HIV care engagement and antiretroviral therapy (ART) adherence interventions aimed at decreasing viral suppression disparities for women living with HIV (WLWH) in the Southern United States (i.e., the South) are few and seldom consider diverse social locations. These refer broadly and dynamically to contextual factors and the position people occupy in a social hierarchy based on intersecting systems of oppression and social determinants of health like gender, race/ethnic, and class inequities; geographic location; and HIV-related stigma. Using an intersectional approach, we conducted in-depth interviews and used a phased approach to directed content analysis to describe women’s perceptions of their social location and how it impacts their decision-making about HIV care engagement and ART adherence. Participants were recruited to participate from a broad geographic area and represented the diverse social locations occupied by WLWH in the South. Findings from 40 in-depth interviews include descriptions of how geographic context impacts HIV care engagement and medication adherence through access to care, quality of care, and the place-based context of day-to-day experiences of living with HIV. Participants spoke of multilevel power relationships based on their gender and racial identities, and how social determinants and intersecting identities occur simultaneously and vary as a function of one another to impact health and HIV care decision-making. The findings offer a nuanced understanding of how WLWH perceive their contextually specific social locations and make critical decisions about their HIV care engagement and medication adherence.

Background: More than three years have elapsed since the onset of the full-scale invasion of Ukraine by the Russian Federation, displacing millions of Ukrainians. While preserving cultural identity in the host country is important for gaining resilience among refugees, we found no studies about how cultural identity influences health care experiences during resettlement. Objective: This study explores how cultural identity shapes health care experiences among Ukrainian refugees during resettlement in the United States. Methods: We conducted an interpretive description study using focus groups to elicit the perspectives of Ukrainian refugees who resettled in North Carolina after 24 February 2022. Twelve Ukrainian women participated in one of four focus groups. Thematic content analysis was employed for case comparison, and themes were inductively derived. Results: Two themes were identified: troubled health care partnerships and imprecise notions of preventive practices. Troubled partnerships represented a lack of trust between refugees and U.S. clinicians and the health care system. Imprecise notions of preventive practices represented mistaken beliefs about prevention. Conclusions: This study adds to the science on refugee health in two ways. First, newly arrived refugees often maintain strong ties to their homeland, which shapes their health care decisions and reinforces their cultural identity. Second, despite being well educated, some refugees held misconceptions about preventive health care, highlighting the need for clinicians to provide clear guidance on primary and secondary prevention practices. Findings may help guide clinicians in delivering culturally sensitive care to refugee populations.