Sex Roles

, Volume 70, Issue 5–6, pp 221–231 | Cite as

Resilience Among Women with HIV: Impact of Silencing the Self and Socioeconomic Factors

  • Sannisha K. DaleEmail author
  • Mardge H. Cohen
  • Gwendolyn A. Kelso
  • Ruth C. Cruise
  • Kathleen M. Weber
  • Cheryl Watson
  • Jane K. Burke-Miller
  • Leslie R. BrodyEmail author
Original Article


In the U.S., women account for over a quarter of the approximately 50,000 annual new HIV diagnoses and face intersecting and ubiquitous adversities including gender inequities, sexism, poverty, violence, and limited access to quality education and employment. Women are also subjected to prescribed gender roles such as silencing their needs in interpersonal relationships, which may lessen their ability to be resilient and function adaptively following adversity. Previous studies have often highlighted the struggles encountered by women with HIV without focusing on their strengths. The present cross-sectional study investigated the relationships of silencing the self and socioeconomic factors (education, employment, and income) with resilience in a sample of women with HIV. The sample consisted of 85 women with HIV, diverse ethnic/racial groups, aged 24–65 enrolled at the Chicago site of the Women’s Interagency HIV Study in the midwestern region of the United States. Measures included the Connor-Davidson Resilience Scale -10 item and the Silencing the Self Scale (STSS). Participants showed high levels of resilience. Women with lower scores on the STSS (lower self-silencing) reported significantly higher resilience compared to women with higher STSS scores. Although employment significantly related to higher resilience, silencing the self tended to predict resilience over and above the contributions of employment, income, and education. Results suggest that intervention and prevention efforts aimed at decreasing silencing the self and increasing employment opportunities may improve resilience.


Resilience Silencing the self HIV Women Socioeconomic factors 



Data in this manuscript were collected by the Chicago site of the Women’s Interagency HIVstudy (WIHS), which is funded by the National Institute of Allergy and Infectious DiseasesGrant U01-AI-34994 (PI, Dr. Mardge Cohen) and co-funded by the National Cancer Institute and National Institute of Drug Abuse. Sannisha K. Dale is funded by a National Research Service Award (#F31MH095510) from the National Institute of Mental Health. Kathleen Weber is also funded in part by P30- AI082151. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the views of the National Institutes of Health.

We would like to express tremendous gratitude to the WIHS participants in this study and to WIHS staff Cheryl Watson, Crystal Winston, Sally Urwin and Karlene Schowalter who were key in data collection and management.


