Understanding Social Structural Barriers and Facilitators to Behavioral Change: The Case of Cisgender Women Diagnosed with HIV

Part of the Nebraska Symposium on Motivation book series (NSM, volume 65)


In the USA, to receive a diagnosis of human immunodeficiency virus (HIV) is to be expected to embark on a lifelong course of medical, lifestyle, and interpersonal change. To preserve their health, people with HIV are expected to take daily medication, remain in medical care for HIV and get screened and treated for other co-occurring health problems, to develop and/or maintain a healthy lifestyle and to cope with the ongoing stigma and social isolation associated with the diagnosis. In particular, cisgender women who are at the margins of society face social, medical, financial, and structural barriers that render them uniquely vulnerable to contracting HIV, and those same barriers impede diagnosis, beginning care, and staying in care. Most interventions to ensure that PLHIV maintain cART adherence and remain in medical care are biomedically focused and therefore centered on individual-level, behavioral-based interventions. Yet, there are numerous structural barriers that interfere with individual behaviors and compound individual suffering. This chapter serves as an introduction to HIV/AIDS epidemiology, treatment, and policy for people living with HIV/AIDS with a specific focus on cisgender women. In it we utilize a constrained choice approach to systematically examine how decisions made and actions taken at the levels of family, workplace, community, and governmental policy can create barriers to initiating and maintaining cART adherence for PLHIV generally and cWLHIV specifically, and how these barriers can be successfully remedied through local, state, and federal policies.


HIV/AIDS Cisgender women with HIV Constrained choice Health disparities Women with HIV 


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© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Providence CollegeProvidenceUSA
  2. 2.RAND CorporationSanta MonicaUSA

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