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10:2
Intersectionality and the
Sociology of HIV/AIDS:
Past, Present, and Future
Research Directions
Celeste Watkins-Hayes
Departments of Sociology and African American Studies, Northwestern University,
Evanston, Illinois 60208; email: c-watkins@northwestern.edu
Keywords
HIV/AIDS, intersectionality, inequality, health
Abstract
This review focuses on three topics that have dominated the sociologi-
cal literature on HIV/AIDS in the United States: (a) the demographics
of the epidemic and the dynamics of structural-, neighborhood-, and
individual-level risk; (b) the lived experiences of HIV-positive people;
and (c) the collective response to HIV/AIDS through community-based
services, political activism and social movements, and public policy.
Sociologists have pursued inquiry in all of these areas and have often
advanced the implicit and explicit use of approaches that reveal the
epidemic’s embedded power relations. Previous research and the dy-
namics of the epidemic suggest a fundamental argument: HIV/AIDS is
an epidemic of intersectional inequality that is fueled by racial, gender,
class, and sexual inequities at the macro-structural, meso-institutional,
and micro-interpersonal levels. These inequalities significantly shape
the likelihood of exposure to the virus; the realities of living with the
infection; and medical, programmatic, political, and social-scientific
responses.
431
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INTRODUCTION
The United States will become a place where
new HIV infections are rare, and when they do
occur, every person, regardless of age, gender,
race/ethnicity, sexual orientation, gender identity
or socio-economic circumstance, will have unfet-
tered access to high quality, life-extending care,
free from stigma and discrimination.
—President Barack Obama, July 13, 2010
Since the first cases over 30 years ago, the hu-
man immunodeficiency virus (HIV) has caused
a pandemic that has produced devastating
consequences and is now seared into our social
fabric. HIV attacks specific cells of the immune
system, known as CD4 cells or T cells, and
reduces the body’s ability to fight infections
and disease. HIV progresses to acquired immu-
nodeficiency syndrome (AIDS) when too many
T cells have been destroyed, and it can be fatal
if left untreated. Although HIV resides per-
manently in the body following infection, the
advent of highly active antiretroviral therapy
(HAART) in the mid-1990s has dramatically
prolonged the lives of many HIV-infected
people and reduced their chances of infecting
others. Today, an HIV-positive individual can
enjoy nearly normal life expectancy if diag-
nosed and treated early. As a result, although
the Centers for Disease Control (CDC) find
that there remain around 1.1 million people
with HIV/AIDS in the United States, fewer
and fewer are dying of AIDS (CDC 2013f ).
Nevertheless, approximately 50,000 new HIV
infections occur every year in this country,
and of the 1.1 million currently infected, about
16% do not know their status.
The transformation of HIV/AIDS from an
inevitable death sentence to a chronic illness
has produced new social and cultural realities.
The goal of an AIDS-free generation seems
attainable in well-resourced countries like the
United States, and experts now publicly con-
template “the beginning of the end of AIDS.”
However, President Obama’s statement as he
unveiled a national HIV/AIDS strategy hinted
at the vexing reality that social status contin-
Watkins-Hayes
ues to play a significant role in determining
who is most at risk of infection, who is most
likely to receive life-saving treatment, and how
the epidemic disproportionately affects certain
communities. HIV increasingly operates as a
concentrated epidemic in the United States,
with high rates among specific subpopulations.
Unlike many other illnesses, it has a particu-
lar cultural significance that obliges its carri-
ers, and those most intimately involved in their
lives, to grapple with weighty and contentious
social issues: sex, sexuality, drugs, class, race,
gender, and inequality of exposure to harm.
HIV/AIDS intersects with long-standing social
hierarchies that seemingly render some groups
more expendable than others. After all, many
believe that this infection is a kind of punish-
ment, complete with sympathetic and unsym-
pathetic victims. As such, HIV/AIDS is not only
a medical epidemic but also a social and cul-
tural Rorschach test that pushes our views about
difference and complex inequalities to center
stage.
Research on HIV/AIDS has emphasized
randomized controlled trials, clinic-based re-
search, and evaluations that assess the efficacy
of the field’s latest biomedical and behavioral
interventions in HIV prevention and treatment
and in the pursuit of a cure. Sociologists have
participated in such intervention work (Adam
et al. 2011, Baker et al. 2003, Comfort et al.
