Aging Mexican Women Living with HIV: Responding to Structural Oppression through Agency and Care Practices
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Abstract
Introduction. Aging Mexican women living with HIV (AMWLWH) experience intersecting inequities associated with gender, age, socioeconomic status, and in some cases, Indigenous origin, shaping their access to HIV care.
Objective: Analyze how AMWLWH respond to these conditions of structural oppression through agency and care practices.
Method. Qualitative study conducted at a public HIV clinic in Mexico City (July 2024-March 2025). Twenty-seven cisgender AMWLWH aged ≥ 50 participated in semi-structured, face-to-face, Spanish-language interviews. Data were analyzed using reflexive thematic analysis and interpreted through an intersectional lens.
Results. AMWLWH responded to structural oppression by continuing to engage in precarious work, protecting the continuity of HIV care, practicing self- and collective care, sharing situated knowledge, re-signifying aging, and imagining preferred futures centered on autonomy and dignity.
Discussion and conclusion. AMWLWH actively negotiate structural constraints through self- and collective-care practices, economic strategies, and re-authoring later-life identities. Interventions and policies designed to enhance women’s agency, address age- and gender-related barriers, and support community-based care are essential to improving later-life wellbeing among AMWLWH.
References
Amuchástegui, A., & Evangelista, A. A. (2022). Interseccionalidad y condicionantes sociales de la salud: una aproximación teórico-metodológica sobre el efecto del estigma en la vida de mujeres con VIH/sida en Chiapas. Revista Interdisciplinaria de Estudios de Género de El Colegio de México, 8, 1–42. https://doi.org/10.24201/reg.v8i1.929
Arsuffi, S., Quiros-Roldan, E., Colombo, F. R., Fioretti, B., Candela, C., Celesia, B. M., Ferrara, M., Milic, J., De Socio, G. V., Madeddu, G., Cattelan, A. M., Piconi, S., Bonfanti, P., Riva, A., Guaraldi, G., Calza, S., Calcagno, A., Focà, E., & GEPPO Cohort. (2025). Health profiles of foreign-born elderly women with HIV in Italy. Frontiers in Aging, 6, 1659751. https://doi.org/10.3389/fragi.2025.1659751
Bautista-Arredondo, S., Servan-Mori, E., Beynon, F., González, A., & Volkow, P. (2015). A tale of two epidemics: Gender differences in socio-demographic characteristics and sexual behaviors among HIV positive individuals in Mexico City. International Journal for Equity in Health, 14, Article 147. https://doi.org/10.1186/s12939-015-0286-4
Beaudoin, M. (2022). Revisiting Agency and Choice in the Face of Trauma: A Narrative Therapy Map. Journal of Systemic Therapies, 41(4), 64–66. https://doi.org/10.1521/jsyt.2022.41.4.64
Beaudoin, M. (2023). Agency and Choice in the Face of Trauma: A Narrative Therapy Map. Journal of Systemic Therapies, 41(4), 67–85. https://doi.org/10.1521/jsyt.2022.41.4.67
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. https://doi.org/10.1191/1478088706qp063oa
Brown, R. (2020). When the Body Is a Weapon: An Intersectional Feminist Analysis of HIV Criminalization in Louisiana. Berkeley Journal of Gender, Law & Justice, 35(1). 91–136 https://doi.org/10.15779/Z38NS0KZ4H
Caballero-Suárez, N. P., Rodríguez Estrada, E., Candela-Iglesias, M., & Reyes-Terán, G. (2017). Comparison of levels of anxiety and depression between women and men living with HIV of a Mexico City clinic. Salud Mental, 40(1), 15–22. https://doi.org/10.17711/sm.0185-3325.2017.003
Cantero-Sánchez, M. (2023). Aportaciones de Kimberlé Crenshaw a la noción de interseccionalidad: mecanismos de invisibilización y reivindicación. Lectora: revista de dones i textualitat, 137–151. https://doi.org/10.1344/lectora2023.29
Celeste-Villalvir, A., Payan, D. D., Armenta, G., Palar, K., Then-Paulino, A., Acevedo, R., Fulcar, M. A., & Derose, K. P. (2023). Exploring gender differences in HIV-related stigma and social support in a low-resource setting: A qualitative study in the Dominican Republic. PLOS ONE, 18(8), e0290228. https://doi.org/10.1371/journal.pone.0290228
Centro Nacional para la Prevención y el Control del VIH y el Sida. (2025). Informe histórico de VIH Día Mundial 2025. Secretaría de Salud. https://www.gob.mx/cms/uploads/attachment/file/1040435/InformeHist_rico_VIH_DVEET_DIA_MUNDIAL2025.pdf
Combs, G., & Freedman, J. (2012). Narrative, Poststructuralism, and Social Justice: Current Practices in Narrative Therapy. The Counseling Psychologist, 40(7), 1033–1060. https://doi.org/10.1177/0011000012460662
Couto, M. T., De Oliveira, E., Separavich, M. A. A., & Luiz, O. D. C. (2019). La perspectiva feminista de la interseccionalidad en el campo de la salud pública: revisión narrativa de las producciones teórico-metodológicas. Salud Colectiva, 15, e1994. https://doi.org/10.18294/sc.2019.1994
Cruz-Cruz, C., Zamora-Macorra, M., Astudillo-García, C. I., & Guerra, G. (2023). Intersectionality and depression symptoms in Mexican adults aged ≥50, MHAS 2001 and 2012. Salud Pública de México, 65(5), 475-484. https://doi.org/10.21149/14733
Denzin, N. K., & Lincoln, Y. S. (2005). The Sage handbook of qualitative research (3rd ed.). Sage.
