Skip to main content

Advertisement

Log in

Understanding HIV-Related Stigma Among Women in the Southern United States: A Literature Review

  • Substantive Review
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

Societal stigmatization of HIV/AIDS due to assumptions about transmission and associated behaviors plays a substantial role in the psychosocial well-being of people living with this chronic illness, particularly for women in traditionally conservative geographic regions. Known for social conservatism, the Southern United States (US) holds the highest incidence rate of HIV infection in the US. A systematic search of four databases was used to identify 27 relevant scientific articles pertaining to HIV-related stigma among women living with HIV/AIDS in the Southern US. These studies revealed a rudimentary understanding of stigma sources, effects, and stigma-reduction interventions in this population. Due to the cultural specificity of stigma, further differentiation of stigma in discrete sectors of the South as well as a dialogue about the moral implications of stigma is necessary to lay the groundwork for patient-centered interventions to mitigate the destructive effects of stigma experienced by women in this region.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Goffman E. Stigma: notes on the management of spoiled identity. London: Penguin Books; 1963.

    Google Scholar 

  2. Earnshaw V, Chaudoir S. From conceptualizing to measuring HIV stigma: a review of HIV stigma mechanism measures. AIDS Behav. 2009;13(6):1160–77.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Berger BE, Ferrans CE, Lashley FR. Measuring stigma in people with HIV: psychometric assessment of the HIV stigma scale. Res Nurs Health. 2001;24(6):518–29.

    Article  CAS  PubMed  Google Scholar 

  4. Colbert AM, Kim KH, Sereika SM, Erlen JA. An examination of the relationships among gender, health status, social support, and HIV-related stigma. J Assoc Nurs AIDS Care. 2010;21(4):302–13.

    Article  Google Scholar 

  5. Sandelowski M, Lambe C, Barroso J. Stigma in HIV-positive women. J Nurs Scholarsh. 2004;36(2):122–8.

    Article  PubMed  Google Scholar 

  6. Bunting SM. Sources of stigma associated with women with HIV. ANS Adv Nurs Sci. 1996;19(2):64–73.

    Article  CAS  PubMed  Google Scholar 

  7. Ogden J, Nyblade L. Common at its core: HIV-related stigma across contexts. International Center for Research on Women; 2005.

  8. Liamputtong P. Stigma, discrimination, and living with HIV/AIDS: a cross-cultural perspective. Dordrecht: Springer Science + Business Media; 2013.

    Book  Google Scholar 

  9. Baunach DM, Burgess EO. HIV/AIDS prejudice in the American deep south. Sociol Spectr. 2013;33(2):175–95.

    Article  Google Scholar 

  10. Reif SS, Whetten K, Wilson ER, McAllaster C, Pence BW, Legrand S, et al. HIV/AIDS in the Southern USA: a disproportionate epidemic. AIDS Care. 2014;26(3):351–9.

    Article  PubMed  Google Scholar 

  11. US Census Bureau: Annual Estimates of the Resident Population: April 1, 2010 to July 1, 2014. 2014.

  12. Center for Disease Control & Prevention. Diagnoses of HIV infection in the United States and dependent areas, 2014. HIV Surveillance Report 2015;26.

  13. Reif S, Geonnotti KL, Whetten K. HIV Infection and AIDS in the Deep South. Am J Public Health. 2006;96(6):970–3.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Center for Disease Control & Prevention. HIV among women: fast facts 2014. Available from: http://www.cdc.gov/hiv/pdf/risk_women.pdf. Accessed 2016 June 10.

  15. Fleming PL, Lansky A, Lee LM, Nakashima AK. The epidemiology of HIV/AIDS in women in the Southern United States. Sex Transm Dis. 2006;33(7 Suppl):S32–8.

    Article  PubMed  Google Scholar 

  16. Hall HI, Li J, McKenna MT. HIV in predominantly rural areas of the United States. J Rural Health. 2005;21(3):245–53.

    Article  PubMed  Google Scholar 

  17. Lichtenstein B. Domestic violence, sexual ownership, and HIV risk in women in the American deep south. Soc Sci Med. 2005;60:701–14.

    Article  PubMed  Google Scholar 

  18. Sowell R, Seals B, Moneyham L, Guillory J, Mizuno Y. Experiences of violence in HIV-seropositive women in the south-eastern United States of America. J Adv Nurs. 1999;30(3):606–15.

