Impact of community residence on HIV transmission: Voices from African American women in Massachusetts

Background: Despite gains in HIV prevention and treatment in the last three decades, the HIV/AIDS epidemic continues to disproportionately affect Black/African American women in the United States. To date, there is limited research on the impact of community residence on HIV transmission among Black/African American women.

Methods: Primary data were collected in focus groups with African American women in seven communities across Massachusetts. The study was grounded and analyzed using a socio-ecological theoretical framework. The research was also framed around the concept of intersectionality to describe simultaneous intersections between aspects of social difference and identity, and forms of systematic oppression at the micro and macro levels.

Results: Participants readily identified micro and macro level factors that put women at greater risk for HIV infection. Women were particularly concerned about stigma, men on the down low, intergenerational sexual violence, gender norms, self-esteem, and community level factors as key contributors to HIV transmission. The intersection of systematic and social oppression was identified as a main contributor to HIV transmission. Further, cultural norms were indentified as a main barrier to HIV testing. HIV testing decision-making was highly influenced by interpersonal relationships.

Conclusions: This research provides a richer understanding of factors affecting HIV transmission among women. Participants identified school systems and faith-based organizations as underutilized avenues for HIV prevention in Massachusetts. Participants recommended strengthening parent-child relationships, and female empowerment programs. For policy makers, this research identifies areas that must be harnessed for the prevention of HIV/AIDS.