  1. Abraído-Lanza, A. F. (1997). Latinas with arthritis: effects of illness, role identity, and competence on psychological well-being. American Journal of Community Psychology, 25, 601–627. doi: 10.1023/a:1024682800238.PubMedCentralPubMedCrossRefGoogle Scholar
  2. Adimora, A. A., & Schoenbach, V. J. (2005). Social context, sexual networks, and racial disparities in rates of sexually transmitted infections. Journal of Infectious Diseases, 191(Suppl 1), S115–S122. doi: 10.1086/425280.PubMedCrossRefGoogle Scholar
  3. Bacon, M. C., von Wyl, V., Alden, C., Sharp, G., Robison, E., Hessol, N., et al. (2005). The Women’s interagency HIV study: an observational cohort brings clinical sciences to the bench. Clinical Vaccine Immunology, 12, 1013–1019. doi: 10.1128/ CDLI.12.9.1013-1019.CrossRefGoogle Scholar
  4. Barkan, S. E., Melnick, S. L., Preston-Martin, S., Weber, K., Kalish, L. A., Miotti, P., et al. (1998). The Women’s interagency HIV study. WIHS collaborative study group. Epidemiology, 9, 117–125.PubMedCrossRefGoogle Scholar
  5. Boden, R. J., Jr. (1999). Gender inequality in wage earnings and female self-employment selection. The Journal of Socio-Economics, 28, 351–364. doi: 10.1016/S1053-5357(99)00026-8.CrossRefGoogle Scholar
  6. Bonanno, G. A. (2012). Uses and abuses of the resilience construct: loss, trauma, and health-related adversities. Social Science & Medicine, 74, 753–756. doi: 10.1016/j.socscimed.2011.11.022.CrossRefGoogle Scholar
  7. Bonanno, G. A., Galea, S., Bucciarelli, A., & Vlahov, D. (2006). Psychological resilience after disaster: New York City in the aftermath of the September 11th terrorist attack. Psychological Science, 17, 181–186. doi: 10.1111/j.1467-9280.2006.01682.x.PubMedCrossRefGoogle Scholar
  8. Bonanno, G. A., Galea, S., Bucciarelli, A., & Vlahov, D. (2007). What predicts psychological resilience after disaster? the role of demographics, resources, and life stress. Journal of Consulting and Clinical Psychology, 75, 671–682. doi: 10.1037/0022-006X.75.5.671.PubMedCrossRefGoogle Scholar
  9. Bowleg, L., Belgrave, F., & Reisen, C. (2000). Gender roles, power strategies, and precautionary sexual self-efficacy: implications for black and Latina Women’s HIV/AIDS protective behaviors. Sex Roles, 42, 613–635. doi: 10.1023/a:1007099422902.CrossRefGoogle Scholar
  10. Brody, L. R. (1999). Gender, emotion and the family. Cambridge: Harvard University Press.Google Scholar
  11. Brody, L., Dale, S., Kelso, G., Cruise, R., Weber, K., Watson, C., et al. (in press). Gender roles and coping in relation to depression and quality of life in women with and at risk for HIV. In S. Dworkin, M. Gandhi, & P. Passano (Eds.), In justice and in health: A new era in women’s health and empowerment. Berkeley: UC Press.Google Scholar
  12. Callahan, S. T., & Cooper, W. O. (2005). Uninsurance and health care access among young adults in the United States. Pediatrics, 116, 88–95. doi: 10.1542/peds.2004-1449.PubMedCrossRefGoogle Scholar
  13. Campbell-Sills, L., & Stein, M. B. (2007). Psychometric analysis and refinement of the connor–davidson resilience scale (CD-RISC): validation of a 10-item measure of resilience. Journal of Traumatic Stress, 20, 1019–1028. doi: 10.1002/jts.20271.PubMedCrossRefGoogle Scholar
  14. Campbell-Sills, L., Forde, D., & Stein, M. B. (2009). Demographic and childhood environmental predictors of resilience in a community sample. Journal of Psychiatric Research, 43, 1007–1012. doi: 10.1016/j.jpsychires.2009.01.013.PubMedCrossRefGoogle Scholar
  15. Caspi, A., Sugden, K., Moffitt, T. E., Taylor, A., Craig, I. W., Harrington, H., et al. (2003). Influence of life stress on depression: moderation by a polymorphism in the 5-HTT gene. Science, 301, 386–389. doi: 10.1126/science.1083968.PubMedCrossRefGoogle Scholar
  16. Centers for Disease Control and Prevention. (2013a). HIV surveillance - Epidemiology of HIV infection (through 2011). Retrieved from