Denzin, N. K., & Lincoln, Y. S. (2011). El campo de la investigación cualitativa. Manual de investigación cualitativa. Gedisa.
Erickson, M., Shannon, K., Ranville, F., Magagula, P., Braschel, M., Ratzlaff, A., Pick, N., Kestler, M., & Deering, K., on behalf of the SHAWNA Project. (2021). Interpersonal violence and other social structural barriers associated with needing HIV treatment support for women living with HIV. Journal of Interpersonal Violence, 37(11–12), 9926–9952. https://doi.org/10.1177/0886260520983257
Eruotor, S., & Letvak, S. (2022). Reducing health disparities through understanding the lived experiences of women living with HIV regarding intimate relationship power and reproductive decision-making. Analyses of Social Issues and Public Policy, 22(1), 448–463. https://doi.org/10.1111/asap.12305
Ferrer-Pérez, V. A. (2025). Amor romántico y violencia contra las mujeres en la pareja: Mitos y realidades. Apuntes de Psicología, 43(1), 61–67. https://doi.org/10.70478/apuntes.psi.2025.43.06
Hanass-Hancock, J., Carpenter, B., & Myezwa, H. (2019). The missing link: exploring the intersection of gender, capabilities, and depressive symptoms in the context of chronic HIV. Women & Health, 59(10), 1212–1226. https://doi.org/10.1080/03630242.2019.1607799
Jagatdeb, S., Mishra, S., Bajpai, T., & Sen, S. (2024). “Externalizing the Internalized:” Exploring Externalizing Conversations in Narrative Therapy with Adolescents and Young Adults in the Indian Context. Journal of Indian Association for Child and Adolescent Mental Health, 20(2), 153–160. https://doi.org/10.1177/09731342241238096
Kisvetrová, H., Mandysová, P., Tomanová, J., & Steven, A. (2022). Dignity and attitudes to aging: A cross-sectional study of older adults. Nursing Ethics, 29(2), 413–424. https://doi.org/10.1177/09697330211057223
Kokorelias, K., Brown, P., Walmsley, S., Zhabokritsky, A., Su, E., & Sirisegaram, L. (2024). Age-related experiences of diverse older women living with HIV: A scoping review protocol informed by intersectionality. PLOS ONE, 19(6), e0306225. https://doi.org/10.1371/journal.pone.0306225
Kokorelias, K. M., Su, E., Brown, P., McKinlay, S., Flanagan, A., Walmsley, S., & Zhabokritsky, A. (2025). “It's like it's the old boys club”—the age-related experiences of diverse older women living with HIV: A scoping review and consultative exercise. HIV Medicine, 26(4), 546–568. https://doi.org/10.1111/hiv.13751
La Torre-Gentoso, I. (2024). Dignidad por partes. RIL editores.
