Women around the world are at risk for HIV because they are in close, long-term relationships with male partners who are unfaithful, abusive, and/or use alcohol or illicit drugs. HIV risk is particularly high among couples that migrate for work and experience extended periods of physical separation. This study used Constructivist Grounded Theory methodology to explore women's perceptions of and experiences with HIV risk among a community sample of migrant farmworkers of Mexican descent in southern California. Twenty women with a history of a close, long-term risky relationship participated in one or two in-depth interviews. After initial coding, focused coding identified the most significant areas of interest and categories were formed. Theoretical sampling helped to fill the gaps and detail how participants navigated and responded to risk in their relationships. A Community Advisory Board comprised of stakeholders and farmworker women from the target community offered insight and advice into research design and preliminary data interpretations.
Results are presented in a theory grounded in women's words, consisting of two simultaneous, overlapping processes. The first is a process of expanding perspective. While explaining their perceptions of partner risk, women repeatedly used metaphors of eyesight and "seeing" risk over a fluid five-phase process that included being blinded by vulnerabilities, making the discovery, weighing priorities, adopting a risk perspective, and assessing the consequences. While expanding their views of what HIV risk meant to them, women were also simultaneously pushing back against the actions of their abusive, unfaithful, and/or addicted long-term male partners. In this second process, called "gaining leverage," participants did not feel that they had overcome the danger of their risky relationships. Instead, they felt they were gaining leverage over risk in small but important ways through the use of three specific categories of action: fighting the bad (pushing back against a partner's actions using personal resources), finding the good (navigating complex external resources while avoiding additional harm), and fortifying the self (helping themselves "move forward" in the aftermath of risky relationships). Future interventions should focus on the ways in which migrant women cognitively, socially and emotionally navigate their perceptions of and responses to risky relationships.
