Journal of General Internal Medicine

, Volume 26, Issue 7, pp 737–744 | Cite as

Understanding Social Capital and HIV Risk in Rural African American Communities

  • Crystal W. CenéEmail author
  • Aletha Y. Akers
  • Stacey W. Lloyd
  • Tashuna Albritton
  • Wizdom Powell Hammond
  • Giselle Corbie-Smith
Original Research



African Americans (AA) and rural communities often suffer disproportionately from poorer health. Theory-guided research examining how individual- and community-level factors influence health behaviors and contribute to disparities is needed.


To understand how a social network model that captures the interplay between individual and community factors might inform community-based interventions to reduce HIV risk in rural AA communities.


Qualitative study.


Eleven focus groups with 38 AA 16–24 year olds, 42 adults over age 25, and 13 formerly incarcerated individuals held in community settings in two rural, predominantly AA counties in North Carolina. Thirty-seven semi-structured interviews with multiethnic key informants.


Semi-structured interviews and focus groups with open-ended questions assessed a) perceptions of multi-level HIV risk determinants from a social network model (individual, interpersonal, social, economic, political and structural) identified through literature review and b) community needs and assets affecting local HIV rates. Qualitative data was analyzed using directive content analysis guided by a social network model.


We identified four themes regarding the interaction between individuals and their communities that mediate HIV risk: interpersonal processes, community structural environment, social disorder, and civic engagement. Communities were characterized as having a high degree of cohesiveness, tension, and HIV-related stigma. The community structural environment—characterized by neighborhood poverty, lack of skilled jobs, segregation, political disenfranchisement and institutional racism—was felt to reduce the availability and accessibility of resources to combat HIV. Adults noted an inability to combat social problems due to social disorder, which fuels HIV risk behaviors. Civic engagement as a means of identifying community concerns and developing solutions is limited by churches’ reluctance to address HIV-related issues.


To combat HIV-related stigma, physicians should follow recommendations for universal HIV testing. Besides asking about individual health behaviors, physicians should ask about the availability of support and local community resources. Physicians might consider tailoring their treatment recommendations based on available community resources. This strategy may potentially improve patient adherence and clinical outcomes.


social capital HIV prevention rural communities African Americans community-based participatory research 



We would like to acknowledge the contributions of all steering committee members in the development of Project GRACE Consortium: Larry Auld, Reuben Blackwell, Hank Boyd, III, John Braswell, Angela Bryant, Cheryl Bryant, Don Cavellini, Trinette Cooper, Dana Courtney, Eugenia Eng, Jerome Garner, Vernetta Gupton, Davita Harrell, Shannon Hayes-Peaden, Stacey Henderson, Doris Howington, Clara Knight, Gwendolyn Knight, Taro Knight, Patricia Oxendine-Pitt, Donald Parker, Reginald Silver, Doris Stith, Jevita Terry, and Cynthia Worthy. We would also like to thank the three anonymous reviewers, Dr. Amina Chaudhry, Dr. Karran Phillips, and Mr. R.H. Wright for their helpful comments on this manuscript. We would especially like to thank the assigned Deputy Editor for her very detailed and thoughtful comments which strengthened this manuscript tremendously.

This work was funded by grants from the National Center on Minority Health and Health Disparities (R24MD001671) and The University of North Carolina Center for AIDS Research (UNC CFAR P30 AI50410). Dr. Corbie-Smith is a Health Disparities Scholar with the National Center on Minority Health and Health Disparities. Drs. Cené and Akers received support as funded scholars through the Clinical Translational Science Award-K12 Scholars Program (KL2). The CTSA is a national consortium with the goal of transforming how clinical and translational research is conducted, ultimately enabling researchers to provide new treatments more efficiently and quickly to patients. Drs. Cené and Aker’s work on this project was supported by award number KL2RR025746 and KL2 RR024154-0, respectively from the National Center for Research Resources, a component of the National Institutes of Health (NIH) and NIH Roadmap for Medical Research. Dr. Powell Hammond is supported by the National Center for Minority Health and Health Disparities (Award # 1L60MD002605-01), National Cancer Institute (Grant # 3U01CA114629-04 S2) and a developmental award from the UNC Center for Aids Research Award (CFAR P30 AI50410).

The content is solely the responsibility of the authors and does not necessarily represent the official views of any of the funding agencies. This paper was presented at the 32th Annual Meeting of the Society of General Internal Medicine, May 14, 2009, Miami, Florida.

Conflicts of Interest

None disclosed.


