Thinking outside the condom: incorporating women's challenges and strengths into safer sex interventions for women living with HIV/AIDS

Michelle Teti

doi:10.17918/etd-2943

Developing effective prevention programs for women living with HIV/AIDS hinges on understanding and responding to the myriad contexts in which women make sexual decisions. These include the challenges imposed on women by intersecting social inequities that can limit their relationship power, such as gender, racial/ethnic, and economic inequality. Existing behavioral research on the reasons why HIV positive women make sexual decisions is limited in scope, however, and current prevention programs posit male condoms as a panacea for HIV positive women's complex safer sex needs. This study explored HIV positive women's experiences of structural violence (oppression) and stress-related growth (growth from adversity) in order to understand better the context of their sexual practices. Methods: The participants included 24 women living with HIV/AIDS who attended skill and peer support groups that were part of the Protect and Respect program. The women were predominantly Black (83%), reported earning less than $10,000/year (80%) and reported acquiring HIV through sex with a male partner (58%). I transcribed 30 group sessions verbatim, editing for clarity only; entered the transcripts into Atlas.ti.5.2, a qualitative software analysis package; and employed analytic strategies of grounded theory and narrative analysis to explore women's structural violence and stress-related growth experiences. Results: Structural violence manifested in the women's lives in three primary ways: (1) daily and overwhelming stress; (2) AIDS related stigma; and (3) unhealthy and violent relationships. The women associated these experiences with emotional pain, suffering and substance use. In addition, the participants responded to these challenges through their examples of: (1) stress-related growth; (2) resilience; and (3) resistance. Conclusions: Women's experiences with structural violence and stress-related growth revealed their barriers and facilitators to having safer sex and suggested that traditional HIV prevention interventions for women living with HIV/AIDS fail to account for women's challenges and their strengths. The analysis of women's experiences with structural violence revealed that women have fundamental health and safety challenges that must be addressed in order for them to be able to have safer sex. The analysis of women's stress related growth experiences revealed that women possess various strengths that are ignored in current HIV prevention programming, but that women associate with their health and ability to have safer sex. These findings suggested that interventions that are not grounded in women's experiences may do more harm than good by instructing women to engage in behaviors that are unrealistic or harmful in the context of their challenges (e.g., condom use in violent relationships), reinforcing women's sense of powerlessness, and obscuring the root causes of and solutions for women's sexual risk practices. I discuss the theoretical, practical, research and methodological implications of these findings, all of which focus on the significance of holistic and multi-leveled prevention strategies for women and addressing the precursors that facilitate or hinder safe sex in prevention programs for women, and not just condom use.

Thinking outside the condom: incorporating women's challenges and strengths into safer sex interventions for women living with HIV/AIDS

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Thinking outside the condom: incorporating women's challenges and strengths into safer sex interventions for women living with HIV/AIDS

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