Holding On: African American Women Surviving HIV/AIDS

Holding On: African American Women Surviving HIV/AIDS

Holding On: African American Women Surviving HIV/AIDS

Holding On: African American Women Surviving HIV/AIDS


In Holding On anthropologist Alyson O'Daniel analyzes the abstract debates about health policy for the sickest and most vulnerable Americans as well as the services designated to help them by taking readers into the daily lives of poor African American women living with HIV at the advent of the 2006 Treatment Modernization Act. At a time when social support resources were in decline and publicly funded HIV/AIDS care programs were being re-prioritized, women's daily struggles with chronic poverty, drug addiction, mental health, and neighborhood violence influenced women's lives in sometimes unexpected ways.

An ethnographic portrait of HIV-positive black women and their interaction with the U.S. healthcare system, Holding On reveals how gradients of poverty and social difference shape women's health care outcomes and, by extension, women's experience of health policy reform. Set among the realities of poverty, addiction, incarceration, and mental illness, the case studies in Holding On illustrate how subtle details of daily life affect health and how overlooking them when formulating public health policy has fostered social inequality anew and undermined health in a variety of ways.


In 2009 I sat with Lady E. in an HIV/AIDS service organization’s conference room as she described a recent relapse in her recovery from drug addiction. Her hands shook as we talked, perhaps as a result of withdrawal but certainly as an effect of the fear she felt concerning her health and well-being. “I lost my apartment and missed my opportunity for Section 8.1 smoked up all of my Social Security back pay. I was smoking day and night. I was defecating and vomiting. I had smoked so much quality cocaine that it had stripped the membranes in my mouth. So I couldn’t eat. My throat didn’t work. I went nine days with no food. I could put the food in my mouth and chew it up, but I didn’t have enough juices to swallow it. I know all of this was because I was having a pity party.”

As Lady E. recounted the details of her two-week crack binge, I began to wonder how a woman so intimately connected to the local system of public health care could slip through the cracks as quickly as she did. I wondered, too, what it meant that Lady E. considered her relapse as a personal failure. After spending more than a year in the low-income communities of Midway, North Carolina, I knew well the strategies that drug dealers used when looking to hold their consumers captive. Offering a “free taste” had proven particularly effective for sabotaging an overstressed and underserved HIV-positive woman’s recovery plans. I also knew that Section 8 housing was indeed a scarce resource that many women, whose daily life realities were incompatible with policymandated eligibility procedures, lost. Still I was surprised that Lady E. had stumbled on what she described as “the path to wellness.”

Over the course of sixteen months, Lady E. had made dramatic changes . . .

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