  17. Centers for Disease Control and Prevention. (2013b). HIV infection among heterosexuals at increased risk — United States, 2010. Morbidity and Mortality Weekly Report, 62, 183–188.Google Scholar
  18. Cohen, M., Deamant, C., Barkan, S., Richardson, J., Young, M., Holman, S., et al. (2000). Domestic violence and childhood sexual abuse in HIV-infected women and women at risk for HIV. American Journal of Public Health, 90, 560–565. doi: 10.2105/AJPH.90.4.560.PubMedCentralPubMedCrossRefGoogle Scholar
  19. Cohen, J., Cohen, P., West, S. G., & Aiken, L. S. (2002). Applied multiple regression/correlation analysis for the behavioral sciences (3rd ed.). New Jersey: Routledge.Google Scholar
  20. Connor, K. M., & Davidson, J. R. T. (2003). Development of a new resilience scale: The Connor-Davidson Resilience Scale (CD-RISC). Depression and Anxiety, 18, 76–82. doi: 10.1002/da.10113.
  21. Delpierre, C., Cuzin, L., Lauwers-Cances, V., Datta, G. D., Berkman, L., & Lang, T. (2008). Unemployment as a risk factor for AIDS and death for HIV-infected patients in the era of highly active antiretroviral therapy. Sexually Transmitted Infections, 84, 183–186. doi: 10.1136/sti.2007.027961.PubMedCrossRefGoogle Scholar
  22. DeMarco, R., Johnsen, C., Fukuda, D., & Deffenbaugh, O. (2001). Content validity of a scale to measure silencing and affectivity among women living with HIV/AIDS. Journal of the Association of Nurses in AIDS Care, 12(4), 77–88. doi: 10.1016/S1055-3290(06)60219-7.PubMedCrossRefGoogle Scholar
  23. Demarco, R., Lynch, M. M., & Board, R. (2002). Mothers who silence themselves: a concept with clinical implications for women living with HIV/AIDS and their children. Journal of Pediatric Nursing, 17, 89–95. doi: 10.1053/jpdn.2002.124126.PubMedCrossRefGoogle Scholar
  24. DiClemente, R. J., & Wingood, G. M. (1995). A randomized controlled trial of an HIV sexual risk-reduction intervention for young African-American women. Journal of the American Medical Association, 274(16), 1271–1276. doi: 10.1001/jama.1995.03530160023028 Google Scholar
  25. England, P. (2005). Gender inequality in labor markets: the role of motherhood and segregation. Social Politics: International Studies in Gender, State & Society, 12, 264–288. doi: 10.1093/sp/jxi014.CrossRefGoogle Scholar
  26. Farber, E. W., Schwartz, J. A., Schaper, P. E., Moonen, D. J., & McDaniel, J. S. (2000). Resilience factors associated with adaptation to HIV disease. Psychosomatics, 41, 140–146. doi: 10.1176/appi.psy.41.2.140 pp. 140-6.PubMedCrossRefGoogle Scholar
  27. Golub, S. A., Tomassilli, J. C., & Parsons, J. T. (2008). Partner serostatus and disclosure stigma: implications for physical and mental health outcomes among HIV-positive adults. AIDS and Behavior, 13, 1233–1240. doi: 10.1007/s10461-008-9466-1.PubMedCrossRefGoogle Scholar
  28. Grant, T. M., Jack, D. C., Fitzpatrick, A., Jull, P., & Ernst, C. (2009). Carrying the burdens of poverty, parenting, and addiction: depression symptoms and self-silencing among ethnically diverse women. Community Mental Health Journal, 47, 90–98. doi: 10.1007/s10597-009-9255.PubMedCrossRefGoogle Scholar
  29. Harvey, S. M., Bird, S. T., Galavotti, C., Duncan, E. A., & Greenberg, D. (2002). Relationship power, sexual decision making and condom use among women at risk for HIV/STDS. Women & Health, 36(4), 69–84. doi: 10.1300/J013v36n04_06.CrossRefGoogle Scholar
  30. Haskett, M. E., Nears, K., Ward, C. S., & McPherson, A. V. (2006). Diversity in adjustment of maltreated children: factors associated with resilient functioning. Clinical Psychology Review, 26, 796–812. doi: 10.1016/j.cpr.2006.03.005.PubMedCrossRefGoogle Scholar
  31. Jacelon, C. S. (1997). The trait and process of resilience. Journal of Advanced Nursing, 25, 123–129. doi: 10.1046/j.1365-2648.1997.1997025123.x.PubMedCrossRefGoogle Scholar
  32. Jack, D. C., & Ali, A. (Eds.). (2010). Self-silencing and depression across cultures: Depression and gender in the social world. New York: Oxford University Press.Google Scholar
