title: Experiences with HIV testing, entry, and engagement in care by HIV-infected women of color, and the need for autonomy, competency, and relatedness.
abstract: Self-determination theory examines the needs of people adopting new behaviors but has not been applied to the adoption of HIV healthcare behaviors. The current study applied self-determination theory to descriptions of healthcare behaviors adopted by ethnic minority women after an HIV diagnosis. Women of color were asked to describe their experiences with HIV testing, entry, and engagement-in-care in qualitative interviews and focus groups. Participants were mostly African-American (88%), over 40 years old (70%), had been diagnosed for more than 6 years (87%) and had disclosed their HIV infection to more than 3 people (73%). Women described unmet self-determination needs at different time points along the HIV Continuum of Care. Women experienced a significant loss of autonomy at the time of HIV diagnosis. Meeting competency and relatedness needs assisted women in entry and engagement-in-care. However, re-establishing autonomy was a key element for long-term engagement-in-care. Interventions that satisfy these needs at the optimal time point in care could improve diagnosis, entry-to-care, and retention-in-care for women living with HIV.
authors.affiliation: Institute for Global Health & Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA. ebq@med.unc.edu
authors.forename: E Byrd
authors.initials: EB
authors.lastname: Quinlivan
authors.forename: Lynne C
authors.initials: LC
authors.lastname: Messer
authors.forename: Adaora A
authors.initials: AA
authors.lastname: Adimora
authors.forename: Katya
authors.initials: K
authors.lastname: Roytburd
authors.forename: Natasha
authors.initials: N
authors.lastname: Bowditch
authors.forename: Heather
authors.initials: H
authors.lastname: Parnell
authors.forename: Julia
authors.initials: J
authors.lastname: Seay
authors.forename: Lynda
authors.initials: L
authors.lastname: Bell
authors.forename: Jonah K
authors.initials: JK
authors.lastname: Pierce
mesh_terms: D000328:Adult; D000368:Aged; D003266:Continuity of Patient Care; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000208:ethnology* / Q000523:psychology / Q000628:therapy; D006301:Health Services Needs and Demand; D054625:Healthcare Disparities; D006801:Humans; D007407:Interviews as Topic; D008403:Mass Screening; D008875:Middle Aged; D008913:Minority Groups; D010342:Patient Acceptance of Health Care; D026684:Personal Autonomy; D011369:Professional-Patient Relations; D036301:Qualitative Research; D020377:Self Efficacy; D012959:Socioeconomic Factors; D055815:Young Adult