Sexual stigma and symbolic violence experienced, enacted, and counteracted in young Africans’ writing about same-sex attraction

et al. 2020

Int J Equity Health

Background: Persons living with HIV (PLWH) are living longer, although racial/ethnic and socioeconomic status (SES) disparities persist. Yet, little is known about the experience of living with and managing HIV over decades. The present study took a qualitative approach and used the lens of symbolic violence, a type of internalized, nonphysical violence manifested in the power differential between social groups. We focused on adult African American/Black and Latinx (AABL) PLWH from low-SES backgrounds. Methods: Data were drawn from two studies with AABL PLWH in New York City (N = 59). After providing signed informed consent, participants engaged in in-depth semi-structured interviews on aspects of HIV management. Interviews were audio-recorded and professionally transcribed verbatim, and data were analyzed using directed qualitative content analysis. Results: Participants in the two studies were comparable on sociodemographic and background characteristics. They had lived with HIV for 20 years, on average (range 3-33 years). All were from low-SES backgrounds and most were African American/Black and men. Participants experienced a convergence of multiple social exclusions, harms, and stigmas, consistent with symbolic violence, which contributed to disengagement from HIV care and discontinuation of HIV medications. We organized results into five sub-themes: (1) participants were "ground down" over time by material, social, and emotional challenges and this diminished self-worth and, at times, the will to live; (2) social isolation and self-isolation, based in part on feeling devalued and dehumanized, served as stigma-avoidance strategies and mechanisms of social exclusion; (3) stigmatizing aspects of patient-provider interactions, both experienced and anticipated, along with (4) restricted autonomy in HIV care and other settings (e.g., parole) reduced engagement; and (5) poor HIV management was internalized as a personal failure. Importantly, resilience was evident throughout the five sub-themes.

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Understanding long-term HIV survivorship among African American/Black and Latinx persons living with HIV in the United States: a qualitative exploration through the lens of symbolic violence

Freeman¹,

et al. 2020

Int J Equity Health

“…Symbolic violence is a type of internalized, non-physical violence manifested in the power differential between social groups, and it highlights that social interaction occurs in a symbolic framework, created and maintained by society (27,28). Although described in the literature less commonly than other forms of violence, the framework of symbolic violence has proved useful in past public health-related research as a means of examining the ways in which social control is tacitly maintained by shared cultural practices within a given milieu without the use of force or coercion (29)(30)(31)(32).…”

Section: The Importance Of Understanding Symbolic Violencementioning

confidence: 99%

“…As an example, Winskell and colleagues (32) explored symbolic violence among sexual minorities in sub-Saharan Africa. In this context, symbolic violence took the form of internalized sexual stigma and the belief that homosexuality should be condemned and cured.…”

Section: The Importance Of Understanding Symbolic Violencementioning

confidence: 99%

Understanding long-term HIV survivorship among African American/Black and Latinx persons living with HIV in the United States: A qualitative exploration through the lens of symbolic violence

Freeman

et al. 2020

Preprint

Background Persons living with HIV (PLWH) are living longer, although racial/ethnic and socioeconomic status (SES) disparities persist. Yet, little is known about successful HIV management over decades. To address this gap, the present study took a qualitative approach and used the lens of symbolic violence, a type of internalized, non-physical violence manifested in the power differential between social groups. We focused on adult African American/Black and Hispanic/Latinx (AABHL) PLWH from low SES-backgrounds. Methods Data were drawn from two studies with AABHL PLWH in New York City ( N =59). After providing signed informed consent, participants engaged in in-depth semi-structured interviews on aspects of HIV management. Interviews were audio-recorded and professionally transcribed verbatim, and data were analyzed using a systematic content analysis approach. Results Participants in the two studies were comparable on sociodemographic and HIV history characteristics. They had lived with HIV for 20 years, on average (range 3-33 years). All were from low-SES backgrounds and most were African American/Black and men. Participants experienced a convergence of multiple intersecting social exclusions, harms, and stigmas, consistent with symbolic violence, which contributed to disengagement from HIV care and medications. We found five specific sub-themes: (1) material, social, and emotional challenges combined to “grind down” participants over time and diminish self-worth and even, at times, the will to live, (2) social isolation and self-isolation, based in part on feeling devalued and dehumanized, served as both a stigma-avoidance strategy and a mechanism of social exclusion, (3) stigmatizing aspects of patient-provider interactions, both experienced and anticipated, and (4) perceived restricted autonomy in HIV care reduced engagement, and (5) poor HIV management was internalized as a personal failure. Importantly, resilience was also evident throughout the five sub-themes. Conclusions Symbolic violence is a useful framework for understanding the experiences of long-term HIV management/survivorship among AABHL PLWH from low-SES backgrounds. Aspects of symbolic violence are internalized over time (e.g., experiencing devaluation, dehumanization, loss of self-worth, and anticipated stigma), thereby impeding successful HIV management, including because avoiding HIV care and discontinuing HIV medications are primary coping strategies. Study findings have implications for interventions in community and health care settings.

