2012 Theses Doctoral

A Qualitative Examination of HIV-Positive Identity and Vocational Identity Development among Female Adolescents and Young Adults Living with HIV in New York City

Ramjohn, Destiny Quiana Simone

Background: Young Black and Hispanic women living in metropolitan areas in the United States are at a disproportionately high risk for contracting HIV/AIDS; the reasons for this disparity are inadequately explained by research. A recent study reported that African American and Hispanic females represent approximately one-fourth of all U.S. women, yet account for more than three-fourths (79%) of reported AIDS cases among women in the United States (Centers for Disease Control and Prevention Surveillance Report, 2002). Moreover, while the epidemic is alarming and especially pronounced among Black and Hispanic female adolescents and young adults, most of what we know about the illness among young people is based on cross-sectional or longitudinal survey data of high-risk adolescents that are typically not female, but rather gay and bisexual males (up to17%; Rotheram-Borus et al., 2003); injecting drug users (up to 40%) (National Institute on Drug Abuse 1995); and homeless youth (up to 4%) (Stricof, Kennedy, Nattell, Weisfuse, & Novick, 1991). Only a small number of investigations have examined the significant challenges that HIV poses for young women who test positive as they contend with "normal" issues of adolescent development while managing their HIV disease. Accordingly, this exploratory study developed a conceptual framework that integrated multiple disciplines and theoretical concepts pertinent to HIV risk in this population including identity and identity development; family structure and life chances; and theories that describe the influence of social structures on human behavior. Method: This study was based on semi-structured in-depth interview data previously collected from 26 young Black and Latina women (16-24) in the New York City metropolitan area. The methodology involved qualitative analysis of secondary data using an inductive, modified grounded theory approach. Analyses were conducted in two phases. During the first phase, the constant comparative method was employed; open coding followed by structured coding allowed a theoretical pattern to emerge from the data. During the second phase of the analysis, each of the 26 interviews was interpreted based on the theoretical pattern that emerged. Common patterns and processes were identified that supported the interrelationships between constructs posited by the conceptual framework. An alternative identity framework emerged that, through explicit consideration of personal and social factors, contextualized the HIV Identity and Vocational Identity development processes in this population. Findings: A typology of identity development emerged from the analysis of the data, yielding four identity types: Immersers, Withdrawers, Boot-Strappers, and Suspenders. These four identity types were categorized by the socioeconomic and socio-emotional resources they perceived were accessible in their family environments, and the extent to which they had engaged in domain-specific identity explorations. Across all identity types, the HIV diagnosis resulted in what Bury (1982) described as a "biographical disruption." Respondents experienced a loss in their sense of self post-diagnosis - a disruption in their taken-for-granted assumptions that required a rethinking of their personal biographies as well as their social relationships. Participants varied in the ways in which they mobilized existing and sought out new resources or affiliations in light of their illness. Several participants experienced the diagnosis as an assault to their developing identities. As a result, many "gave up" or suspended the identity development process, the consequences of which included continued risky sexual behavior (e.g. unprotected sex, sex with a partner they know is infected with HIV); failure to comply with prescribed medication regimens (e.g. missing multiple doses of antivirals); or not pursuing previously set academic goals (e.g. dropping out of high school). These findings highlight the importance of ancillary social services in facilitating identity development among young women living with HIV.