    Article  CAS  PubMed  Google Scholar 

  19. Carr RL, Gramling LF. Stigma: a health barrier for women with HIV/AIDS. J Assoc Nurs AIDS Care. 2004;15(5):30–9.

    Article  Google Scholar 

  20. Muturi N, An S. HIV/AIDS stigma and religiosity among African American women. J Health Commun. 2010;15(4):388–401.

    Article  PubMed  Google Scholar 

  21. Stringer KL, Turan B, McCormick L, Durojaiye M, Nyblade L, Kempf MC, et al. HIV-related stigma among healthcare providers in the Deep South. AIDS Behav. 2015;20(1):115–25.

    Article  Google Scholar 

  22. Neal TM, Lichtenstein B, Brodsky SL. Clinical implications of stigma in HIV/AIDS and other sexually transmitted infections. Int J STD AIDS. 2010;21(3):158–60.

    Article  CAS  PubMed  Google Scholar 

  23. Nyblade L, Stangl A, Weiss E, Ashburn K. Combating HIV stigma in health care settings: what works? J Int AIDS Soc. 2009;12:15.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Sowell RL, Seals BF, Phillips KD, Julious CH. Disclosure of HIV infection: how do women decide to tell? Health Educ Res. 2003;18:32–44.

    Article  CAS  PubMed  Google Scholar 

  25. Clum G, Chung S-E, Ellen JM. The adolescent medicine trials network for HIVAI. Mediators of HIV-related stigma and risk behavior in HIV infected young women. AIDS Care. 2009;21(11):1455–62.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Audet CM, McGowan CC, Wallston KA, Kipp AM. Relationship between HIV stigma and self-isolation among people living with HIV in Tennessee. PLoS One. 2013;8(8):e69564.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Tyer-Viola LA, Corless IB, Webel A, Reid P, Sullivan KM, Nichols P. Predictors of medication adherence among HIV-positive women in North America. J Obstet Gynecol Neonatal Nurs. 2014;43(2):168–78.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Turan B, Smith W, Cohen MH, Wilson TE, Adimora AA, Merenstein D, Adedimeji A, Wentz EL, Foster AG, Metsch L, Tien PC, Weiser SD, Turan JM. Mechanisms for the negative effects of internalized HIV-related stigma on ART adherence in women: the mediating roles of social isolation and depression. J Acquir Immune Defic Syndr. 2016;72(2):198–205.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Teti M, Bowleg L, Lloyd L. ‘Pain on top of pain, hurtness on top of hurtness’: social discrimination, psychological well-being, and sexual risk among women living with HIV/AIDS. Int J Sex Health. 2010;22:205–18.

    Article  Google Scholar 

  30. Craft SM, Delaney RO, Bautista DT, Serovich JM. Pregnancy decisions among women with HIV. AIDS Behav. 2007;11(6):927–35.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Kirshenbaum SB, Hirky AE, Correale J, Goldstein TB, Johnson MO, Rotheram-Borus MJ, et al. “Throwing the dice”: pregnancy decision-making among HIV-positive women in four U.S. cities. Perspect Sex Reprod Health. 2004;36(3):106–13.

    Article  PubMed  Google Scholar 

  32. Cuca YP, Rose CD. Social stigma and childbearing for women living with HIV/AIDS. Qual Health Res. 2015. [Epub ahead of print].

  33. Peltzer JN, Domian EW, Teel CS. Infected lives: lived experiences of young African American HIV-positive women. West J Nurs Res. 2016;38(2):216–30.

    Article  PubMed  Google Scholar 

  34. Greene SMP, Ion AM, Kwaramba G, Smith S. Loutfy MRMFM. “Why are you pregnant? What were you thinking?”: how women navigate experiences of HIV-related stigma in medical settings during pregnancy and birth. Social Work Health Care. 2015;55:1–20.

    Google Scholar 

  35. Cook JE, Purdie-Vaughns V, Meyer IH, Busch JT. Intervening within and across levels: a multilevel approach to stigma and public health. Soc Sci Med. 2014;103:101–9.

    Article  PubMed  Google Scholar 

  36. US Census Bureau: Geographic Terms and Concepts-Census Divisions and Census Regions. 2014.

  37. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Int Med. 2009;151(4):264–9.

    Article  PubMed  Google Scholar 

  38. Sowell RL, Lowenstein A, Moneyham L, Demi A, Mizuno Y, Seals BF. Resources, stigma, and patterns of disclosure in rural women with HIV infection. Public Health Nurs. 1997;14:302–12.

    Article  CAS  PubMed  Google Scholar 

  39. Wingood GM, Diclemente RJ, Mikhail I, McCree DH, Davies SL, Hardin JW, et al. HIV discrimination and the health of women living with HIV. Women Health. 2007;46(2–3):99–112.