  33. Jack, D. C., & Dill, D. (1992). The silencing the self scale: schemas of intimacy associated with depression in women. Psychology of Women Quarterly, 16, 97–106. doi: 10.1111/j.1471-6402.1992.tb00242.x.CrossRefGoogle Scholar
  34. Kelso, G., Cohen, M., Weber, K., Dale, S. K., Cruise, R. C., & Brody, L. (2013). Critical consciousness, racial and gender discrimination, and HIV disease markers in African-American women with HIV. AIDS & Behavior. doi: 10.1007/s10461-013-0621-y.Google Scholar
  35. Kjellstrand, E. K., & Harper, M. (2012). Yes, She Can: an examination of resiliency factors in middle- and upper-income single mothers. Journal of Divorce & Remarriage, 53, 311–327. doi: 10.1080/10502556.2012.671677.CrossRefGoogle Scholar
  36. Klasen, S. (2002). Low schooling for girls, slower growth for all? cross‐country evidence on the effect of gender inequality in education on economic development. The World Bank Economic Review, 16, 345–373. doi: 10.1093/wber/lhf004.
  37. Lewis, M. (2007, February). Stepwise versus Hierarchal Regression. Paper presented at the annual meeting of the Southwest Educational Research Association, San Antonio. Retrieved from
  38. Machtinger, E. L., Wilson, T. C., Haberer, J. E., & Weiss, D. S. (2012). Psychological trauma and PTSD in HIV-positive women: a meta-analysis. AIDS and Behavior, 16, 2091–2100. doi: 10.1007/s10461-011-0127-4.PubMedCrossRefGoogle Scholar
  39. Masten, A. S., Best, K. M., & Garmezy, N. (1990). Resilience and development: contributions from the study of children who overcome adversity. Development and Psychopathology, 2, 425–444. doi: 10.1017/S0954579400005812.CrossRefGoogle Scholar
  40. McGeary, D. D. (2011). Making sense of resilience. Military Medicine, 176, 603–604.PubMedCrossRefGoogle Scholar
  41. Morenoff, J. D., Sampson, R. J., & Raudenbush, S. W. (2001). Neighborhood inequality, collective efficacy, and the spatial dynamics of urban violence. Criminology, 39, 517–558. doi: 10.1111/j.1745-9125.2001.tb00932.x.CrossRefGoogle Scholar
  42. Olsson, C. A., Bond, L., Burns, J. M., Vella-Brodrick, D. A., & Sawyer, S. M. (2003). Adolescent resilience: a concept analysis. Journal of Adolescence, 26, 1–11. doi: 10.1016/S0140-1971(02)00118-5.PubMedCrossRefGoogle Scholar
  43. Perry, M. J. (1998). Gender, race and economic perspectives on the social epidemiology of HIV infection: implications for prevention. The Journal of Primary Prevention, 19, 97–104. doi: 10.1023/a:1022688827012.CrossRefGoogle Scholar
  44. Quina, K., Harlow, L. L., Morokoff, P. J., Burkholder, G., & Deiter, P. J. (2000). Sexual communication in relationships: when words speak louder than actions. Sex Roles, 42, 523–549. doi: 10.1023/A:1007043205155.CrossRefGoogle Scholar
  45. Radford-Hill, S. (2002). Keepin’ it real: a generational commentary on Kimberly Springer’s “third wave black feminism?”. Signs: Journal of Women in Culture and Society, 27, 1083–1089. doi: 10.1086/339638.
  46. Scali, J., Gandubert, C., Ritchie, K., Soulier, M., Ancelin, M.-L., & Chaudieu, I. (2012). Measuring resilience in adult women using the 10-items Connor-Davidson resilience scale (CD-RISC). role of trauma exposure and anxiety disorders. PLoS ONE, 7(6), e39879. doi: 10.1371/journal.pone.0039879.PubMedCentralPubMedCrossRefGoogle Scholar
  47. Sen, B. (2003). Why do women feel the way they do about market work: the role of familial, social and economic factors. Review of Social Economy, 61, 211–234. doi: 10.1080/0034676032000098228.CrossRefGoogle Scholar
  48. Shearer, C. L., Hosterman, S. J., Gillen, M. M., & Lefkowitz, E. S. (2005). Are traditional gender role attitudes associated with risky sexual behavior and condom-related beliefs? Sex Roles, 52, 311–324. doi: 10.1007/s11199-005-2675-4.CrossRefGoogle Scholar
  49. Steinhardt, M., & Dolbier, C. (2008). Evaluation of a resilience intervention to enhance coping strategies and protective factors and decrease symptomatology. Journal of American College Health, 56(4), 445–453. doi: 10.3200/JACH.56.44.445-454 Google Scholar