2000) and have stridently advocated for re-
search approaches that address the structural,
institutional, neighborhood, network, and cul-
tural factors that influence individual behavioral
outcomes. Consequently, social drivers are now
more widely recognized as “both influence[ers]
of HIV transmission . . . and possible points of
intervention at the societal level” (Auerbach
et al. 2009, p. 3). Therefore, although I include
research conducted by scholars from other dis-
ciplines, in this review I emphasize the work of
sociologists contributing to the understanding
of HIV/AIDS as well as work that most closely
speaks to sociological concerns.
Sociologists believe that group cate-
gories, and the social meanings and resources
historically and presently assigned to them, are
 SO40CH20-Watkins-Hayes ARI 1 July 2014 10:2
foundational for understanding HIV/AIDS.
Thus, in this review I synthesize this litera-
ture while looking through an intersectional
lens. First advanced by feminists of color, the
paradigm of intersectionality challenges single-
category thinking about identity and group
status and emphasizes approaches that inter-
rogate how race, class, gender, sexuality, and
other social locations operate simultaneously in
social life (Collins 1990, Crenshaw 1991, King
1988). An intersectional approach seeks to
make interlocking power dynamics visible and
to highlight how they are shaped by sameness
and difference (Cho et al. 2013). Scholars have
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conceptualized intersectionality as a theory of
power relations, a methodological imperative
to uncover interlocking inequalities, and a
political assertion that sometimes embraces
modes of resistance (Choo & Ferree 2010,
Cohen 1997, McCall 2005). The concept
operates in several disciplines including so-
ciology, public health, ethnic studies, gender
studies, queer studies, history, psychology,
social work, and anthropology. I argue that
HIV/AIDS is an epidemic of intersectional
inequality fueled by racial, gender, class, and
sexual inequities at the macro-structural,
meso-institutional, and micro-interpersonal
levels. These inequalities shape the likelihood
of exposure to the virus; the realities of living
with HIV; and our medical, programmatic,
political, and social-scientific responses.
After briefly charting the sociology of
HIV/AIDS as an area of study, this review
focuses on three topics that have dominated
the sociological literature on HIV/AIDS in the
United States: (a) the demographics of the epi-
demic and the dynamics of multilayered risk
(e.g., structural-, institutional-, neighborhood-,
network-, and individual-level risk); (b) the lived
experiences of HIV-positive people; and (c) the
collective response to the epidemic through
community-based services, political activism
and social movements, and public policy. I in-
clude work on the epidemic’s impact on both
men and women, with an emphasis on the three
racial groups with the highest numbers of peo-
ple living with HIV/AIDS in the United States
www.annualreviews.org • Intersectionality and the Sociology of HIV/AIDS
(whites, blacks, and Latinos). These areas of fo-
cus reflect the largest bodies of work in the field
and provide a landscape through which to pin-
point the unique contributions of the sociology
of HIV/AIDS.
It is important to note that sociologists have
contributed to the vast research examining the
AIDS pandemic all over the globe (Mojola
2011, Swidler & Watkins 2007). According to
the World Health Organization (2013), an es-
timated 34 million people are living with HIV
globally, and several recent literature reviews
examine the AIDS pandemic in various re-
gions (De Cock et al. 2013, Mahajan et al.
2008), including sub-Saharan Africa (Foster
& Williamson 2000, Heimer 2007), home to
more than two-thirds of the world’s HIV infec-
tions, and China (Hong & Li 2009). Although
multilayered inequalities aggressively influence
the pandemic in all parts of the world, coun-
tries with generalized epidemics face very dif-
ferent issues from those faced by the United
States in terms of the most common modes
of transmission, the medical and social reali-
ties of HIV-infected individuals, and the polit-
ical responses to AIDS from the grass roots to
the upper echelons of government (Decoteau
2013). In some countries, the ravages of AIDS
are so widespread that they threaten the sta-
bility of families, communities, and even labor
forces (Heimer 2007). Given these complexi-
ties, and the practicalities of space constraints, I
focus this review on the epidemic in the United
States. However, the development of more in-
ternational or cross-cultural frameworks for the
study of HIV/AIDS is a fertile direction for fu-
ture research.
