States today. The purpose of the current systematic review was to identify the characteristics of efficacious HIV risk-reduction prevention interventions targeting African American adolescent women in order to inform future intervention development and expansion. We searched PubMed, PsychInfo, and ProQuest databases for journal articles and dissertations published between 2000 and 2015 reporting the impacts of HIV risk-reduction prevention interventions in the U.S. targeting African American adolescent women under age 25. Twenty articles assessing the efficacy of 12 interventions were eligible for inclusion. Selected interventions represented a total of 5,556 African American adolescent women and primarily drew from self-efficacy and self-empowerment-based theoretical frameworks. One intervention targeted girls under age 13; eight included participants ages 13–17; ten targeted adolescents aged 18–24 years; and five interventions included women over age 24 among their participants. Most interventions consisted of in-person knowledge and skills-based group or individual sessions led by trained African American female health professionals. Three were delivered via personal electronic devices. All programs intervened directly at the individual-level; some additionally targeted mothers, friends, or sexual partners. Overall, efficacious interventions among this population promote gender and ethnic pride, HIV risk-reduction self-efficacy, and skills building. They target multiple socio-ecological levels and tailor content to the specific age range, developmental period, and baseline behavioral characteristics of participants. However, demonstrated sustainability of program impacts to date are limited and should be addressed for program enhancements and expansions.

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A Multilevel Understanding of HIV/AIDS Disease Burden among African American Women

Cited by 15 publications

References 48 publications

Multilevel Drivers of Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome Among Black Philadelphians

Multilevel Drivers of Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome Among Black Philadelphians

Intersectional stigma among midlife and older Black women living with HIV

HIV Risk-Reduction Prevention Interventions Targeting African American Adolescent Women

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