Term of Award

Spring 2018

Degree Name

Doctor of Public Health in Community Health Behavior and Education (Dr.P.H.)

Document Type and Release Option

Dissertation (restricted to Georgia Southern)

Copyright Statement / License for Reuse

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


Jiann-Ping Hsu College of Public Health

Committee Chair

Moya Alfonso

Committee Member 1

Ashley Walker

Committee Member 2

Stacy Smallwood

Committee Member 3


Committee Member 3 Email


Committee Member 4


Committee Member 4 Email



Background: HIV is an emerging health concern worldwide including in the U.S. in 2015, the fourth largest number of all new HIV infections in the U.S. occurred among heterosexual African American women. Stigma is one of the major socio-cultural barriers that impact systems and structures that hinder early diagnosis. Stigma can be based on multiple aspects of one’s’ actual or perceived identity (HIV-positive serostatus) or group membership (race, gender). A key facet missing in HIV-related stigma research is the association between HIV-related stigma and other forms of stigma (e.g. racism, sexism) and their interdependent (intersecting) impact on HIV testing behaviors among African American women. The purpose of this research was to explore the overlapping experiences with HIV-related stigma and other forms of stigma at multiple ecological levels (micro, meso, and macro) to explain their impact on the uptake of HIV testing behaviors. The study also explores coping strategies to overcome stigmatization experiences at micro, meso, and macro levels. Methods: the study was a qualitative investigation using semi-structured in depth face-to-face individual interviews. The participants were recruited purposefully from two rural counties in Florida through flyers over the period of two weeks. The participants included 20 sexually active, English speaking, heterosexual African American women between 18-60 years of age. A $20 Wal-mart gift card was offered to participants for their time and input. Data analysis was done on QSR Nvivo 11 using constant comparative methodology. Results: individual participants described enacted and anticipated mutually constitutive experiences with different forms of stigma at micro (internalized), meso (interpersonal), maco (structural/institutional) levels. Participants across interviews described intersecting experiences of stereotyping and discrimination related to their gender, race and actual or perceived HIV-positive serostatus from self, friends, family, healthcare professionals, employers and housing authorities. Participants also described strategies of coping with intersectional stigma at micro (self-empowerment), meso (support from family and friends), and macro (support from religious and non-religious organizations). Conclusion: participants described mutually constitutive relationships between different marginalized actual or perceived social identities. These intersecting multilevel forms of stigma experiences represent existence of intersectional stigma and its impact on HIV testing behaviors among African American women. The findings of the study can be used to design and develop culturally sensitive and targeted stigma reduction and HIV testing interventions.

Research Data and Supplementary Material