“Let’s Talk About HIV”: Middle Class Black Women’s Self-Advocacy in Patient-Provider Communication

Allison Mathews, our guest blogger, is a doctoral candidate in the Department of Sociology and Humphreys Fellow with the Graduate School at UNC-Chapel Hill. Her dissertation research focuses on the role that Black and gay identity play in Black gay men’s religious choice and participation. Her research interests include race and ethnicity, masculinity and sexuality, religion, and health disparities.

A recent article in The New Yorker entitled, “HIV’s Grip on the American South,” highlighted the devastating and long-term effects that high rates of HIV prevalence have on the American south, and specifically Black Americans. Despite recent findings in HIV/AIDS research that boast medical advances leading to a possible cure, the risk for contracting and dying from the disease is still a heavy burden for Black southerners to bear. In their recent presentation for the IAAR spring 2014 talk series, Kia Lilly Caldwell (Associate Professor, Dept of African, African American and Diaspora Studies, UNC-Chapel Hill) and Niasha Fray (doctoral student, Dept of Health Behavior, UNC-Chapel Hill) take on a new and refreshing perspective to this public health issue by examining the experiences of middle class Black women, who are an often understudied population. They seek to understand how the experiences of middle class Black women living in the southeastern United States engage in conversations with their health care providers around risk and preventive methods for contracting HIV/AIDS. Caldwell and Fray find that participants’ perceptions of their need to self-advocate for HIV/AIDS and STD testing in patient-provider interactions served as a potential pathway to increase testing. However, patients’ self-advocacy was also a reaction to the providers’ hesitance in offering the test. Participants in the study had a perception that their healthcare providers assumed they were not at risk for contracting HIV/AIDS or other STDs because of their middle class status. Thus, they believed health care providers were not as willing to offer Black middle class women HIV/AIDS or STD tests. Importantly, all participants in the study had been tested at one point in their lives and most were likely to get tested while visiting a healthcare provider.

Attendees to the brown-bag presentation actively engaged both speakers after the presentation with questions that extended the discussion. One attendee asked, “Are assumptions of low risk for contracting HIV/AIDS among middle class patients affecting patient-provider communication across the board or is this pattern unique to Blacks?” Caldwell and Fray responded that in general, providers are more likely to assume that middle class patients are not at high risk for contracting HIV/AIDS; however, there is little research to substantiate these assumptions because few statistics examine class differences for HIV/AIDS rates. Additionally, Black Americans are disproportionately affected by the disease, have less access to health care, and often are provided with less effective treatment due to both patient mistrust and provider bias. Thus, it is important to try to find ways to improve patient-provider communication for those disproportionately impacted by the disease, including Black middle class women. Needless to say, the research presented was timely and important for understanding factors that affect patient-provider communication around HIV/AIDS and ways to improve such communication.