  50. Ungar, M. (2008). Resilience across cultures. British Journal of Social Work, 38, 218–235. doi: 10.1093/bjsw/bcl343.CrossRefGoogle Scholar
  51. Vella, F. (1994). Gender roles and human capital investment: the relationship between traditional attitudes and female labour market performance. Economica, 61, 191–211.Google Scholar
  52. Waaktaar, T., & Torgersen, S. (2012). Genetic and environmental causes of variation in trait resilience in young people. Behavior Genetics, 42, 366–377. doi: 10.1007/s10519-011-9519-5.PubMedCentralPubMedCrossRefGoogle Scholar
  53. Wagnild, G. M., & Young, H. M. (1993). Development and psychometric evaluation of the resiliency scale. Journal of Nursing Measurement, 1, 165–178.PubMedGoogle Scholar
  54. Weder, N., Yang, B. Z., Douglas-Palumberi, H., Massey, J., Krystal, J. H., Gelernter, J., et al. (2009). MAOA genotype, maltreatment, and aggressive behavior: the changing impact of genotype at varying levels of trauma. Biological Psychiatry, 65, 417–424. doi: 10.1016/j.biopsych.2008.09.013.Google Scholar
  55. Wells, M. (2009). Resilience in rural community-dwelling older adults. Journal of Rural Health, 25, 415–419. doi: 10.1111/j.1748-0361.2009.00253.x.PubMedCrossRefGoogle Scholar
  56. Werner, E. E. (1993). Risk, resilience, and recovery: perspectives from the Kauai longitudinal study. Development and Psychopathology, 5, 503–515. doi: 10.1017/s095457940000612x.CrossRefGoogle Scholar
  57. Werner, E. E. (2004). Journeys from childhood to midlife: risk, resilience, and recovery. Pediatrics, 114, 492.PubMedCrossRefGoogle Scholar
  58. Whetten, K., Reif, S., Whetten, R., & Murphy-McMillan, L. K. (2008). Trauma, mental health, distrust, and stigma among HIV-positive persons: implications for effective care. Psychosomatic Medicine, 70, 531–538. doi: 10.1097/PSY.0b013e31817749dc.PubMedCrossRefGoogle Scholar
  59. Wingo, A. P., Wrenn, G., Pelletier, T., Gutman, A. R., Bradley, B., & Ressler, K. J. (2010). Moderating effects of resilience on depression in individuals with a history of childhood abuse or trauma exposure. Journal of Affective Disorders, 126, 411–414. doi: 10.1016/j.jad.2010.04.009.PubMedCentralPubMedCrossRefGoogle Scholar
  60. Wingood, G. M., DiClemente, R. J., Mikhail, I., Lang, D. L., McCree, D. H., Davies, S. L., et al. (2004). A randomized controlled trial to reduce HIV transmission risk behaviors and sexually transmitted diseases among women living with HIV: the WiLLOW program. Journal of Acquired Immune Deficiency Syndromes, 37(Suppl 2), S58–S67. doi: 10.1097/01.qai.0000140603.57478.a9.PubMedCrossRefGoogle Scholar
  61. Wyatt, G. E. (1994). The sociocultural relevance of sex research. Challenges for the 1990s and beyond. American Psychology, 49, 748–754. doi: 10.1037/0003-066X.49.8.748.CrossRefGoogle Scholar
  62. Yu, X. N., Lau, J. T. F., Mak, W. W. S., Cheng, Y. M., Lv, Y. H., & Zhang, J. X. (2009). Risk and protective factors in association with mental health problems among people living with HIV who were former plasma/blood donors in rural China. AIDS Care, 21, 645–654. doi: 10.1080/09540120802459770.PubMedCrossRefGoogle Scholar
  63. Zierler, S., & Krieger, N. (1997). Reframing women’s risk: social inequalities and HIV infection. Annual Review of Public Health, 18, 401–436. doi: 10.1146/annurev.publhealth.18.1.401.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Sannisha K. Dale
    • 1
    Email author
  • Mardge H. Cohen
    • 2
    • 3
    • 4
  • Gwendolyn A. Kelso
    • 1
  • Ruth C. Cruise
    • 1
  • Kathleen M. Weber
    • 2
    • 3
    • 4
  • Cheryl Watson
    • 2
    • 3
    • 4
  • Jane K. Burke-Miller
    • 2
    • 3
    • 4
  • Leslie R. Brody
    • 1
    Email author
  1. 1.Boston UniversityBostonUSA
  2. 2.Departments of MedicineCook County Health & Hospital SystemChicagoUSA
  3. 3.Rush University ChicagoChicagoUSA
  4. 4.CORE Center at John H. Stroger Jr Hospital of Cook CountyChicagoUSA

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