Literature on the African American family supports the notion of the family as both a source of support and source of stress for women dealing with myriad problems (Belle, 1982; Lindbald-Goldberg, Dukes, & Lasley, 1988; McDoo, 1982; Wilson & Tolson, 1990). Yet, we know little about the experience of African American women living with HIV/AIDS in the context of family. What do African American women perceive as supportive aspects of the black family that help them to better live with HIV/AIDS? In what ways is family viewed as a source of stress when dealing with HIV/AIDS? For social workers to develop and strengthen practice strategies with this population, it is essential to hear the experiences of African American women living with HIV/AIDS in their own voices.
Social support as used in this study refers to interpersonal transactions between individuals that foster positive adjustments when dealing with problems (Baumeister, Roy, & Leary, 1995). Stress as used in this article is based on Monat and Lazarus's (1991) transactional model. According to this framework, an individual is likely to experience stress when he or she evaluates an event as stressful, lacks coping strategies to deal with effects of the stress, and perceives the event to be potentially threatening or blocking toward some goal.
African American Women and HIV/AIDS
African American women, particularly those from low-income urban areas, constitute the largest percentage of AIDS cases among women. Although African American women are 12 percent of women in the United States, they account for more than one-half (55 percent) of AIDS cases among women reported to the Centers for Disease Control and Prevention (CDC, 1999). Although there has been a decline in AIDS cases in other groups, the rate of HIV infection among African American women continues to increase (CDC, 1998). AIDS is the most cited reason for death among African American women between ages 25 and 44 (Dunbar, Mueller, Medina, & Wolf, 1998; Hackl, Somlai, Kelly, & Kalichman, 1997; Marcenko & Samost, 1999). In addition, once diagnosed, African American women do not survive as long as white women (Hernandez & Smith, 1991).
African American women living with HIV/AIDS are likely to be single (Land, 1994). The majority lack a high school degree, are underemployed or unemployed, and are most severely affected by welfare reforms (Quinn, 1993). They are women frequently without health insurance options and often do not have access to health services in their communities. Although women experience discrimination based on gender and socioeconomic status, African American women, and by extension other women of color, must deal with the combined factors of gender, race, and socioeconomic status. "Triple burden" (Quinn) is the term used in the appreciation of African American women's experiences living with HIV/AIDS. Thus, these factors may have an affect on their access to services and to culturally sensitive services.
AIDS is a disease that can affect any family; however, it may pose particular challenges for African American women living with AIDS. Boyd-Franklin and Aleman (1990) noted that many African Americans living with HIV were from families in which AIDS is a "multigenerational family disease." This means parents, children, friends, and other members of the extended family may also be living with AIDS. Richie (1994) pointed out that women of this age group (30s and 40s) may have responsibilities of caring for other family members living with HIV or AIDS, while dealing with the physical and emotional effects of their own disease.
Most research on African American women and HIV/AIDS is on prevention and intervention (Fullilove, Fullilove, Haynes, & Gross, 1990; Kalichman, Kelly, & Hunter, Murphy, & Tyler, 1993; Lewis, Watters, & Human, 1989; Nyamathi, & Lewis, 1991). How African American women experience living with HIV/AIDS is an area in which insufficient research exists. …