CHARTING THE SOCIOLOGY
OF HIV/AIDS
Despite the contributions of sociologists of
HIV/AIDS to policy, scholarship, and com-
munity responses to the epidemic, this im-
portant area of study remains at the periph-
ery of “mainstream sociology.” Starting in the
mid-1980s, pioneers such as Judith Auerbach
et al. (1994), Benjamin Bowser (1989), Samuel
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Friedman (see Marmor et al. 1984), Martin
Levine (1989), Beth Schneider (1988), and Rose
Weitz (1987, 1991) began publishing work
on AIDS in important social science journals
such as Social Problems, teaching sociology of
HIV/AIDS classes in colleges and universities,
organizing sessions on HIV/AIDS at annual
meetings of various sociological associations,
and building the Sociologists AIDS Network of
the American Sociological Association (ASA).
Nevertheless, articles on HIV/AIDS are scarce
in sociology’s flagship journals, appearing only
within the last decade and focusing on the epi-
demic in countries other than the United States.
The American Sociological Review published
studies examining how uncertainty about HIV
status shapes decision making about childbear-
ing among young adults in southern Malawi
(Trinitapoli & Yeatman 2011) and measuring
the transformation of international intellectual
property protections for AIDS drugs (Chorev
2012). The American Journal of Sociology pub-
lished a study on cultural interpretations of
AIDS campaigns in Accra, Ghana (McDonnell
2010). Carol Heimer’s Annual Review of Sociol-
ogy paper on HIV/AIDS in sub-Saharan Africa
appeared in 2007. In a 2001 article published in
the ASA newsletter Footnotes, Bronwen Licht-
enstein observes, “The dearth of AIDS-related
articles in the reviewed journals suggests that
AIDS has never truly been perceived to be a
sociological issue.”
Sociologists studying HIV/AIDS have had
a much more prominent voice in interdisci-
plinary health journals, publishing numerous
articles in outlets such as Social Science and
Medicine, AIDS and Behavior, AIDS Care, Jour-
nal of Health and Social Behavior, and the Sociol-
ogy of Health and Illness. They have also con-
tributed to widely read sociology and social
science journals such as Social Problems, Social
Forces, and the Annals of the American Academy of
Political and Social Science and frequented public
health journals including the American Journal
of Public Health. Monographs on HIV/AIDS in
the United States have experienced more main-
stream success, including two books on AIDS
activism that received ASA awards, Impure Sci-
Watkins-Hayes
ence: AIDS, Activism, and the Politics of Knowledge
(Epstein 1996) and Moving Politics: Emotion and
ACT UP’s Fight Against AIDS (Gould 2009).
INTERSECTIONALITY AND THE
SOCIOLOGY OF HIV/AIDS
Although most HIV/AIDS researchers do
not explicitly engage the concept of intersec-
tionality in their work, most understand that
HIV/AIDS involves a multifaceted blend of
interlocking group memberships (Schneider
1992). Identities and statuses based on race,
sexual orientation, class, gender, and other
categories serve as organizing principles and
help to determine how power is distributed,
(im)balanced, maintained, and challenged
(Watkins-Hayes 2008). Various forms of
inequality rendered through racism, sexism,
class subordination, heterosexism, and other
forms of exclusion intersect and interact with
one another, creating what Collins (1990) calls
interlocking systems of oppression. As individ-
uals navigate their social worlds and encounter
privileges or disadvantages by virtue of their
various social group memberships, they affirm,
acquiesce to, resist, or create alternatives to
dominant ways of thinking and behaving.
Intersectionality is therefore a conceptual
framework that acknowledges how multiple,
simultaneous, and structurally embedded
social locations influence the life experiences,
opportunities, investments, and constraints of
individuals and groups (Choo & Ferree 2010,
Collins 1990, Glenn 2000, McCall 2005). It
calls upon us not only to attend to difference,
subjectivities, and categories of identity, but
also to consider how dimensions and dynamics
of dominance generate and sustain structural,
group, and interpersonal inequalities.