Lelaurain, S., Fonte, D., Giger, J., Guignard, S., & Lo Monaco, G. (2021). Legitimizing Intimate Partner Violence: The Role of Romantic Love and the Mediating Effect of Patriarchal Ideologies. Journal of Interpersonal Violence, 36(13–14), 6351–6368. https://doi.org/10.1177/0886260518818427
Manalel, J., & Brennan-Ing, M. (2023). Intersectionality Can Shape the Support Networks of Older Women with HIV. Generations, 47(Suppl 1), 00010. https://pubmed.ncbi.nlm.nih.gov/39346896/
Marg, L. Z., Ruiz, G., Chagolla, F., Cabral, A., Taylor, J., Christensen, C., Martin, M., Picou, B., & Brown, B. (2020). “We are becoming older women and then we have two stigmas”: Voicing women’s biopsychosocial health issues as they age with HIV. Journal of Women & Aging, 32(4), 365–388. https://doi.org/10.1080/08952841.2020.1751566
Marks, L. R., Hayes, L. R., Amos, A. T. M., Moore, K. L., & Dark, T. (2023). ‘Don’t judge me ‘til you walk through my shoes’: A qualitative investigation of the experiences of women living with HIV. Ethnicity & Health, 28(8), 1128–1144. https://doi.org/10.1080/13557858.2023.2231667
Marsten, D., & Howard, G. (2006). Shared Influence: A Narrative Approach to Teaching Narrative Therapy. Journal of Systemic Therapies, 25(4), 97–110. https://doi.org/10.1521/jsyt.2006.25.4.97
Medeiros, P., Gupta, M., Wong, H., Kazemi, M., Ndung’u, M., Smith, S., Kishibe, T., & Loutfy, M. (2022). Women-centred HIV care: A scoping review to understand the current state of service delivery for women living with HIV globally. AIDS Care, 34(9), 1083–1093. https://doi.org/10.1080/09540121.2021.1948498
Neundorfer, M., Harris, P., Britton, P., & Lynch, D. (2005). HIV-risk factors for midlife and aging women. The Gerontologist, 45(5), 617—625. https://doi.org/10.1093/geront/45.5.617
Norcini-Pala, A., Stringer, K. L., Kempf, M., Konkle-Parker, D., Wilson, T. E., Tien, P. C., Wingood, G., Neilands, T. B., Johnson, M. O., Weiser, S. D., Logie, C. H., Topper, E. F., Turan, J. M., & Turan, B. (2025). Longitudinal associations between intersectional stigmas, antiretroviral therapy adherence, and viral load among women living with HIV using multidimensional latent transition item response analysis. Social Science & Medicine, 366, 117643. https://doi.org/10.1016/j.socscimed.2024.117643
Ojukwu, E., Cianelli, R., Villegas Rodriguez, N., De Oliveira, G., & Kalu, V. (2022). A Qualitative Study on the Social Determinants of HIV Treatment Engagement Among Black Older Women Living With HIV in the Southeastern United States. Journal of the Association of Nurses in AIDS Care, 33(2), 211–223. https://doi.org/10.1097/jnc.0000000000000299
Owusu, A. Y. (2020). A gendered analysis of living with HIV/AIDS in the Eastern Region of Ghana. BMC Public Health, 20(1). https://doi.org/10.1186/s12889-020-08702-9
Pageau, F., Fiasse, G., Nordenfelt, L., & Mihailov, E. (2024). Care of the older person and the value of human dignity. Bioethics, 38(1), 44–51. https://doi.org/10.1111/bioe.13251
Plach, S. K., Stevens, P. E., & Keigher, S. (2005). Self-Care of Women Growing Older With HIV and/or AIDS. Western Journal of Nursing Research, 27(5), 534–553. https://doi.org/10.1177/0193945905275973
Psaros, C., Stanton, A. M., Goodman, G. R., Raggio, G., Briggs, E. S., Lin, N., Robbins, G. K., & Park, E. R. (2023). Adapting, testing, and refining a resilience intervention for older women with HIV: An open pilot study. Journal of Women & Aging, 35(4), 395–415. https://doi.org/10.1080/08952841.2022.2094163
Rice, W. S., Turan, B., Fletcher, F. E., Nápoles, T. M., Walcott, M., Batchelder, A., Kempf, M., Konkle-Parker, D. J., Wilson, T. E., Tien, P. C., Wingood, G. M., Neilands, T. B., Johnson, M. O., Weiser, S. D., & Turan, J. M. (2019). A Mixed Methods Study of Anticipated and Experienced Stigma in Health Care Settings Among Women Living with HIV in the United States. AIDS Patient Care and STDs, 33(4), 184–195. https://doi.org/10.1089/apc.2018.0282
Rosenfeld, D., Anderson, J., & On behalf of the HIV and Later Life (HALL) Team. (2020). “The own” and ”the wise” as social support for aging people living with HIV in the United Kingdom. Ageing & Society, 40(1), 188–204. https://doi.org/10.1017/S0144686X18000909
