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Chapter 3 The Intersection of Women’s Health and Poverty

Abstract

We sought to understand the multilevel syndemic factors that are concurrently contributing to the HIV epidemic among women living in the USA. We specifically examined community, network, dyadic, and individual factors to explain HIV vulnerability within a socioecological framework. We analyzed data from four diverse locations: Atlanta, New York City (the Bronx), Raleigh/Durham, and Washington, D.C. The following themes were identified at four levels including (1) exosystem (community): poverty prevalence, discrimination, gender imbalances, community violence, and housing challenges; (2) mesosystem (network): organizational social support and sexual concurrency; (3) microsystem (dyadic): sex exchange, interpersonal social support, and intimate partner violence; and (4) individual: HIV/STI awareness, risk taking, and substance use. A strong theme emerged with over 80 % of responses linked to the fundamental role of financial insecurity underlying risk-taking behavioral pathways. Multilevel syndemic factors contribute to women’s vulnerability to HIV in the USA. Financial insecurity is a predominant theme, suggesting the need for tailored programming for women to reduce HIV risk.

Keywords

  • Black Woman
  • Male Partner
  • Focus Group Participant
  • Gender Imbalance
  • National Alliance

These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Fig. 3.1

References

  • Adimora, A. A., Ramirez, C., Auerbach, J. D., Aral, S. O., Hodder, S., Wingood, G., … HIV Prevention Trials Network Women at Risk Committee. (2013). Preventing HIV infection in women. Journal of Acquired Immune Deficiency Syndromes, 63(Suppl 2), S168–S173. doi: 10.1097/QAI.0b013e318298a166.

  • 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.

    CrossRef  Google Scholar 

  • Adimora, A. A., Schoenbach, V. J., Martinson, F. E., Coyne-Beasley, T., Doherty, I., Stancil, T. R., & Fullilove, R. E. (2006). Heterosexually transmitted HIV infection among African Americans in North Carolina. Journal of Acquired Immune Deficiency Syndromes, 41(5), 616–623. doi: 10.1097/01.qai.0000191382.62070.a5.

  • Adimora, A. A., Schoenbach, V. J., Martinson, F., Donaldson, K. H., Stancil, T. R., & Fullilove, R. E. (2004). Concurrent sexual partnerships among African Americans in the rural south. Annals of Epidemiology, 14(3), 155–160. doi:10.1016/S1047-2797(03)00129-7.

    CrossRef  Google Scholar 

  • Aral, S. O. (2010). Partner concurrency and the STD/HIV epidemic. Current Infectious Disease Reports, 12(2), 134–139. doi:10.1007/s11908-010-0087-2.

    CrossRef  Google Scholar 

  • Aral, S. O., Adimora, A. A., & Fenton, K. A. (2008). Understanding and responding to disparities in HIV and other sexually transmitted infections in African Americans. Lancet, 372(9635), 337–340. doi:10.1016/S0140-6736(08)61118-6.

    CrossRef  Google Scholar 

  • Aral, S. O., & Wasserheit, J. N. (1995). Interactions among HIV, other sexually transmitted diseases, socioeconomic status, and poverty in women. In Women at risk: Issues in the primary prevention of AIDS (pp. 13–42). New York, NY: Plenum Press.

    Google Scholar 

  • Bauermeister, J. A., Zimmerman, M. A., & Caldwell, C. H. (2011). Neighborhood disadvantage and changes in condom use among African American adolescents. Journal of Urban Health, 88(1), 66–83. doi:10.1007/s11524-010-9506-9.

    CrossRef  Google Scholar 

  • Bell, E. L. J. E., & Nkomo, S. M. (2003). Our separate ways: Black and white women and the struggle for professional identity. Boston: Harvard Business Review Press.

    Google Scholar 

  • Bhandari, S., Bullock, L. F., Bair-Merritt, M., Rose, L., Marcantonio, K., Campbell, J. C., & Sharps, P. (2012). Pregnant women experiencing IPV: Impact of supportive and non-supportive relationships with their mothers and other supportive adults on perinatal depression: A mixed methods analysis. Issues in Mental Health Nursing, 33(12), 827–837. doi: 10.3109/01612840.2012.712628.

  • Bishaw, A., & Fontenot, K. (2014). Poverty: 2012 and 2013. In U.S. Census Bureau (Ed.), American community survey briefs (pp. 9). Washington, DC: U.S. Department of Commerce—Economics and Statistics Administration, U.S. Census Bureau.

    Google Scholar 

  • Bogart, L. M., Landrine, H., Galvan, F. H., Wagner, G. J., & Klein, D. J. (2013). Perceived discrimination and physical health among HIV-positive Black and Latino men who have sex with men. AIDS and Behavior, 17(4), 1431–1441. doi:10.1007/s10461-012-0397-5.

