"No good man will ever want me". How structural social inequality increases women's vulnerability to HIV transmission: a qualitative study from Bandung, Indonesia

Understanding the pathways that expose women to HIV transmission are vital in improving HIV prevention, especially among a "hidden" group of women without pre-established known risk for HIV. We investigated the pathways which place certain women at greater risk for HIV in a qualitative exp...

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Bibliographic Details
Published in:AIDS care 2021-08, Vol.33 (8), p.1016-1023
Main Authors: Rahmalia, Annisa, Pohan, Mawar Nita, Wisaksana, Rudi, Laga, Marie, Peeters Grietens, Koen
Format: Article
Language:English
Subjects:
Abuse
AIDS/HIV
At risk populations
Disease prevention
Disease transmission
Divorce
Health disparities
Health policy
Health risks
High risk
HIV
HIV transmission
HIV vulnerability
Human immunodeficiency virus
Indonesia
Interviews
Midwives
Nurses
Obstetricians
Poverty
Premarital sex
Prevention
Prevention programs
Preventive medicine
Public health
Qualitative research
Risk
Risk behavior
Risk groups
Risk taking
Sex
Sex industry
Sexual abuse
Sexual assault
sexual norms
Sexually transmitted diseases
Social inequality
STD
Urban areas
Urban environments
Women
Womens health
Young women
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Summary:Understanding the pathways that expose women to HIV transmission are vital in improving HIV prevention, especially among a "hidden" group of women without pre-established known risk for HIV. We investigated the pathways which place certain women at greater risk for HIV in a qualitative exploratory study with theoretical sampling using an emergent theory study design in an urban setting in Indonesia. We conducted semi-structured interviews with 47 HIV-infected women, one focus group discussion with five young women who occassionally engage in sex work, participant observation at six sex work venues and two midwife clinics, and 11 informal interviews with midwives, nurses, and obstetricians. Our research found that many women not characterized as belonging to a "high-risk group" or "key population" were nevertheless at increased risk for HIV. A history of sexual abuse, premarital sex, divorce, or involvement in sex work, often precipitated by poverty coupled with discriminatory public health policies further heightened women's exposure to HIV. While reaching at-risk populations is a key strategy in HIV prevention, a novel and more tailored approach is needed to reach more hidden categories of women with less apparent risk behavior yet considerable risk for HIV infection.
ISSN:0954-0121
1360-0451
DOI:10.1080/09540121.2020.1801980