Rosenfeld, D., Anderson, J., Catalan, J., Delpech, V., & Ridge, D. (2021). How older people living with HIV narrate their quality of life: Tensions with quantitative approaches to quality-of-life research. SSM - Qualitative Research in Health, 1, 100018. https://doi.org/10.1016/j.ssmqr.2021.100018
Rubtsova, A. A., Wingood, G., Ofotokun, I., Mehta, C. C., Gustafson, D., Vance, D. E., Sharma, A., Adimora, A. A., & Holstad, M. (2021). Psychosocial Mechanisms of Self-rated Successful Aging with HIV: A Structural Equation Model. AIDS and Behavior, 25(9), 2875–2885. https://doi.org/10.1007/s10461-021-03340-7
Sangaramoorthy, T., Jamison, A., & Dyer, T. (2017). Intersectional stigma among midlife and older Black women living with HIV. Culture, Health & Sexuality, 19(12), 1329–1343. https://doi.org/10.1080/13691058.2017.1312530
Scofield, D., Moseholm, E., Aebi-Popp, K., Hachfeld, A., & Women Against Viruses in Europe (WAVE), European AIDS Clinical Society. (2024). Management of menopause in women living with HIV: A comparative guideline review. Maturitas, 183, 107937. https://doi.org/10.1016/j.maturitas.2024.107937
Seffren, V., Familiar, I., Murray, S. M., Augustinavicius, J., Boivin, M. J., Nakasujja, N., Opoka, R., & Bass, J. (2018). Association between coping strategies, social support, and depression and anxiety symptoms among rural Ugandan women living with HIV/AIDS. AIDS Care, 30(7), 888–895. https://doi.org/10.1080/09540121.2018.1441969
Solomon, P., O'Brien, K., Wilkins, S., & Gervais, N. (2014). Aging with HIV and disability: The role of uncertainty. AIDS Care, 26(2), 240–245. https://doi.org/10.1080/09540121.2013.811209
Sommer, S., & Barroso, J. (2023). A qualitative metasynthesis of stigma in women living with HIV in the United States. International Journal for Equity in Health, 22(1). https://doi.org/10.1186/s12939-023-01969-5
Sommer, S. B., & Barroso, J. V. (2025). Research-based narrative videos to reduce stigma: Insights from older women living with HIV. Frontiers in Public Health, 13. https://doi.org/10.3389/fpubh.2025.1620599
Stevenson, J. (2022). ‘It feels like my visibility matters’: Women ageing with HIV overcoming the ‘violence of invisibility’ through community, advocacy and the radical act of care for others. Women's Health, 18. https://doi.org/10.1177/17455057221095911
Suarez-García, I., Alejos, B., Pérez-Elías, M. J., Iribarren, J. A., Hernando, A., Ramírez, M., Tasias, M., Pascual, M., Jarrin, I., Hernando, V., & CoRIS Cohort (2021). How do women living with HIV experience menopause? Menopausal symptoms, anxiety and depression according to reproductive age in a multicenter cohort. BMC Women’s Health, 21(1), Article 223. https://doi.org/10.1186/s12905-021-01370-w
Subramaniam, S., Camacho, L. M., Carolan, M. T., & López-Zerón, G. (2017). Resilience in low-income African American women living and aging with HIV. Journal of Women & Aging, 29(6), 543–550. https://doi.org/10.1080/08952841.2016.1256735
Tong, A., Sainsbury, P., & Craig, J. (2007). Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care, 19(6), 349–357. https://doi.org/10.1093/intqhc/mzm042
United Nations General Assembly. (2007). World Day of Social Justice. United Nations.
Urcia, I. A. (2021). Comparisons of Adaptations in Grounded Theory and Phenomenology: Selecting the Specific Qualitative Research Methodology. International Journal of Qualitative Methods, 20. https://doi.org/10.1177/16094069211045474
Uribe, P., Villafuerte, A., & Magis, C. (2018). Atención a salud reproductiva y VIH en mujeres. In A. Amuchástegui (Ed.), Mujeres y VIH en México: Diálogos y tensiones entre perspectivas de atención a la salud. Imagia.
White, M. (2015). Práctica narrativa. La conversación continúa. PRANAS Chile Ediciones.
White, M., & Epston, D. (1993). Medios narrativos para fines terapéuticos. Paidós.
Yang, L. H., Eschliman, E. L., Mehta, H., Misra, S., Poku, O. B., Entaile, P., Becker, T. D., Melese, T., Brooks, M. J., Eisenberg, M., Stockton, M. A., Choe, K., Tal, D., Li, T., Go, V. F., Link, B. G., Rampa, S., Jackson, V. W., Manyeagae, G. D., ... Blank, M. B. (2022). A pilot pragmatic trial of a “what matters most”-based intervention targeting intersectional stigma related to being pregnant and living with HIV in Botswana. AIDS Research and Therapy, 19(1), Article 26. https://doi.org/10.1186/s12981-022-00454-3