    CrossRef  Google Scholar 

  • Bolton, R. (1992). AIDS and promiscuity: Muddles in the models of HIV prevention. Medical Anthropology, 14(2–4), 145–223. doi:10.1080/01459740.1992.9966072.

    CrossRef  Google Scholar 

  • Bronfenbrenner, U. (1994). Ecological models of human development (International encyclopedia of education 2nd ed., Vol. 3). Oxford, UK: Elsevier.

    Google Scholar 

  • Cene, C. W., Akers, A. Y., Lloyd, S. W., Albritton, T., Powell Hammond, W., & Corbie-Smith, G. (2011). Understanding social capital and HIV risk in rural African American communities. Journal of General Internal Medicine, 26(7), 737–744. doi:10.1007/s11606-011-1646-4.

    CrossRef  Google Scholar 

  • Corneil, T. A., Kuyper, L. M., Shoveller, J., Hogg, R. S., Li, K., Spittal, P. M., … Wood, E. (2006). Unstable housing, associated risk behaviour, and increased risk for HIV infection among injection drug users. Health Place, 12(1), 79–85. doi: 10.1016/j.healthplace.2004.10.004.

  • Denning, P., & DiNenno, E. (2010). Communities in crisis: Is there a generalized HIV epidemic in impoverished urban areas of the United States? Center for Disease Control and Prevention.

    Google Scholar 

  • Drumright, L. N., Gorbach, P. M., & Holmes, K. K. (2004). Do people really know their sex partners? Concurrency, knowledge of partner behavior, and sexually transmitted infections within partnerships. Sexually Transmitted Diseases, 31(7), 437–442.

    CrossRef  Google Scholar 

  • El-Bassel, N., Gilbert, L., Wu, E., Chang, M., Gomes, C., Vinocur, D., & Spevack, T. (2007). Intimate partner violence prevalence and HIV risks among women receiving care in emergency departments: Implications for IPV and HIV screening. Emergency Medicine Journal, 24(4), 255–259. doi: 10.1136/emj.2006.041541.

  • Elifson, K. W., Sterk, C. E., & Theall, K. P. (2007). Safe living: The impact of unstable housing conditions on HIV risk reduction among female drug users. AIDS and Behavior, 11(6 Suppl), 45–55. doi:10.1007/s10461-007-9306-8.

    CrossRef  Google Scholar 

  • Entmacher, J., Gallagher Robins, K., Vogtman, J., & Frohlich, L. (2013). Insecure and unequal: Poverty and income among women and families 2000-2012. Washington, DC: National Women’s Law Center.

    Google Scholar 

  • Eshleman, S. H., Hughes, J. P., Laeyendecker, O., Wang, J., Brookmeyer, R., Johnson-Lewis, L., … Hodder, S. (2013). Use of a multifaceted approach to analyze HIV incidence in a cohort study of women in the United States: HIV Prevention Trials Network 064 Study. Journal of Infectious Diseases, 207(2), 223–231. doi: 10.1093/infdis/jis658.

  • Ezzy, D., de Visser, R., & Bartos, M. (1999). Poverty, disease progression and employment among people living with HIV/AIDS in Australia. AIDS Care, 11(4), 405–414.

    CrossRef  Google Scholar 

  • Fawcett, J. (1999). The relationship of theory and research (3rd ed.). Philadelphia, PA: FA Davis Company.

    Google Scholar 

  • Ferguson, Y. O., Quinn, S. C., Eng, E., & Sandelowski, M. (2006). The gender ratio imbalance and its relationship to risk of HIV/AIDS among African American women at historically black colleges and universities. AIDS Care, 18(4), 323–331. doi:10.1080/09540120500162122.

    CrossRef  Google Scholar 

  • Flom, P. L., Friedman, S. R., Kottiri, B. J., Neaigus, A., Curtis, R., Des Jarlais, D. C., … Zenilman, J. M. (2001). Stigmatized drug use, sexual partner concurrency, and other sex risk network and behavior characteristics of 18- to 24-year-old youth in a high-risk neighborhood. Sexual Transmitted Diseases, 28(10), 598–607.

    Google Scholar 

  • Frew, P. M., Archibald, M., Hixson, B., & del Rio, C. (2011). Socioecological influences on community involvement in HIV vaccine research. Vaccine, 29(36), 6136–6143. doi:10.1016/j.vaccine.2011.06.082.

