Self-determination among HIV+ women of color – sociodemographic and trauma-related correlates

Background. Women of color (WOC) are disproportionately affected by the HIV epidemic, both in terms of infection and mortality. To benefit from available treatment, HIV+ WOC must acquire healthcare utilization behaviors. Sustaining these health behaviors requires internalized motivation (self-determination) which is dependent on feeling autonomous, connected (related) and competent to act. Here we describe the correlates of self-determination criteria among HIV+ WOC in North Carolina.

Methods. Baseline data were collected from 179 unique (335 total interviews) HIV+ WOC patients at a large university's infectious diseases clinic (April-December, 2010). Interviewers asked validated questions related to self-determination theory constructs (autonomy, relatedness, competency), trauma, psychological abuse and demographics (age, education, employment, insurance status), among others. Linear regression models resulted in beta coefficients (95% confidence intervals for predictors of self-determination constructs.

Results. Approximately one-third of women had less than, high school and more than high school education and 35 percent (%) were more than 50 years old. About 10% were in non-permanent housing and 28% reported some employment. In adjusted models, reported autonomy was inversely associated with psychological abuse, lack of permanent housing and low education, while both relatedness and competency were inversely associated with unemployment, low education, child trauma and psychological abuse.

Conclusion. Autonomy, competence and relatedness needs are described by HIV+ women when recounting HIV testing and engagement experiences. Programs that link women to HIV testing and care may be more successful if self-determination needs are addressed during the orientation of women and the delivery of services.