Being diagnosed with HIV challenges individuals physically, socially, and psychologically, and for most people living with HIV/AIDS (PLHA) in the U.S. occurs in the contexts of lives already burdened by socioeconomic disadvantage and structural racism. Despite these challenges, little research examines the developmental process of psychological adaptation to HIV diagnosis, particularly among high-risk heterosexual (HRH) low-SES PLHA of color. This study, informed by ecological theory and Critical Race Theory uses qualitative methods to address this gap by operationalizing a new multidimensional construct of adaptation comprised of three mutually reinforcing sub-constructs (acceptance, engagement in medical care, disclosure of HIV status), and examining the factors that influence adaptation. Black and Latino adult HRH-PLHA (N = 140) were recruited through peer referral in Brooklyn, NY in 2012-2015. A subset (N = 28) were purposively sampled for maximum variation for in-depth, semi-structured, qualitative interviews on the cognitive/behavioral process of adaptation to HIV diagnosis. Data were analyzed using an Interpretive Phenomenological Analysis. Most participants were male (60.8%); Black (78.6%; [21.4% Latino]); aged 47 years (SD=7.12 years) on average. Most were unemployed (92.9%); lacked basic necessities in the past year (75.0%); had histories of homelessness (71.4%) and incarceration (85.7%); and met criteria for lifetime problematic substance use (78.6%). Analyses revealed a construct of adaptation to HIV diagnosis that is multidimensional, where each sub-construct (acceptance, engagement in medical care, disclosure of HIV status) is an important, albeit not equally influential aspect of adaptation. Rather, acceptance is the foundation of adaptation, and a prerequisite for engagement in medical care and disclosure. Successful adaptation is characterized as a dynamic process where delayed acceptance is common, disclosure is a life-long process, and for some participants, is positively transformative. Finally, findings showed adaptation is influenced by a dynamic interplay of individual-level and contextual factors (i.e. problematic substance use, social support, diagnosis in coercive environments, poverty and its resultant chaos, and the historical legacy of AZT-monotherapy). Implications include a need for interventions that incorporate trauma-informed approaches and that appreciate the pervasive influence of distal contexts (structural racism, poverty) on the lived experience of low-SES HRH-PLHA of color adapting to their HIV diagnosis.
|Advisor:||Gwadz, Marya V., Leonard, Noelle R.|
|Commitee:||Lanier, Yzette, Tamis-LeMonda, Catherine|
|School:||New York University|
|School Location:||United States -- New York|
|Source:||DAI-B 78/10(E), Dissertation Abstracts International|
|Subjects:||Public health, Counseling Psychology, Psychology|
|Keywords:||Acceptance, HIV, Interpretive phenomenological analysis, Poverty, Qualitative methodology, Structural racism|
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