    Article  PubMed  Google Scholar 

  40. Blake BJ, Jones Taylor GA, Reid P, Kosowski M. Experiences of women in obtaining human immunodeficiency virus testing and healthcare services. J Am Acad Nurse Pract. 2008;20(1):40–6.

    Article  PubMed  Google Scholar 

  41. Black BP, Miles MS. Calculating the risks and benefits of disclosure in African American women who have HIV. J Obstet Gynecol Neonatal Nurs. 2002;31(6):688–97.

    Article  PubMed  Google Scholar 

  42. Melton ML. Sex, lies, and stereotypes: HIV positive Black women’s perspectives on HIV stigma and the need for public policy as HIV/AIDS prevention intervention. Race Gend Class. 2011;18:295–313.

    Google Scholar 

  43. Ingram D, Hutchinson SA. Defensive mothering in HIV-positive mothers. Qual Health Res. 1999;9:243–58.

    Article  CAS  PubMed  Google Scholar 

  44. Ingram D, Hutchinson SA. HIV-positive mothers and stigma. Health Care Women Int. 1999;20:93–103.

    Article  CAS  PubMed  Google Scholar 

  45. Ingram D, Hutchinson SA. Double binds and the reproductive and mothering experiences of HIV-positive women. Qual Health Res. 2000;10:117–32.

    Article  CAS  PubMed  Google Scholar 

  46. Buchberg MK, Fletcher FE, Vidrine DJ, Levison J, Peters MY, Hardwicke R, Yu X, Bell TK. A mixed-methods approach to understanding barriers to postpartum retention in care among low-income, HIV-infected women. AIDS Patient Care STDs. 2015;29:126–32.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Boehme AK, Moneyham L, McLeod J, Walcott MW, Wright L, Seal P, et al. HIV-infected women’s relationships with their health care providers in the rural deep south: an exploratory study. Health Care Women Int. 2012;33(4):403–19.

    Article  PubMed  Google Scholar 

  48. Edwards LV. Perceived social support and HIV/AIDS medication adherence among African American women. Qual Health Res. 2006;16(5):679–91.

    Article  PubMed  Google Scholar 

  49. Grodensky CA, Golin CE, Jones C, Mamo M, Dennis AC, Abernethy MG, et al. “I should know better”: the roles of relationships, spirituality, disclosure, stigma, and shame for older women living with HIV seeking support in the South. J Assoc Nurs AIDS Care. 2015;26(1):12–23.

    Article  Google Scholar 

  50. Kempf M, McLeod J, Boehme AK, Walcott MW, Wright L, Seal P, et al. A qualitative study of the barriers and facilitators to retention-in-care among HIV-positive women in the rural Southeastern United States: implications for targeted interventions. AIDS Patient Care STDS. 2010;24(8):515–20.

    Article  PubMed  Google Scholar 

  51. Moneyham L, Seals B, Demi A, Sowell R, Cohen L, Guillory J. Perceptions of stigma in women infected with HIV. AIDS Patient Care STDS. 1996;10(3):162–7.

    Article  CAS  PubMed  Google Scholar 

  52. Phillips KD, Moneyham L, Thomas SP, Gunther M, Vyavaharkar M. Social context of rural Women with HIV/AIDS. Issues Ment Health Nurs. 2011;32(6):374–81.

    Article  PubMed  Google Scholar 

  53. Relf MV, Williams M, Barroso J. Voices of women facing HIV-related stigma in the Deep South. J Psychosoc Nurs Ment Health Serv. 2015;53:1–9.

    Article  Google Scholar 

  54. Vyavaharkar MV, Moneyham L, Corwin S. Health care utilization: the experiences of rural HIV-positive African American women. J Health Care Poor Unders. 2008;19(1):294–306.

    Article  Google Scholar 

  55. Walcott M, Kempf MC, Merlin JS, Turan JM. Structural community factors and sub-optimal engagement in HIV care among low-income women in the Deep South of the USA. Cult Health Sex. 2015;18:1–13.

    Google Scholar 

  56. Przybyla SM, Golin CE, Widman L, Grodensky CA, Earp JA, Suchindran C. Serostatus disclosure to sexual partners among people living with HIV: examining the roles of partner characteristics and stigma. AIDS Care. 2013;25(5):566–72.

