"Pain on top of pain, hurtness on top of hurtness": Understanding HIV Positive Women's Daily Experiences with Oppression

Background

Social inequities such as race, class, and gender discrimination limit HIV positive women's sexual choices. Current prevention programs, however, posit male condoms as a panacea for women's complex safer sex needs. This study explored how participants in Protect and Respect, a safer sex intervention for women with HIV/AIDS, experienced oppression, to understand better the relationship between oppression and safer sex.

Methods

The primary author transcribed 30 group intervention sessions verbatim; entered the transcripts into Atlas.ti.5.2, a qualitative analysis software package; and employed qualitative analytic strategies of grounded theory and narrative analysis to explore women's experiences with oppression.

Results

The participants included 24 women who were predominantly Black (83%), earned less than $10,000/year (80%), and acquired HIV through sex with a male partner (58%). Oppression manifested in the women's lives in three primary ways: (1) poverty; (2) AIDS related stigma; and (3) unhealthy and violent relationships with men. The experiences were associated with intense suffering and substance use.

Conclusion

Women have fundamental physical and emotional needs that must be met before they can have safer sex. Interventions that focus on condoms only may instruct women to engage in behaviors that are unrealistic in the context of their challenges (e.g., condom use in violent relationships). These findings call for safer sex interventions for women that address the social context of women's risk, promote women's human rights, and integrate strategies to end oppression into traditional prevention programming (i.e., housing or loans as HIV prevention).