Abstract: Applying Intersectionality to Address Social Contextual Influence on Health Behavior related to PrEP for HIV prevention

◆ Yangsun Hong, University of New Mexico

A majority of research in health communication focuses on studying personalistic, cognitive, and motivational precursors of health behavior (Dutta-Bergman, 2005; Lupton, 1994; Viswanath & Emmons, 2006). However, health is not only shaped by agency such as efficacy and lifestyle choices, but it is also influenced by the social, structural factors (Cockerham, 2005; Rütten & Gelius, 2011). Health behaviors are constrained or facilitated by structural environment, which creates social contexts and life experiences that may make health prevention too expensive, difficult, or impossible to reach for some groups of people – but not for other groups – by limiting experiences, supportive context, access to resources, and knowledge. Health behavior should be understood in consideration of the social context where health inequalities are produced and reproduced (Emmons, 2000; Frohlich & Potvin, 2010).

This study argues that health communication would magnify the effectiveness if it pays attention to social-structural context particularly when studying health of minorities. Intersectionality (Crenshaw, 1991) offers a useful framework that addresses the ways in which intersecting systems of oppression and power produce health inequalities for people with marginalized positions (Bowleg, 2008). Considering intersectionality as a framework, this study proposes the social process model of health behavior that demonstrates social contextual processes in which individuals with intersectional marginalization are disempowered in ways that matter to their health behavior.

This interdisciplinary study aims to propose and test the mechanisms through which individuals’ social locations influence their health behavior by constructing social context related to health behavior. Based on theoretical integration of models in multiple disciplines, I specify and test a multilevel health behavior model in the context of a new HIV prevention method (i.e., PrEP) for women with HIV risk. The social process model of health behavior focuses on how disadvantaged social experiences of groups with multiple marginalization, in terms of race, gender, and socioeconomic status, influence social contextual and psychosocial predictors of health behavior. The model also explores how state-level structural support influences the mechanisms.

I surveyed low income Black women living in Washington, D.C. and Atlanta, and found that experiences of discrimination as an upstream societal factor constrains chances to build and maintain social contextual opportunities to have social connections to communicate health information, to have trust in medical services, and obtain social support. Thus, experience of discrimination links one’s marginalized social positioning and their social contextual conditions that affect adoption of health behavior. Moreover, state-level policy support for marginalized groups (i.e., Washington, D.C., vs Atlanta, GA) contributes to social contextual factors and psychosocial predictors of behavioral intention for PrEP information seeking.

This study identifies that social contextual factors, which can be modified by health communication intervention to promote health behavior. This study found that talking about health with others positively affects PrEP awareness, perceived norms about PrEP uptake, and self-efficacy, which are predictors of behavior. Based on these findings, this study proposes a strategy for social-structural intervention that reduces social barriers, such as lack of awareness and negative social norms.