  1. 1.
    Institute of Medicine, Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care. Unequal treatment: Confronting racial and ethnic disparities in health care. 2002.Google Scholar
  2. 2.
    Shaw M, Dorling D, Smith GD. Poverty, social exclusion, and minorities. In: Marmot M, Wilkinson RG, eds. Social determinants of health. 2nd ed. Oxford: Oxford University Press; 2006:196–223.Google Scholar
  3. 3.
    Nazroo JY, Williams DR. The social determination of ethnic/racial inequalities in health. In: Marmot M, Wilkinson RG, eds. Social determinants of health. 2nd ed. Great Britain: Oxford University Press; 2006:238–66.Google Scholar
  4. 4.
    Bourdieu P. The handbook of theory and research for the sociology of education. In: Richardson JG, ed. The forms of capital. New York: Greenwood Press; 1986:241–58.Google Scholar
  5. 5.
    Coleman JS. Social Capital in the Creation of Human Capital. AJS. 1988;94(Supplement):S95-S120.Google Scholar
  6. 6.
    Putnam RD. Bowling alone: America’s declining social capital. JOD. 1995;6(1):65–78.Google Scholar
  7. 7.
    Hsieh CH. A concept analysis of social capital within a health context. Nurs Forum. 2008;43(3):151–59.PubMedCrossRefGoogle Scholar
  8. 8.
    Kawachi I, Kennedy BP, Lochner K, Prothrow-Stith D. Social capital, income inequality, and mortality. Am J Public Health. 1997;87(9):1491–8.PubMedCrossRefGoogle Scholar
  9. 9.
    Kawachi I, Kennedy BP, Glass R. Social capital and self-rated health: a contextual analysis. Am J Public Health. 1999;89(8):1187–93.PubMedCrossRefGoogle Scholar
  10. 10.
    Holtgrave DR, Crosby RA. Social capital, poverty, and income inequality as predictors of gonorrhea, syphilis, chlamydia and AIDS case rates in the United States. Sex Transm Infect. 2003;79(1):62–4.PubMedCrossRefGoogle Scholar
  11. 11.
    Semaan S, Sternberg M, Zaidi A, Aral SO. Social capital and rates of gonorrhea and syphilis in the United States: spatial regression analyses of state-level associations. Soc Sci Med. 2007;64(11):2324–41.PubMedCrossRefGoogle Scholar
  12. 12.
    Almedom AM. Social capital and mental health: an interdisciplinary review of primary evidence. Soc Sci Med. 2005;61(5):943–64.PubMedCrossRefGoogle Scholar
  13. 13.
    De Silva MJ, McKenzie K, Harpham T, Huttly SR. Social capital and mental illness: a systematic review. J Epidemiol Community Health. 2005;59(8):619–27.PubMedCrossRefGoogle Scholar
  14. 14.
    Islam MK, Merlo J, Kawachi I, Lindstrom M, Gerdtham UG. Social capital and health: does egalitarianism matter? A literature review. Int J Equity Health. 2006;5:3.CrossRefGoogle Scholar
  15. 15.
    Macinko J, Starfield B. The utility of social capital in research on health determinants. Milbank Q. 2001;79(3):387-427, IV.Google Scholar
  16. 16.
    Pitkin Derose K, Varda DM. Social capital and health care access: a systematic review. Med Care Res Rev. 2009;66(3):272-306.Google Scholar
  17. 17.
    Holtgrave DR, Crosby R. Is social capital a protective factor against obesity and diabetes? Findings from an exploratory study. Ann Epidemiol. 2006;16(5):406–8.PubMedCrossRefGoogle Scholar
  18. 18.
    Crosby RA, Holtgrave DR, DiClemente RJ, Wingood GM, Gayle JA. Social capital as a predictor of adolescents' sexual risk behavior: a state-level exploratory study. AIDS Behav. 2003;7(3):245–52.PubMedCrossRefGoogle Scholar
  19. 19.
    Carlson ED, Chamberlain RM. Social capital, health, and health disparities. J Nurs Scholarsh. 2003;35(4):325–31.PubMedCrossRefGoogle Scholar
  20. 20.
    Carpiano RM. Neighborhood social capital and adult health: an empirical test of a Bourdieu-based model. Health Place. 2007;13(3):639–55.PubMedCrossRefGoogle Scholar
  21. 21.
    Baum F, Palmer C. 'Opportunity structures': urban landscape, social capital and health promotion in Australia. Health Promot Int. 2002;17(4):351–61.PubMedCrossRefGoogle Scholar
  22. 22.