Intersectionality has much to offer
HIV/AIDS studies because it encourages
“the inclusion of perspectives, not only
persons, from the margins of society[,] . . .
problematize[s] relationships of power for
unmarked categories, such as whiteness and
masculinity[,] . . . and treat[s] inequalities as
multiply-determined and intertwined” (Choo
 SO40CH20-Watkins-Hayes ARI 1 July 2014 10:2
& Ferree 2010, p. 131; see also Bredstrom
2006). An intersectional approach has perhaps
been most prominently deployed in both
scholarship and activism related to HIV/AIDS
among blacks (Berger 2004, Cohen 1999,
Hammonds 1995, Mackenzie 2013). More
recently, Collins and colleagues (2008) used
intersectionality to illuminate multifaceted
interconnections between race, ethnicity, gen-
der, class, and mental illness as they influence
sexuality and HIV risk among Latinas in New
York City. The associated systems of power,
Collins et al. (2008, p. 390) write, “might
include laws that determine access to welfare,
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Medicaid, or housing; rules in a residential
facility that govern sexual activity; traditions
in a local community that privilege male
sexual desire and power; or a community’s
reinforcement of stereotypes of women who
are black and Latina with mental illness as hav-
ing uncontrollable sexual urges or dangerous
aggression.” The resulting reduced social and
economic power can limit women’s abilities
to dictate the terms of sexual relationships,
increasing their vulnerability to HIV infection.
THE DEMOGRAPHICS OF
HIV/AIDS AND THE SOCIAL
DIMENSIONS OF INFECTION
RISK
Most HIV infections in the United States have
occurred, and still occur, through male-to-male
sexual contact (CDC 2012). In 2010, men who
have sex with men (MSM) were estimated to
make up approximately 4% of the male US pop-
ulation yet accounted for 78% of new HIV in-
fections among males (CDC 2012, Purcell et al.
2012). Individuals infected through heterosex-
ual sex made up 25% of all new HIV infections
that year. This is the reported mode of trans-
mission for most HIV-positive women, who
accounted for approximately 20% of the esti-
mated 47,500 new infections. In 2010, 8% of
new infections were attributed to intravenous
drug use (IDU) (CDC 2012, 2013f ). Compared
with other racial groups, blacks face the most
severe burden of HIV, making up only 12%
www.annualreviews.org • Intersectionality and the Sociology of HIV/AIDS
of the US population yet comprising 44% of
both new HIV infections and people living with
HIV/AIDS in 2010 (CDC 2013f ).
Bodies and sexuality have historically served
as domains for advancing stereotypes about
marginalized groups, and these preoccupations
have been a continuous thread in the pub-
lic’s response to the AIDS epidemic. Simulta-
neous and interlocking sexual and racial anxi-
eties have manifested through attacks on white
gay men for existing outside of the boundaries
of normative heterosexual whiteness (Carbado
2013), through silences within black communi-
ties about the epidemic’s impact for fear of fur-
ther demonization (Cohen 1999), and through
media obsession with black men on the “down
low” (men who have sex with men and women,
or MSMW, who do not identify as gay or bisex-
ual) who encapsulate the public’s simultaneous
fear and fetishization of black masculinity and
sexuality (Mackenzie 2013, McCune 2014).
Social group identity, however, is not a
proxy for HIV risk. As Treichler (1999) and
others have noted, the risks of HIV are as-
sociated with behavior rather than inherent
demographic characteristics, challenging the
notion that certain groups are somehow “con-
taminated” and “contaminating.” In the United
States, the virus is most commonly transmit-
ted through unprotected sex and the sharing of
drug injection equipment, but these risk behav-
iors occur in a context that unequally distributes
both vulnerability and protective resources.
Watkins-Hayes (2008, pp. 41–42) reflects:
[Sociological] research has encouraged a
more nuanced understanding of the social
context of risk and highlighted the danger of
directly linking certain individuals or groups
to health outcomes without appreciating the
interrelationship between individual attitudes
and behaviors and environmental opportunity
structures and constraints. . . . When our anal-
yses of individual behaviors and experiences
become inextricably linked to the structural,
historical, and situational context of people’s
lives, this allows us to extrapolate larger so-
ciological and epidemiological lessons while
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appreciating the complexity and distinctive-
ness of individuals.
