Social Determination of HIV: Women’s Relationship Work in the Context of Mass Incarceration and Housing Vulnerability

Abstract

We contrast a typical “social determinants of health” framing with a more dynamic and complex “social determination of health” framing to analyze HIV-related sexual risk among women in low-income, segregated neighborhoods in New Haven, CT. Using an abductive approach, we analyze repeated, longitudinal qualitative interviews conducted over a 2-year period with a sample of 14 HIV-negative women who engaged in sex with men during the study period. Three case studies are presented to demonstrate how behaviors and sexual practices typically described as HIV “risks” can be understood as part of the work of establishing and maintaining monogamous committed relationships, which we call “relationship work,” shaped in a context characterized by housing vulnerabilities and the many manifestations of mass incarceration and the surveillance state. We conclude by suggesting that for these women, their relationship work is the work of HIV prevention and life in low-income segregated neighborhoods is their HIV-related risk.

Ending the HIV epidemic for all, not just some: structural racism as a fundamental but overlooked social-structural determinant of the US HIV epidemic

“…literature base. Third, structural racism and intersectional discrimination -racism and heterosexism in the case of Black sexual minority men[43 …”

Probing the Processes: Longitudinal Qualitative Research on Social Determinants of HIV

“…This, in turn, influenced her potential HIV risk. In this way, and as we elaborate further in the article in this issue [25], for women like Desiree, context and not their behaviors shaped their risk for HIV.…”

“…Second, they facilitated writing of analytical memos. For example, in an analysis of gender and HIV risk, material indexed at the intersection of relationships, HIV, and sex was used to write participant-specific analytical memos related to themes of interest [25]. As noted above, indexing was included as a section in the analytic summaries in the Stigma & Social Cohesion for cross-sectional analysis of specific topics to summarize both inductive and deductive themes at each time point.…”

Disrupting the Systems: Opportunities to Enhance Methodological Approaches to Address Socio-Structural Determinants of HIV and End the Epidemic Through Effective Community Engagement

“…As in other work described in this volume, Blankenship et al pushed the boundaries of our understanding of the social and structural determinants of HIV and how they operate at both a conceptual and methodological level [11]. Their work is framed in a social determination model as opposed to a social determinants model.…”

“…We can look to individuals who have navigated the barriers presented by social determinants and social determinism and ask them which models resonate and whether they have thoughts on what the ideal conceptual or theoretical understanding might entail. Further, while as Blankenship et al [11] detailed, housing, incarceration, and dealing with social surveillance systems are central themes that underscore vulnerability to HIV, there may be other forces that need to be investigated and considered. Community partners and members can offer their perspectives on which forces are pre-eminent and suggest other forces of equal or more significant influence such as violence, gender norms, poverty, or educational access.…”