    CrossRef  Google Scholar 

  • Frumence, G., Killewo, J., Kwesigabo, G., Nystrom, L., Eriksson, M., & Emmelin, M. (2010). Social capital and the decline in HIV transmission—A case study in three villages in the Kagera region of Tanzania. SAHARA J, 7(3), 9–20.

    CrossRef  Google Scholar 

  • Garnett, G. P., & Johnson, A. M. (1997). Coining a new term in epidemiology: Concurrency and HIV. AIDS, 11(5), 681–683.

    CrossRef  Google Scholar 

  • Gillies, P., Tolley, K., & Wolstenholme, J. (1996). Is AIDS a disease of poverty? AIDS Care, 8(3), 351–363. doi:10.1080/09540129650125768.

    CrossRef  Google Scholar 

  • Golden, S. D., Perreira, K. M., & Durrance, C. P. (2013). Troubled times, troubled relationships: How economic resources, gender beliefs, and neighborhood disadvantage influence intimate partner violence. Journal of Interpersonal Violence, 28(10), 2134–2155. doi:10.1177/0886260512471083.

    CrossRef  Google Scholar 

  • Gonzalez-Guarda, R. M., Vasquez, E. P., Urrutia, M. T., Villarruel, A. M., & Peragallo, N. (2011). Hispanic women’s experiences with substance abuse, intimate partner violence, and risk for HIV. Journal of Transcultural Nursing, 22(1), 46–54. doi:10.1177/1043659610387079.

    CrossRef  Google Scholar 

  • Gregson, S., Mushati, P., Grusin, H., Nhamo, M., Schumacher, C., Skovdal, M., … Campbell, C. (2011). Social capital and women’s reduced vulnerability to HIV infection in rural Zimbabwe. Population and Development Review, 37(2), 333–359.

    Google Scholar 

  • Hackman, D. A., Betancourt, L. M., Brodsky, N. L., Hurt, H., & Farah, M. J. (2012). Neighborhood disadvantage and adolescent stress reactivity. Frontiers in Human Neuroscience, 6, 277. doi:10.3389/fnhum.2012.00277.

    CrossRef  Google Scholar 

  • Haines, V. A., Beggs, J. J., & Hurlbert, J. S. (2011). Neighborhood disadvantage, network social capital, and depressive symptoms. Journal of Health and Social Behavior, 52(1), 58–73. doi:10.1177/0022146510394951.

    CrossRef  Google Scholar 

  • Hall, J. C., Everett, J. E., & Hamilton-Mason, J. (2012). Black women talk about workplace stress and how they cope. Journal of Black Studies, 43(2), 207–226.

    CrossRef  Google Scholar 

  • Hankins, C. (2008). Gender, sex, and HIV: How well are we addressing the imbalance? Current Opinion in HIV and AIDS, 3(4), 514–520. doi:10.1097/COH.0b013e32830136b4.

    CrossRef  Google Scholar 

  • Harris, A. L. (2010). The economic and educational state of Black Americans in the 21st century: Should we be optimistic or concerned? The Review of Black Political Economy, 37(3–4), 241–252. doi:10.1007/s12114-010-9065-z.

    CrossRef  Google Scholar 

  • Hodder, S. L., Justman, J., Hughes, J. P., Wang, J., Haley, D. F., Adimora, A. A., … Women’s HIV SeroIncidence Study Team. (2013). HIV acquisition among women from selected areas of the United States: a cohort study. Annals of Internal Medicine, 158(1), 10–18. doi: 10.7326/0003-4819-158-1-201301010-00004.

  • Inciardi, J. A., & Surratt, H. L. (1998). Children in the streets of Brazil: Drug use, crime, violence, and HIV risks. Substance Use & Misuse, 33(7), 1461–1480.

    CrossRef  Google Scholar 

  • Jones-Webb, R., & Karriker-Jaffe, K. J. (2013). Neighborhood disadvantage, high alcohol content beverage consumption, drinking norms, and drinking consequences: A mediation analysis. Journal of Urban Health, 90(4), 667–684. doi:10.1007/s11524-013-9786-y.

    CrossRef  Google Scholar 

  • Kakietek, J., Geberselassie, T., Manteuffel, B., Ogungbemi, K., Krivelyova, A., Bausch, S., … Gar, S. (2013). It takes a village: Community-based organizations and the availability and utilization of HIV/AIDS-related services in Nigeria. AIDS Care, 25(Suppl 1), S78–S87. doi: 10.1080/09540121.2012.740158.

  • Karriker-Jaffe, K. J., Zemore, S. E., Mulia, N., Jones-Webb, R., Bond, J., & Greenfield, T. K. (2012). Neighborhood disadvantage and adult alcohol outcomes: Differential risk by race and gender. Journal of Studies on Alcohol and Drugs, 73(6), 865–873.