If HIV transmission can be prevented, why
do an estimated 50,000 new infections oc-
cur annually in the United States? Why does
HIV prevalence differ by race, gender, sex-
uality, and class? We can begin addressing
these questions by considering previous re-
search, mostly epidemiological in nature, that
emphasizes individual risk behaviors and then
pivot to sociological research that places those
behaviors in a larger social context. The lat-
ter considers the role of risk environments in
HIV transmission, factors exogenous to the
individual that may contribute to HIV risk
(Rhodes et al. 2005), suggesting that physi-
cal and social spaces generate relationships be-
tween structural-, community-, and individual-
level HIV risk. As I discuss further below,
these relationships are largely shaped by a com-
plex array of public policies, macroeconomic
changes, racialized and gendered organizing
principles, dynamics of sexual and drug net-
works, neighborhood resources and deficits,
and individual behaviors.
Male-to-Male Sex and HIV
Transmission
MSM accounted for 52% of all people liv-
ing with HIV infection in 2009 (CDC 2013a).
According to the CDC (2013a), unprotected
receptive anal sex carries the highest risk for
HIV acquisition. Simultaneously, “homopho-
bia, stigma, and discrimination can put MSM
at risk for multiple physical and mental health
problems and affect whether MSM seek and
are able to obtain high-quality health services”
(CDC 2013a). MSM are more likely than other
men to experience clinical depression and anxi-
ety disorders, potentially increasing risk behav-
iors (Wolitski & Fenton 2011). Several studies
also find that MSM have elevated rates of child-
hood sexual abuse relative to the US population
and heterosexual men (Paul et al. 2001), and
Latino MSM are twice as likely as non-Latino
MSM to report a history of childhood sexual
Watkins-Hayes
abuse (Arreola et al. 2005). These experiences
increase the likelihood of high-risk sexual be-
havior later in life (Barnshaw & Letukas 2010).
In a study of gay and bisexual Latino men in
three US cities, Arreola and colleagues (2009)
find that those who reported childhood sexual
abuse were significantly more likely to report
sexual situations that involved drug and/or al-
cohol use, an escape from loneliness or depres-
sion, or a non-monogamous partner than were
those who reported no history of childhood sex-
ual abuse.
Sociologists explicate the broader social
norms, environments, and discourses that may
fuel conditions for HIV transmission. Sev-
eral studies point to the significance of so-
cial networks in shaping sex norms, as men
who perceive strong social support and risk
reduction norms among peers are less likely
to practice unprotected sex (McKechnie et al.
2013). Ghaziani & Cook (2005) generated a
conceptual framework to explain the hypoth-
esized link between “circuit party” attendance
by self-identified gay and bisexual men and
new HIV infections. Although intended to
promote HIV/AIDS awareness and encourage
gay community-building and promote cultural
identity, these weekend-long parties may in-
advertently encourage the spread of HIV by
creating an environment in which unprotected
sex frequently occurs. “Circuit parties,” the au-
thors write, “may be caught in a tension be-
tween building community and undermining
the basis for that very same community . . . by
endangering its collective health” (Ghaziani &
Cook 2005, pp. 42–43).
Other scholars incorporate structural ex-
planations for HIV risk. Diaz and colleagues
(2004) encourage scholars to think about HIV
risk as an outcome of social oppression, show-
ing that experiences of social discrimination and
financial hardship among gay Latino men are
strongly correlated with encountering risky sex-
ual situations that place them at risk for HIV
transmission such as sex involving drug or alco-
hol use or partners who resist condom use (also
see Mizuno et al. 2012). In line with this social
oppression framework, Ayala and colleagues
 SO40CH20-Watkins-Hayes ARI 1 July 2014 10:2
(2012) find that reported experiences with ho-
mophobia, racism, financial hardship, and lack
of social support were associated with unpro-
tected anal intercourse with a serodiscordant or
sero-unknown partner in a study of both black
and Latino MSM.
Not all sociologists have emphasized the
cultural and structural dimensions of HIV. In
his work on sexual narratives of Mexican gay
and bisexual immigrant men in San Diego,
Fontdevila (2009) focuses on the micro-level
interactions that facilitate HIV transmission,
emphasizing protective versus trusting frames
during sexual encounters. Protective cooper-
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ative frames promote self-protective barriers
such as condom use, whereas trusting cooper-
ative frames depend on trust, trustworthiness,
and reciprocity of information about HIV sta-
tus between sexual partners. Individuals often
move between frames during sexual encoun-
ters, reacting to contextual cues and deciding
in the moment whether to use condoms.
