Mujeres ingeniosas [resourceful women]: HIV+ Puerto Rican women and the urban health care system

This ethnographic study explores the help-seeking strategies of poor HIV+ Puerto Rican women living in the greater Newark area. A group of eighteen participants were accompanied to their health care appointments and the throughout the course of their daily lives. The project sought to answer four questions: (a) how is HIV disease managed by Puerto Rican women dependent on the public health care system? (b) which help-seeking, economic and treatment strategies do they employ most frequently in order to circumvent access and treatment barriers? (c) which of these strategies appear to result in better quality of life? and finally, (d) what role does CAM (complementary and alternative medicine) play in their treatment strategies? Drawing on the work of French sociologist Pierre Bourdieu, I argue that the range of cultural capital that my informants have accumulated over the course of their lives largely determines their ability to generate social capital in the form of collaborative alliances with health care professionals of all kinds, social service workers and other resource gatekeepers. Such alliances can literally mean the difference between life and death for impoverished minority women facing a serious, heavily stigmatized illness. In this way, social capital moderates the impact of structural constraints and structural violence such as poverty, ethnic balkanization, limited resources and lack of adequate medical care; it also promotes the expression of agency in the form of self-advocacy. Additionally, I found that those women who had accumulated the most diverse forms of cultural and social capital also used the greatest number of CAM modalities, although almost all of the women with whom I worked used at least one. Thus, women with greater cultural and social capital also tended to adhere to more multifaceted treatment strategies. Deployment of the concepts of cultural and social capital clarify why the medical, mental health and economic help-seeking strategies generated by the most successful women were so effective at preserving both the quality and length of their lives; it also helps to explain why the least successful women whom I encountered so often fell short of achieving their treatment and health promotion goals.