    Article  PubMed  Google Scholar 

  57. Sowell RL, Seals BF, Moneyham L, Demi A, Cohen L, Brake S. Quality of life in HIV-infected women in the south-eastern United States. AIDS Care. 1997;9:501–12.

    Article  CAS  PubMed  Google Scholar 

  58. Clark HJ, Lindner G, Armistead L, Austin BJ. Stigma, disclosure, and psychological functioning among HIV-infected and non-infected African-American women. Women Health. 2003;38:57–71.

    Article  PubMed  Google Scholar 

  59. McCoy K, Higgins M, Zuniga JA, Holstad MM. Age, stigma, adherence and clinical indicators in HIV-infected women. HIV/AIDS Res Treat. 2015;2015(SE3):S1–8.

    PubMed  PubMed Central  Google Scholar 

  60. Vyavaharkar M, Moneyham L, Corwin S, Saunders R, Annang L, Tavakoli A. Relationships between stigma, social support, and depression in HIV-infected African American women living in the rural Southeastern United States. J Assoc Nurs AIDS Care. 2010;21(2):144–52.

    Article  Google Scholar 

  61. Vyavaharkar M, Moneyham L, Murdaugh C, Tavakoli A. Factors associated with quality of life among rural women with HIV disease. AIDS Behav. 2012;16(2):295–303.

    Article  PubMed  Google Scholar 

  62. Barroso J, Relf MV, Williams MS, Arscott J, Moore ED, Caiola C, et al. A randomized controlled trial of the efficacy of a stigma reduction intervention for HIV-infected women in the Deep South. AIDS Patient Care STDS. 2014;28(9):489–98.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Relf MV, Silva SG, Williams MS, Moore E, Arscott J, Caiola C, Barroso J. Feasibility of using an iPod touch device and acceptability of a stigma reduction intervention with HIV-infected women in the Deep South. AIDS Behav. 2015;19:1896–904.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Lennon-Dearing R. The benefits of women-only HIV support groups. J HIV AIDS Soc Serv. 2008;7(1):27–45.

    Article  Google Scholar 

  65. Caiola C, Docherty SL, Relf M, Barroso J. Using an intersectional approach to study the impact of social determinants of health for African American mothers living with HIV. ANS Adv Nurs Sci. 2014;37(4):287–98.

    Article  PubMed  PubMed Central  Google Scholar 

  66. Shayne VT, Kaplan BJ. Double victims: poor women and AIDS. Women Health. 1991;17(1):21–37.

    Article  CAS  PubMed  Google Scholar 

  67. Malcolm SE, Ng JJ, Rosen RK, Stone VE. An examination of HIV/AIDS patients who have excellent adherence to HAART. AIDS Care. 2003;15:251–61.

    Article  CAS  PubMed  Google Scholar 

  68. Preau M, Leport C, Salmon-Ceron D, Carrieri P, Portier H, Chene G, et al. Health-related quality of life and patient-provider relationships in HIV-infected patients during the first three years after starting PI-containing antiretroviral treatment. AIDS Care. 2004;16(5):649–61.

    Article  CAS  PubMed  Google Scholar 

  69. Whetten K, Reif S, Lowe K, Eldred L. Gender differences in knowledge and perceptions of HIV resources among individuals living with HIV in the Southeast. South Med J. 2004;97:342–9.

    Article  PubMed  Google Scholar 

  70. Squires KE, Hodder SL, Feinberg J, Bridge DA, Abrams S, Storfer SP, et al. Health needs of HIV-infected women in the United States: insights from the women living positive survey. AIDS Patient Care STDS. 2011;25(5):279–85.

    Article  PubMed  PubMed Central  Google Scholar 

  71. MacCarthy S, Rasanathan JJK, Ferguson L, Gruskin S. The pregnancy decisions of HIV-positive women: the state of knowledge and way forward. Reprod Health Matters. 2012;20(39):119–40.

    Article  PubMed  Google Scholar 

  72. Kleinman A, Hall-Clifford R. Stigma: a social, cultural, and moral process. J Epidemiol Commun Health. 2009;63:418–9.

    Article  Google Scholar 

Download references

Acknowledgments

The first author would like to acknowledge the Chancellor’s Honors Program and the Nursing Honors Program at the University of Tennessee, Knoxville.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Caroline K. Darlington.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed Consent

For this type of study formal consent is not required.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Darlington, C.K., Hutson, S.P. Understanding HIV-Related Stigma Among Women in the Southern United States: A Literature Review. AIDS Behav 21, 12–26 (2017). https://doi.org/10.1007/s10461-016-1504-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-016-1504-9

Keywords

Navigation