    CrossRef  Google Scholar 

  • Kidder, D. P., Wolitski, R. J., Royal, S., Aidala, A., Courtenay-Quirk, C., Holtgrave, D. R., … Housing and Health Study Team. (2007). Access to housing as a structural intervention for homeless and unstably housed people living with HIV: Rationale, methods, and implementation of the housing and health study. AIDS and Behavior, 11(6 Suppl), 149–161. doi: 10.1007/s10461-007-9249-0.

  • Konkle-Parker, D. J., Erlen, J. A., & Dubbert, P. M. (2008). Barriers and facilitators to medication adherence in a southern minority population with HIV disease. Journal of the Association of Nurses in AIDS Care, 19(2), 98–104. doi:10.1016/j.jana.2007.09.005.

    CrossRef  Google Scholar 

  • Lipsitz, G. (2011). “In an avalanche every snowflake pleads not guilty”: The collateral consequences of mass incarceration and impediments to women’s fair housing rights. UCLA Law Review, 59, 1746–1809.

    Google Scholar 

  • Marshall, B. D., Kerr, T., Shoveller, J. A., Patterson, T. L., Buxton, J. A., & Wood, E. (2009). Homelessness and unstable housing associated with an increased risk of HIV and STI transmission among street-involved youth. Health & Place, 15(3), 753–760. doi:10.1016/j.healthplace.2008.12.005.

    CrossRef  Google Scholar 

  • Mason, C. N., Salas, D., Ebanks, J., & Bowser, K. (2013). Economic security and well-being index for women in New York City. New York, NY: The New York Women’s Foundation.

    Google Scholar 

  • Mayer, K. H., Pape, J. W., Wilson, P., Diallo, D. D., Saavedra, J., Mimiaga, M. J., … Farmer, P. (2012). Multiple determinants, common vulnerabilities, and creative responses: Addressing the AIDS pandemic in diverse populations globally. Journal of Acquired Immune Deficiency Syndromes, 60(Suppl 2), S31–S34. doi: 10.1097/QAI.0b013e31825c16d9.

  • Meader, N., Semaan, S., Halton, M., Bhatti, H., Chan, M., Llewellyn, A., & Des Jarlais, D. C. (2013). An international systematic review and meta-analysis of multisession psychosocial interventions compared with educational or minimal interventions on the HIV sex risk behaviors of people who use drugs. AIDS and Behavior, 17(6), 1963–1978. doi: 10.1007/s10461-012-0403-y.

  • Ms. Foundation for Women. (2013). More to do: The road to equality for women in the United States. Brooklyn, NY: Ms. Foundation for Women.

    Google Scholar 

  • National Alliance of State and Territorial AIDS Directors. (2008). The landscape of HIV/AIDS among African American women in the United States (Issue Brief No. 1 ed.). Washington, DC: National Alliance of State and Territorial AIDS Directors.

    Google Scholar 

  • National Coalition Against Domestic Violence. (2014). Intimate partner violence and HIV/AIDS quick facts. Retrieved from http://www.ncadv.org/files/Quick_Facts_About_Domestic_Violence_and_HIV_AIDS.doc

  • National Low Income Housing Coalition. (2012). Who lives in federally assisted housing? In M. Bolton (Ed.), Housing spotlight (Vol. 2, p. 6). Washington, DC: National Low Income Housing Coalition.

    Google Scholar 

  • National Minority AIDS Council, & Housing Works. (2013). Mass incarceration, housing instability and HIV/AIDS: Research findings and policy recommendations. In G. Shubert (Ed.), National Minority AIDS Council.

    Google Scholar 

  • National Women’s Law Center. (2000, June 30). Sex discrimination in the American workplace: Still a fact of life. Retrieved December 8, 2014, from http://www.nwlc.org/resource/sex-discrimination-american-workplace-still-fact-life

  • National Women’s Law Center. (2013a, July 23). 60 Percent of women’s job gains in the recovery are in the 10 largest low-wage jobs. Retrieved 2014, from http://www.nwlc.org/resource/60-percent-women%E2%80%99s-job-gains-recovery-are-10-largest-low-wage-jobs

  • National Women’s Law Center. (2013b, August). Women sharing in slow job growth, but full recovery is a long way off. Retrieved 2014, from http://www.nwlc.org/resource/women-sharing-slow-job-growth-full-recovery-long-way

  • Newsome, V., & Airhihenbuwa, C. O. (2013). Gender ratio imbalance effects on HIV risk behaviors in African American women. Health Promotion Practice, 14(3), 459–463. doi:10.1177/1524839912460869.

