Cultural Narratives of HIV-Positive African American Women Living in Rural and Urban South Carolina: Place Matters

Background: Rural counties are among the poorest counties, and women living there are limited in their access to care (Phillips, et al., 2011).  For poor women living with HIV/AIDS in rural areas, day-to-day survival may take precedence over HIV management and care (Riley, et al., 2007). Culture-specific interventions demonstrate success, however few have used true culture-centric approaches with African American women. The purpose of this qualitative study is to compare cultural narratives of HIV-positive African American women living in rural and urban areas.

Methods: This qualitative study employed semi-structured individual private interviews with HIV-positive African American women 18 and older (N=25).  Interview guides were developed using a chronological and ecological approach based on grounded theory. Comparative narrative analysis of transcribed interviews from rural (N=9) and urban (N=16) women were conducted through a sensitizing framework of hardships while living with HIV.

Results: While hardships experienced by HIV-positive women living in urban and rural areas were similar, findings suggest contextually greater hardships for women living in rural areas.  Findings reflected instances of isolation, both from family and society, mental health issues such as depression and lack of privacy and confidentiality within community settings for women living in rural areas.

Conclusion: Narratives provide insight into the lives and experiences of HIV-positive African American women and offer greater context into the layered interactions in their lives.  Storytelling using cultural narratives may be effective in HIV social support interventions, especially among women living in rural areas whose access to traditional interventions is limited.