“…Symbolic violence is a type of internalized, non-physical violence manifested in the power differential between social groups, and highlights that social interaction occurs in a symbolic framework, created and maintained by society (27,28). Although less commonly described in the literature compared to other forms of violence, symbolic violence has proved useful in past public health-related research as a means of uncovering the ways in which social control is tacitly maintained by shared cultural practices within a given milieu without the use of force or coercion (29)(30)(31)(32). This paper seeks to add to this literature by examining the experience of HIV management through the lens of symbolic violence to draw attention to the ways in which the social positions of stigmatized individuals and groups, including PLWH, are often experienced as natural and self-evident, which in turn serves to reinforce and often exacerbate various forms of social exclusion and inequality.…”

Section: Integrating a Multi-level Perspective And The Lens Of Symbolmentioning

confidence: 99%

“You don't know my story. You don't know what I've been going through.” A qualitative exploration of HIV survivorship over decades through the lens of symbolic violence

Freeman

et al. 2020

Preprint

Background Persons living with HIV (PLWH) are living longer, although racial/ethnic and socioeconomic status (SES) disparities persist. Yet, little is known about successful HIV management over decades. To address this gap, the present study took a qualitative approach and used the lens of symbolic violence, a type of internalized, non-physical violence manifested in the power differential between social groups. We focused on adult African American/Black and Hispanic/Latinx (AABHL) PLWH from low SES-backgrounds. Methods Data were drawn from two studies with AABHL PLWH in New York City ( N =59). After providing signed informed consent, participants engaged in in-depth semi-structured interviews on aspects of HIV management. Interviews were audio-recorded and professionally transcribed verbatim, and data were analyzed using a systematic content analysis approach. Results Participants in the two studies were comparable on sociodemographic and HIV history characteristics. They had lived with HIV for 20 years, on average (range 3-33 years). All were from low-SES backgrounds and most were African American/Black and men. Participants experienced a convergence of multiple intersecting social exclusions, harms, and stigmas, consistent with symbolic violence, which contributed to disengagement from HIV care and medications. We found five specific sub-themes: (1) material, social, and emotional challenges combined to “grind down” participants over time and diminish self-worth and even, at times, the will to live, (2) social isolation and self-isolation, based in part on feeling devalued and dehumanized, served as both a stigma-avoidance strategy and a mechanism of social exclusion, (3) stigmatizing aspects of patient-provider interactions, both experienced and anticipated, and (4) perceived restricted autonomy in HIV care reduced engagement, and (5) poor HIV management was internalized as a personal failure. Importantly, resilience was also evident throughout the five sub-themes. Conclusions Symbolic violence is a useful framework for understanding the experiences of long-term HIV management/survivorship among AABHL PLWH from low-SES backgrounds. Aspects of symbolic violence are internalized over time (e.g., experiencing devaluation, dehumanization, loss of self-worth, and anticipated stigma), thereby impeding successful HIV management, including because avoiding HIV care and stopping HIV medications are primary coping strategies. Study findings have implications for interventions in community and health care settings.