Original Article
Communication Between Middle SES Black Women and Healthcare Providers About HIV Testing

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Abstract

Purpose

This article explores the impact of patient and healthcare provider communication (PPC) on the HIV testing behaviors of middle socioeconomic status (SES) Black women in North Carolina. We explore how PPC about STIs and HIV (or the lack thereof) affects the provision of STI/HIV testing by either confirming the need for middle SES Black women to test routinely or potentially deterring women from feeling they need to be tested.

Methods/Findings

After conducting 15 qualitative interviews with middle SES Black women between 25 and 45 years of age, we uncovered the role of patient self-advocacy in promoting HIV testing among middle SES Black women when they communicate with their healthcare providers.

Conclusions

We discuss the importance of healthcare providers engaging their middle SES Black female patients in routine discussions about sexual health and sexual risk reduction, regardless of providers' perceptions of their potential STI/HIV risk. We recommend including SES as a variable in data collection and research in order to better understand how social class, race, and gender affect sexual health behavior and the provision of STI and HIV/AIDS prevention to diverse populations.

Introduction

The Centers for Disease Control and Prevention (CDC) recommends voluntary routine HIV testing of all patients ages 13–64 as part of standard medical care in healthcare settings.1 In 2012, the CDC reported that 31% of adult Black people had never been tested and more than 70% reported not being offered an HIV test by their healthcare provider.2 For Black women, the issue of testing is particularly critical given the racial disparities in rates of HIV infection among women. In 2010, Black women accounted for 64% of HIV cases among women, such that the rate of HIV infection in the United States was 40.0 per 100,000 among Black women compared to 2.0 per 100,000 among White women.3, 4 While there are pronounced racial and gender disparities in HIV rates, there is currently very little literature that examines HIV incidence and prevalence by SES within racial and gender groups. In particular, the experiences of middle SES Black women have been largely overlooked in HIV/AIDS surveillance data as well as in HIV research and prevention efforts. Instead, most of the literature on HIV prevention and testing among Black women examines women of low SES.3, 4, 5 Given the growing emphasis on routine HIV testing, it is important and timely to examine HIV testing and prevention in the Black community as they relate to gender and SES.

Section snippets

Data collection

Data was collected as part of an exploratory qualitative pilot study titled Sister Circle: Black Women Talking about Health, Sexual, and Relationship Experiences.6 This pilot study used a phenomenological approach7 to examine HIV testing behavior as well as perceived and actual HIV risk among middle SES Black women in North Carolina. In this study we used personal income and education, as well as occupation, to define middle SES and also included these variables as inclusion criteria. We

HIV testing and HIV incidence

The measurement of HIV incidence is dependent on the reporting of HIV diagnosis, which is also dependent on HIV testing rates.10 In order for the estimates of HIV incidence to be accurate, HIV testing must be performed as recommended by the CDC. The routine nature of these recommendations allows HIV incidence estimates to be calculated based on the date of the first HIV antibody positive test, date of the most recent HIV antibody negative test, and number of negative HIV tests in the two years

Sample

Fifteen women participated in semi-structured interviews. Their mean age was 34.7 years (range 26–45). Their occupations ranged broadly and included law enforcement officers, educators, counselors, graduate students, and human resources managers.

HIV testing

All of the research participants had been tested for HIV, which was not a requirement for study participation and is therefore a noteworthy finding. Although all of the participants had been tested for HIV, there was variation in frequency of HIV

Discussion

By focusing on middle SES Black women, this study provides new insights about a sub-population that is important but often overlooked in the fight against HIV/AIDS. One key finding from this analysis is that all of the women in our sample had been tested for HIV in the past. This finding is one that has been confirmed by previous research, including Rountree, Chen, Brown, and Pomeroy's analysis of the 2005 Behavioral Risk Factor Surveillance Survey (BRFSS), which found that African Americans

Implications for research and practice

This study highlights the importance of assessing how socioeconomic status affects sexual health and HIV prevention for diverse populations. It is also important for researchers and health professionals to recognize how SES interacts with other identity categories, such as race, gender, and sexuality. Future research should explore how PPC influences effective STI/HIV testing for different population groups. As noted in this article, middle SES individuals may often be viewed having lower risk

Acknowledgements

This research was funded in part by a 2011 developmental grant from the UNC Center for AIDS Research (CFAR), an NIH funded program P30 AI50410. There are no employment, appointments or financial arrangements that are a conflict of interest. Niasha A. Fray, MA, MSPH had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. This study has also received support from the American Psychological Association's Cyber

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