Fontdevila’s research contributes to the
growing body of work on HIV among Latinos,
who represented 16% of the US population
but accounted for 21% of new HIV infections
in 2010 (CDC 2013f ). As we consider future
research directions, the literature yields several
contradictory findings that highlight a need for
additional research and meta-analyses to parse
results. For example, studies have produced
mixed findings about whether cultural values
such as machismo, collectivity, and familism
encourage or discourage risky sexual behavior
in Latino communities (Alvarez et al. 2009,
Organista et al. 2004). Research also suggests
that migration and subsequent acculturation to
the host country decrease the likelihood of HIV
transmission, perhaps owing to sexual modesty
or a commitment to self-determination that
results in less risky sexual behavior (Marı́n
2003). Other studies find the opposite—higher
levels of risk among recent immigrants or less
acculturated Latinos(as)—hypothesizing that
immigration disrupts previous sexual relation-
ships and increases adventurism in a new sexual
culture (Organista et al. 2004). This has led
Carrillo (2004) to call on scholars to further
www.annualreviews.org • Intersectionality and the Sociology of HIV/AIDS
explore the relationship between sexual health
and migration that is directly or indirectly mo-
tivated by the sexuality of those who migrate.
“Assertions,” he argues, “are often made mostly
on the basis of the authors’ own perceptions
of Latino sexual culture and gender norms”
(p. 67).
Black MSM are currently experiencing the
highest HIV/AIDS infection rates relative to
their share of the population. In 2010, black
MSM represented an estimated 72% of new in-
fections among all black men and 36% of an
estimated 29,800 new HIV infections among
all MSM (CDC 2012). Millett and colleagues
(2006) published one of the most comprehen-
sive analyses of HIV infection rates among
black MSM. The authors find little empirical
evidence that high infection rates among this
group are due to riskier sexual behaviors, the re-
luctance to adopt a nongay identity or disclose
sexuality, or reported use of alcohol or illicit
substances, as “most studies have found compa-
rable, if not lower, self-reported rates of unpro-
tected anal intercourse for black MSM relative
to other MSM” (Millett et al. 2006, p. 1008).
Millett et al.’s (2006) review of the research
attributes high rates of HIV infection among
black MSM to a high prevalence of sexually
transmitted infections (STIs) that facilitate
HIV transmission. Network analysis by
Laumann & Youm (1999) points to higher
rates of STIs among blacks relative to whites in
general, driven by sexual networks that include
lower rates of interracial mixing and higher
levels of mixing among individuals exhibiting
high-risk versus low-risk behavior within the
population (also see Bingham et al. 2003,
Morris et al. 2009). In addition to such network
factors, undetected or late HIV diagnoses
due to infrequent or delayed testing are also
thought to be key drivers of high infection
rates among black MSM (Millett et al. 2006).
Men who are unaware of their HIV-positive
status are more likely to transmit the virus
to HIV-negative partners than are men who
know their positive status (Colfax et al. 2002).
In addition, black MSM who are HIV-positive
report less access to and use of medical care
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and HAART, which may keep them more
infectious longer (Millett et al. 2006).
Men on the so-called “down low” gained
widespread media and scholarly attention in the
last decade, in part because of speculation link-
ing them to rising HIV infection rates among
black women in particular. Using survey data
from the Urban Men’s Health Study, Barnshaw
& Letukas (2010) studied a sample of 2,881
white, black, and Latino MSM in four major US
cities, finding significant percentages of whites
(3.5) and nonwhites (2.3) who identify as “het-
erosexual/straight” or something other than
homosexual (2.8% whites, 5.9% nonwhites) yet
have sex with men.
The research linking these practices of sex-
ual self-identification to HIV rates is complex.