    Carpiano RM. Toward a neighborhood resource-based theory of social capital for health: can Bourdieu and sociology help? Soc Sci Med. 2006;62(1):165–75.PubMedCrossRefGoogle Scholar
  23. 23.
    Corbie-Smith G, Adimora A, Youmans S, Muhammad M, Blumenthal C, Ellison A, Akers A, Council B, Thigpen Y, Wynn M, Lloyd S. "Project GRACE: A Staged Approach to Development of a Community-Academic Partnership to address HIV in Rural African American Communities." Health Promotion and Practice.Google Scholar
  24. 24.
    Edgecombe County Health Department/Nash County Health Department. Edgecombe county Health Department/Nash County Statistical Analysis Query Report. Retrieved on April 1, 2007.Google Scholar
  25. 25.
    NC Rural Economic Development Center. North Carolina Rural Data Bank. Updated 2009. Accessed July, 2010.
  26. 26.
    Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277–88.PubMedCrossRefGoogle Scholar
  27. 27.
    Lynch JW, Kaplan GA, Salonen JT. Why do poor people behave poorly? Variation in adult health behaviours and psychosocial characteristics by stages of the socioeconomic lifecourse. Soc Sci Med. 1997;44(6):809–19.PubMedCrossRefGoogle Scholar
  28. 28.
    American College of Physicians. Racial and ethnic disparities in health care, updated 2010.Google Scholar
  29. 29.
    Buffardi AL, Thomas KK, Holmes KK, Manhart LE. Moving upstream: ecosocial and psychosocial correlates of sexually transmitted infections among young adults in the United States. Am J Public Health. 2008;98(6):1128–36.PubMedCrossRefGoogle Scholar
  30. 30.
    Gregson S, Terceira N, Mushati P, Nyamukapa C, Campbell C. Community group participation: can it help young women to avoid HIV? An exploratory study of social capital and school education in rural Zimbabwe. Soc Sci Med. 2004;58(11):2119–32.PubMedCrossRefGoogle Scholar
  31. 31.
    Pronyk PM, Harpham T, Morison LA, et al. Is social capital associated with HIV risk in rural South Africa? Soc Sci Med. 2008;66(9):1999–2010.PubMedCrossRefGoogle Scholar
  32. 32.
    Campbell C, Williams B, Gilgen D. Is social capital a useful conceptual tool for exploring community level influences on HIV infection? An exploratory case study from South Africa. AIDS Care. 2002;14(1):41–54.PubMedCrossRefGoogle Scholar
  33. 33.
    Takahashi LM, Magalong MG. Disruptive social capital: (un)healthy socio-spatial interactions among Filipino men living with HIV/AIDS. Health Place. 2008;14(2):182–97.PubMedCrossRefGoogle Scholar
  34. 34.
    Branson BM, Handsfield HH, Lampe MA, Janssen RS, Taylor AW, Lyss SB, Clark JE. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. 2006:592–7.Google Scholar
  35. 35.
    Khan MR, Wohl DA, Weir SS, et al. Incarceration and risky sexual partnerships in a southern US city. J Urban Health. 2008;85(1):100–13.PubMedCrossRefGoogle Scholar
  36. 36.
    MacGowan RJ, Margolis A, Gaiter J, et al. Predictors of risky sex of young men after release from prison. Int J STD AIDS. 2003;14(8):519–23.PubMedCrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2011

Authors and Affiliations

  • Crystal W. Cené
    • 1
    Email author
  • Aletha Y. Akers
    • 2
  • Stacey W. Lloyd
    • 3
  • Tashuna Albritton
    • 4
  • Wizdom Powell Hammond
    • 5
  • Giselle Corbie-Smith
    • 6
  1. 1.Department of Medicine, UNC Division of General MedicineThe University of North Carolina at Chapel HillChapel HillUSA
  2. 2.Department of Obstetrics, Gynecology and Reproductive ScienceMagee-Women’s HospitalPittsburghUSA
  3. 3.RTI InternationalResearch Triangle ParkUSA
  4. 4.School of Social WorkThe University of North Carolina at Chapel HillChapel HillUSA
  5. 5.Department of Health Behavior and Health EducationThe University of North Carolina at Chapel HillChapel HillUSA
  6. 6.Departments of Social Medicine, Medicine and EpidemiologyThe University of North Carolina at Chapel HillChapel HillUSA

Personalised recommendations