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Infection Prevention

How does intersectionality impact the quality of healthcare services for Black women living with HIV?

11 January 2024
Patient Experience
02 January 2024
Volume 33 · Issue 1

Abstract

Women with HIV are affected more than men by intersecting discriminations. For Black women, additional discrimination can have a detrimental effect on their HIV care. An extended literature review of primary research studies was undertaken to explore the issues and the impact of intersectionality on Black women with HIV. Electronic databases were searched for studies published since antiretroviral treatment became recognised to be effective, and eight studies met detailed inclusion and exclusion criteria. Critical appraisal led to the identification of three themes: discrimination; stigmatisation; and racism. The findings suggest that while Black women with HIV reported barriers to health care because of intersectionality, older women who felt confident in their self-identity were more able to cope with issues around this. Knowledge of the factors affecting these women will enable health professionals to deliver person-centred care.

The HIV epidemic has been present for over four decades but stigmatisation and discrimination continue to challenge the public health sector and remain active in all cultures (Shefer et al, 2013; Marsicano et al, 2014). Women of sub-Saharan African descent continue to dominate new HIV infection rates out of all ethnicities. New diagnoses for Black women living with HIV (BWLWH) have fallen over the past 10 years but, collectively, Black women in the UK were disproportionately represented in 2021, with 42.8% Black African, 3.65% Black Caribbean and 3.14% in the category of Black other accounting for new diagnoses (UK Heath Security Agency, 2022). By the end of 2022, sub-Saharan African women accounted for 63% of all cases of HIV in eastern and southern Africa (UNAIDS, 2023).

BWLWH are affected by intersectionality. Intersectionality is a way of comprehending social relations by examining forms of discrimination that overlap (Jackson-Best and Edwards, 2018). This means acknowledging complicated social systems such as racism, sexism, class discrimination and ageism, all of which can be present at the same time in an individual's life.

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Black women
HIV
Intersectionality
Discrimination
Racism
Stigma