Millett et al. (2006) conclude that several stud-
ies overwhelmingly indicate that black MSM
are less likely than white MSM to identify as gay
and are less likely to disclose their sexual iden-
tity or behavior to associates. However, they
find little evidence that having a nongay identity
increases HIV risk-taking behavior with male
sexual partners among black MSM and may in
fact be associated with lower sexual risk-taking
(see also Millett et al. 2005). Nevertheless,
Mutchler et al. (2008) find that HIV-positive
MSMW who are less connected to a homosex-
ual identification had a greater probability of
engaging in unprotected sex with female part-
ners without disclosing their HIV status, and
black and Latino MSMW were more likely to
report unprotected sex with a female partner
without HIV status disclosure than were white
men (also see Zellner et al. 2009). This sug-
gests that MSMW who fail to disclose their sex-
ual histories to female partners may account for
some of the rise in HIV infection rates among
women, but more research is needed to assess
the magnitude of this relationship and ensure
that it is not overstated.
Heterosexual Sex and HIV
Transmission
Recent trends show that US AIDS cases trans-
mitted by male-to-male sexual contact and IDU
Watkins-Hayes
have decreased, whereas heterosexual transmis-
sion cases have increased (Espinoza et al. 2007).
Infections among women account for much of
this rise, as heterosexual sex is the predomi-
nate mode of HIV infection among this group
(Espinoza et al. 2007, Hader et al. 2001). By the
end of 2010, women represented one in four
people living with HIV infection in the United
States (CDC 2013e). Over the last 30 years, the
epicenter of the epidemic among women has
shifted from injection drug–using women in the
urban Northeast to women at high heterosex-
ual risk in the South, a region with some of the
highest STI rates in the country (Hader et al.
2001, Inrig 2011, Whetten & Pence 2013).
HIV is more efficiently transmitted from
men to women during vaginal or anal in-
tercourse than vice versa, owing to women’s
longer exposure to infectious fluids and in-
creased risk of tissue injury (Bolan et al. 1999,
Nicolosi et al. 1994). Nevertheless, research
overwhelmingly suggests that the social di-
mensions of gender roles and hierarchies are
also key drivers of the dramatic increase in HIV
prevalence among women. As Farmer and col-
leagues (1996) note, those hurt most by gender
inequality, racism, and stigma worldwide are
the most vulnerable to the vagaries of the epi-
demic (see also Adimora et al. 2013, Campbell
1999, Schneider & Stoller 1995). Women are
more likely to be forced into survival-focused
behaviors such as transactional sex for money,
housing, protection, employment, and other
basic needs; power-imbalanced relationships
with older men; and other partnerings in which
they cannot dictate the terms of condom use,
monogamy, or HIV testing (Farmer et al.
1996, Gupta 2004). There is also evidence
that sexual violence places female victims at
risk for HIV infection (Bensley et al. 2000,
Wyatt et al. 2002). Childhood sexual abuse
is a predictor for later nonconsensual sexual
contact as well as substance abuse, multiple
sex partners, and failure to self-protect (Cohen
et al. 2000, Voisin 2005, Wyatt et al. 2002).
HIV prevalence is also much higher among
women suffering from mental illness; the
mental instability and limited power that this
 SO40CH20-Watkins-Hayes ARI 1 July 2014 10:2
diminished and stigmatized social standing
often produces makes them vulnerable (Collins
et al. 2008, Meade & Sikkema 2005).
In 2010, the rate of new HIV infections
among black women was 20 times that of
white women (CDC 2013e). Immigrant sta-
tus, poverty, and traditional ideas about gen-
der roles and skin tone hierarchies can also
work against the abilities of Latinas—whose
rate of new HIV infections was 4.2 times
the rate of white females in 2010—to pro-
tect themselves (Collins et al. 2008). Black
women who are diagnosed HIV-positive of-
ten have no identified or reported risk fac-
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tors and are more likely than white women to
have acquired HIV through heterosexual sex
rather than illicit drug use (Hader et al. 2001).
