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African American Women's Experience of Infection With HIV in the Rural Southeastern United States

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The design of effective behavioral interventions to prevent HIV infection among African American women requires a more complete understanding of the context and circumstances that precipitate infection with the virus. A descriptive study was designed to explore African American women's experiences of infection with HIV in the rural southeastern United States. Ten women living with HIV participated in interviews. All were infected through sex with a man or men; three had engaged in high-risk activities associated with HIV infection including sex trading; seven described themselves as at low risk for infection related to serial monogamy, no injection drug use, and no history of addiction. Participants reported that desire for intimacy coupled with inaccurate risk appraisal of sex partners contributed to their infection. These results provide insight into the role of intimacy in sexual risk taking. Inquiry into how women can be assisted to protect themselves in the context of intimate relationships may improve interventions to prevent HIV.

Section snippets

Literature Review

Despite evidence that the rate of HIV infection among women has risen sharply in the rural south (“Southern women apparently face,” 2001), there remain a limited number of published studies related to prevention of HIV among African American women living in the rural south. A search of electronic databases for published research related to HIV and rural women showed that the areas currently receiving attention include treatment-related issues for those with HIV (Heckman and Carlson, 2007, Reif

Design

Grounded Theory methodology (Glaser, 1992) was used to construct descriptions from participants about how they came to be infected with HIV. Theoretical results from this study are reported elsewhere (Mallory, 2005). This article reports descriptive results as related by the participants. The study was reviewed by the University of North Carolina, Chapel Hill, institutional review board for human rights protection.

Target Population

The target population was rural African American women who were infected with HIV

Results

Participants were between 30 and 64 years of age, had 1 to 11 children, had 10 to 15 years of education, and had limited incomes. Table 1 summarizes demographic data of the sample. All women identified themselves as Black or African American and heterosexual. Participants had been living with HIV from 3 to 14 years at the time of the interviews. All of the women identified their exposures as sexual contact with a man or men, some of whom were injection drug users or had been having sex with

Discussion

The results from this exploratory study, suggesting that a number of important factors influence sexual risk taking among African American women, require attention. Not the least of these factors are continuing pervasive assumptions that only those women engaging in multiple risk-taking behaviors are at risk for HIV infection. The majority of the women in this study contracted HIV while in a monogamous relationship with a man they trusted to protect them from harm. In many ways these women are,

Implications for Nursing Research

There is mounting evidence that sexual decision making among African American women is a complex process influenced by many factors. The current study calls into question the use of the monogamy model as a reasonable protection for rural African American women living in the southeast United States. Future research with this population needs to proceed in the direction of intervention development. To date, there are no published studies that specifically address intervention development for this

Caroline Mallory, PhD, RN, is an associate professor at Mennonite College of Nursing, Illinois State University, Normal, Illinois.

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    Caroline Mallory, PhD, RN, is an associate professor at Mennonite College of Nursing, Illinois State University, Normal, Illinois.

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