Using narratives to explore the role of gender-based violence and inequality on the reproductive health and disease status of HIV+ African immigrant women

The United Nations Population Fund has identified gender inequality and gender-based violence as two of the main threats to women's reproductive health. In fact, researchers have estimated that between one quarter and one half of all women with sexually transmitted infections, including HIV, have abusive partners. Given the pervasiveness and far-reaching effects of these phenomena, it is essential to take steps to mitigate the possible negative consequences on women's reproductive health, including HIV status. This exploratory qualitative research study was designed to gain further insight into the contextual factors and personal experiences of HIV positive African immigrant women, with the goal of informing the development of contextually-tailored HIV risk reduction strategies. This study, guided by a theoretical framework based on Feminist Theory, Critical Race Theory and the Theory of Gender and Power, utilized in-depth interviews with six HIV positive African immigrant women. Narrative analysis was used to explore the women's narratives on the role of gender-based violence and inequality on their disease status. The main overarching theme revealed in the women's narratives was that marriage is a vulnerable status that can actually put women at risk for contracting HIV. This vulnerability is based on social norms that state once women are married, they: 1) should not say "No" to sex with their husbands, 2) should not ask their husbands to use a condom, and 3) should not divorce husbands for having concurrent sexual partners. The women's narratives showed how the gender norms and decision-making process they observed in their families of origin, and in the larger community, affect their sexual decision making in their intimate relationships. Their narratives also introduced us to their experiences of sexual, physical and emotional abuse, as well as physical and emotional neglect. Finally, listening to the narratives of HIV positive African immigrant women educated us on the stigma and silence around HIV in their community, in addition to paving the way for recommendations on preventing the spread of HIV in their communities in the United States, as well as abroad. Implications for social work practice and policy, as well as future research are discussed.