Understanding long-term HIV survivorship among African American/Black and Latinx persons living with HIV in the United States: a qualitative exploration through the lens of symbolic violence

Autor: Linda M. Collins, Robert Hawkins, Amanda M. Applegate, Caroline Dorsen, Sabrina Cluesman, Leo Wilton, Belkis Y. Martinez, Robert Freeman, Marya Gwadz, Noelle R. Leonard, Elizabeth Silverman
Rok vydání: 2020
Předmět:
Male
Gerontology
medicine.medical_specialty
Emotions
Social Stigma
Ethnic group
Psychological intervention
Stigma (botany)
Disparities
HIV Infections
Survivorship
Violence
Race/ethnicity
Symbolic violence
Social group
03 medical and health sciences
Ethnicity
medicine
Humans
HIV care continuum
HIV antiretroviral therapy
Social isolation
Poverty
Socioeconomic status
Qualitative Research
Aged
030505 public health
Research
lcsh:Public aspects of medicine
Health Policy
Public health
Public Health
Environmental and Occupational Health
lcsh:RA1-1270
Hispanic or Latino
Middle Aged
HIV survivorship research
United States
Black or African American
Social Class
Social Isolation
Adherence
Non-persistence
Female
New York City
Social exclusion
medicine.symptom
Qualitative
0305 other medical science
Psychology
Zdroj: International Journal for Equity in Health, Vol 19, Iss 1, Pp 1-23 (2020)
International Journal for Equity in Health
ISSN: 1475-9276
DOI: 10.1186/s12939-020-01253-w
Popis: Background Persons living with HIV (PLWH) are living longer, although racial/ethnic and socioeconomic status (SES) disparities persist. Yet, little is known about the experience of living with and managing HIV over decades. The present study took a qualitative approach and used the lens of symbolic violence, a type of internalized, non-physical violence manifested in the power differential between social groups. We focused on adult African American/Black and Latinx (AABL) PLWH from low-SES backgrounds. Methods Data were drawn from two studies with AABL PLWH in New York City (N = 59). After providing signed informed consent, participants engaged in in-depth semi-structured interviews on aspects of HIV management. Interviews were audio-recorded and professionally transcribed verbatim, and data were analyzed using directed qualitative content analysis. Results Participants in the two studies were comparable on sociodemographic and background characteristics. They had lived with HIV for 20 years, on average (range 3–33 years). All were from low-SES backgrounds and most were African American/Black and men. Participants experienced a convergence of multiple social exclusions, harms, and stigmas, consistent with symbolic violence, which contributed to disengagement from HIV care and discontinuation of HIV medications. We organized results into five sub-themes: (1) participants were “ground down” over time by material, social, and emotional challenges and this diminished self-worth and, at times, the will to live; (2) social isolation and self-isolation, based in part on feeling devalued and dehumanized, served as stigma-avoidance strategies and mechanisms of social exclusion; (3) stigmatizing aspects of patient-provider interactions, both experienced and anticipated, along with (4) restricted autonomy in HIV care and other settings (e.g., parole) reduced engagement; and (5) poor HIV management was internalized as a personal failure. Importantly, resilience was evident throughout the five sub-themes. Conclusions Symbolic violence is a useful framework for understanding long-term HIV management and survivorship among AABL PLWH from low-SES backgrounds. Indeed, forms of symbolic violence are internalized over time (e.g., experiencing devaluation, dehumanization, loss of self-worth, and anticipated stigma), thereby impeding successful HIV management, in part because avoiding HIV care and discontinuing HIV medications are primary coping strategies. Results have implications for interventions in community and health care settings.
Databáze: OpenAIRE
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