Rural Women with HIV and AIDS: Perceptions of Service Accessibility, Psychosocial, and Mental Health Counseling Needs. (Research)

Article excerpt

Women, particularly minority women, are becoming infected with HIV in increasing numbers. Women report feeling socially isolated and have a greater caregiving burden than do men. Rural women in particular may face greater stigma and a more limited accessibility to health services. This study examined rural women with HIV and AIDS and the staff members who work with them, using a qualitative design. Interviews and observations were conducted, and documents were collected as well. Results of the study revealed (a) barriers to these women regarding the accessibility of services, including mental health counseling; (b) a need to empower these women to be proactive in their health care; (c) a stronger social support system and sense of hope in women identified as doing well; (d) a better quality of life may be obtained with protease inhibitors; and (e) empowerment may accrue through support groups.


Human Immunodeficiency Virus (HIV), originally identified in the United States in 1981, was thought to exclusively affect gay men. Since that time, women have contracted HIV and AIDS in ever increasing numbers. Minority women appear to be especially vulnerable; for instance, 45% of women infected with HIV are women of color, primarily African American and Hispanic (Centers for Disease Control, 1998; Kaplan, Marks, & Mertens, 1997); and 57% of all women infected with AIDS are African American (CDC, 1999). Moreover, women die sooner after an AIDS diagnosis than do men (Lea, 1994; Rothenberg et al., 1987). In a disturbing finding, though overall AIDS deaths in the United States in 1996 declined by 15% for men, they increased by 3% for women (Waters, 1997).

The gender differential in AIDS deaths can be attributed to several factors. The decrease in deaths seen in men with AIDS may be due to the advent of antiretroviral medication, which includes protease inhibitors and reverse transcriptase inhibitors. This drug cocktail decreases the HIV viral load in both genders (Morbidity and Mortality Weekly Report, 1998; Notermans et al., 1998). However, U.S. studies indicate that antiretroviral medications are not fully used by HIV-positive women because of limited access, patient or provider knowledge, or attitudes about the treatment (Duerr, 1997). In addition, feminist research suggests that women with HIV/AIDS may use silence as a way to cope when they feel disempowered (DeMarco, Miller, Patsdaughter, Chisolm, & Grindel, 1998). For these women, silence and a lack of self-advocacy could lead to a poor quality of life or early death from the illness. For mothers with HIV/AIDS, this silence can be compounded if they are driven by gender role expectations dictating that they sacrifice their own needs for their children. A mother with HIV/AIDS who ignores her own health to care for her family may very well be hastening an early death from the disease. Miller (1991) noted that if a woman tries to empower herself, she is viewed as selfish, because she is not enhancing the power of others. Travers and Bennett (1996) stated that the lack of power in many areas for women with HIV/AIDS has resulted in isolation, discrimination, and neglect. For some women, however, "a life threatening diagnosis may be the catalyst for rejection of gender-specific norms and thus increased assertiveness" (DeMarco et al., p. 541). One focus of the current study was to examine resiliency in women with HIV/AIDS who seem to cope effectively.

Research relating to women with HIV/AIDS has focused primarily on urban samples. Although a paucity of HIV/AIDS research has been conducted outside of urban settings, recent studies demonstrate an alarming increase in HIV infection rates in rural areas (Heckman, Kelly, Somlai, Kalichman, & Heckman, 1999; McCoy, Metsch, McCoy, & Weatherby, 1999; Zagumny & Holt, 1999). Women in rural areas are becoming HIV infected at higher rates than men, and their willingness to engage in risky sexual behavior underscores the need for prevention efforts. …


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