    CrossRef  Google Scholar 

  • Okechukwu, C. A., El Ayadi, A. M., Tamers, S. L., Sabbath, E. L., & Berkman, L. (2012). Household food insufficiency, financial strain, work-family spillover, and depressive symptoms in the working class: The Work, Family, and Health Network study. American Journal of Public Health, 102(1), 126–133. doi:10.2105/AJPH.2011.300323.

    CrossRef  Google Scholar 

  • Perez, S., Johnson, D. M., & Wright, C. V. (2012). The attenuating effect of empowerment on IPV-related PTSD symptoms in battered women living in domestic violence shelters. Violence Against Women, 18(1), 102–117. doi:10.1177/1077801212437348.

    CrossRef  Google Scholar 

  • Renzetti, C. M. (2013). Identified intimate partner violence (IPV) as a risk for women in contracting HIV/AIDS and other sexually transmitted disease. Violence Against Women, 19(7), 811–813.

    CrossRef  Google Scholar 

  • Riley, E. D., Gandhi, M., Hare, C., Cohen, J., & Hwang, S. (2007). Poverty, unstable housing, and HIV infection among women living in the United States. Current HIV/AIDS Reports, 4(4), 181–186.

    CrossRef  Google Scholar 

  • Saylors, K., & Daliparthy, N. (2005). Native women, violence, substance abuse and HIV risk. Journal of Psychoactive Drugs, 37(3), 273–280.

    CrossRef  Google Scholar 

  • Schwartz, R. M., Bruno, D. M., Augenbraun, M. A., Hogben, M., Joseph, M. A., Liddon, N., … Wilson, T. E. (2011). Perceived financial need and sexual risk behavior among urban, minority patients following sexually transmitted infection diagnosis. Sexually Transmitted Diseases, 38(3), 230–234. doi: 10.1097/OLQ.0b013e3181f41b81.

  • Soto, T., Komaie, G., Neilands, T. B., & Johnson, M. O. (2013). Exposure to crime and trauma among HIV-infected men who have sex with men: Associations with HIV stigma and treatment engagement. Journal of the Association of Nurses in AIDS Care, 24(4), 299–307. doi:10.1016/j.jana.2012.11.008.

    CrossRef  Google Scholar 

  • Stayton, C., Olson, C., Thorpe, L., Kerker, B., Henning, K., & Wilt, S. (2008). Intimate partner violence against women in New York City, 2008. Report from the New York City Department of Health and Mental Hygiene (pp. 1–21). New York, NY: New York City Department of Health and Mental Hygiene.

    Google Scholar 

  • Su, X., Lau, J. T., Mak, W. W., Chen, L., Choi, K. C., Song, J., … Cheng, J. (2013). Perceived discrimination, social support, and perceived stress among people living with HIV/AIDS in China. AIDS Care, 25(2), 239–248. doi: 10.1080/09540121.2012.701713.

  • Sumartojo, E., Doll, L., Holtgrave, D., Gayle, H., & Merson, M. (2000). Enriching the mix: Incorporating structural factors into HIV prevention. AIDS, 14(Suppl 1), S1–S2.

    CrossRef  Google Scholar 

  • Sweet, E., Nandi, A., Adam, E. K., & McDade, T. W. (2013). The high price of debt: Household financial debt and its impact on mental and physical health. Social Science & Medicine, 91, 94–100. doi:10.1016/j.socscimed.2013.05.009.

    CrossRef  Google Scholar 

  • U.S. Census Bureau. (2013a). 2013 American community survey 1-year estimates, table S1701. Retrieved from http://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_13_1YR_S1701&prodType=table

  • U.S. Census Bureau. (2013b). Current population survey, annual social and economic supplement—Poverty status in 2012. Retrieved from http://www.census.gov/cps/data/cpstablecreator.html

  • U.S. Census Bureau. (2014). Poverty: The history of a measure. In U.S. Census Bureau (Ed.). Washington, DC: U.S. Department of Commerce—Economics and Statistics Administration, U.S. Census Bureau.

    Google Scholar 

  • U.S. Equal Employment Opportunity Commission. (2013). African American workgroup report. Washington, DC: U.S. Equal Employment Opportunity Commission.

    Google Scholar 

  • Women of Color Network. (2006). Domestic violence: Communities of color. Harrisburg, PA: Women of Color Network.

    Google Scholar 

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Frew, P.M. et al. (2017). Chapter 3 The Intersection of Women’s Health and Poverty. In: O'Leary, A., Frew, P. (eds) Poverty in the United States. Springer, Cham. https://doi.org/10.1007/978-3-319-43833-7_3

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