Michigan State University, USA
Title: Interactional health disparities within the context of gender inequities in the Dominican Republic
Pilar S. Horner completed her Ph.D. in 2010 from the University of Michigan and is currently an assistant Professor at Michigan State University. Her research interests include health disparities, HIV/AIDS, substance abuse and qualitative methods. Her research looks at how culture impacts health outcomes for disadvantaged populations.
Gender disparities plague existing intervention and prevention services for HIV/AIDS in the over 57,000 Domincans living with HIV/AIDS. Women face unique social and cultural challenges in the face of their diagnosis. To capture the importance of biosocial interconnections, syndemic theory frames this study "to advance recognition and understanding of adverse health effects arising from connections among epidemic disease clustering, disease interaction, and health and social disparities". A qualitative pilot study was used to gather rich data. Eleven one-on-one interviews were conducted in Spanish, and participant observation with two HIV/AIDS community information sessions (charlas) and on-site trips to villages were conducted in the Dominican Republic. Transcribed data was analyzed in Max QDA. A concentration of multiple health conditions and social inequity verified a syndemic of HIV/AIDS, malnutrition, and neighborhood effects within social inequities. However, significant gender disparities exacerbated by cultural and economic divides disproportionately impacted women. Gender differences appeared in two ways: (1) contextually, (2) cognitive compartmentalization. Individuals divided their experiences which included partner infidelity, machismo, poverty, malnutrition, unsanitary and violent living conditions, but did not link the cumulative effects within environmental and social violence. Multiple health conditions exacerbated by social and economic power inequalities lead to non-integrated approaches to care. Although marginalized health inequalities impacted women, participants rarely recognized the extent to which culture, poverty, and social forces impacted their treatment. Culturally competent prevention and treatment of HIV/AIDS in resource limited countries should consider targeted health care to address gender disparities. A typology is offered for potential intervention strategies.