Women at Heterosexual Risk for HIV in Inner-City New York: Reaching the Hard to Reach

Abstract

To develop an HIV prevention program for inner-city women at high risk for HIV heterosexual transmission, we conducted ethnographically informed, individual and focus-group interviews, with key participants, service providers, informal gatekeepers, and project staff—to elicit normative values, relationship contexts, and daily pressures, in participants' own terms. The high-risk woman is likely to be a Latina mother, in a long-term, if unstable relationship with a main male partner. Although she may not know it, he is likely to be involved in drug, especially heroin or cocaine, use. She is likely to have a history of alcohol and drug use. Although experience with HIV in people close to her is virtually universal, a sense of personal risk is rare. Experience with condoms or other safer sex, beyond experimentation, is also rare. Women are constrained by norms for male machismo; intense fears of relationship conflict, abandonment, or even violence; discomfort talking about sex; and strivings to have (more) children.