Collins (1990) points to “sexualized racism”
as an important driver, producing conditions
in which multiple systems of power frame
black women’s sexual options and decision-
making (Gilbert & Wright 2003, Hammonds
1995). Such cultural–historical frames—driven
by stereotypical assumptions, assaults to black
women’s self and societal worth, and silences
that ignore threats to their health—collide with
material and epidemiological realities that in-
crease their risk of exposure to HIV. For ex-
ample, among racial groups, blacks are the
least likely to receive treatment, resulting in
greater risk of transmission within the popu-
lation (Arnold et al. 2009). The sex ratio in
many black communities contributes to dense
social-sexual networks within an economically
and racially segregated context (Adimora &
Schoenbach 2005, Wilson 1987), as “the short-
age of men places women at a disadvantage in
negotiating and maintaining mutually monog-
amous relationships” (Adimora & Schoenbach
2005, p. S118). In an analysis of data from four
nationally representative US surveys, Morris
and colleagues (2009) find consistent support
for the hypothesis that higher levels of con-
current sexual partnerships among blacks, cou-
pled with race-specific patterns of homophily,
may help to explain the disproportionately high
prevalence of HIV and other STIs among
blacks.
www.annualreviews.org • Intersectionality and the Sociology of HIV/AIDS
Scholars have, however, warned against em-
bracing what Higgins and colleagues (2010)
term “the vulnerability paradigm,” which sug-
gests that women are universally oppressed
and men are a powerful, monolithic group.
Although biological differences and patriar-
chal social structures are important drivers of
the epidemic among women, the vulnerability
paradigm fails to recognize heterosexual men as
potential agents of prevention:
The paradigm assumes not only that women
(but not men) want to prevent HIV but lack
the power to do so, but also that men are more
likely than women to bring HIV into the part-
nership. . . . The vulnerability paradigm can
also mask women’s power and agency. Sim-
ilarly, men, but not women, are presumed
to engage deliberately in risky practices.
(Higgins et al. 2010, p. 435)
Challenging the vulnerability paradigm pro-
vides a more nuanced view of the drivers of het-
erosexual HIV transmission. Sobo (1995) cap-
tures the complexity of women’s sexual agency
in Choosing Unsafe Sex, arguing that the expec-
tations and understandings that undergird het-
erosexual unions encourage unprotected sex.
Women may be more vulnerable due to “wish-
ful thinking engendered by women’s hopes for
their relationships and their desires to preserve
status and self-esteem” (Sobo 1995, p. 1). Such
risk denial is inextricably linked to the need to
believe that their unions meet expectations, that
they are wise enough to parse risk, and that the
men in their lives are monogamous.
As heterosexual men grapple with norms
of masculinity that shape their sexuality, they,
too, confront risky situations (CDC 2013b).
As Bowleg & Raj (2012, p. S173) point out
in a commentary on HIV prevention for black
heterosexual men (BHM), “Black heterosexual
women and BHM live, work, socialize, worship,
and form romantic and sexual relationships in
the same communities, and as epidemiological
data document, share sexual risk within their
communities.” In research on Mexican day la-
borers, Organista (2007) finds that men who
439
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440
ARI 1 July 2014 10:2
report a stressful and vulnerable state of des-
peration due to their economic and social strug-
gles and difficult work conditions in the United
States are more likely to engage in risky sex
(also see Organista et al. 2004). Nevertheless,
Higgins et al. (2010) observe that, although
heterosexual sex is the leading means of HIV
transmission worldwide, programs and policies
largely fail to include the prevention needs of
men who have sex with women.
Intravenous Drug Use and HIV
Transmission
Sociological approaches have also been adopted
to consider HIV risk through IDU, which was
the reported mode of transmission for 16% of
those living with HIV in 2009 (CDC 2012,
2013f ). Arnold et al. (2009) find that IDU is
a significant predictor of delayed or no medi-
cal treatment as well as higher mortality among
people living with HIV/AIDS. Non-Hispanic
blacks are overrepresented among users, and
this likely contributes to disparities in treat-
ment take-up between HIV-positive blacks and
the rest of the population. In 2005 several lead-
ing scholars, including Tim Rhodes, Philippe
Bourgois, and Samuel Friedman, published a
review of literature on the social-structural
production of HIV risk associated with IDU
(Rhodes et al. 2005). Factors that appear to in-
crease the availability and use of contaminated
needles and thus increase vulnerability to HIV
transmission include the presence of shooting
galleries, severe neighborhood disadvantage,
neighborhood transitions produced by gentri-
fication that disrupt social networks, and pop-
ulation movement that facilitates the transport
of drugs (also see Ciccarone & Bourgois 2003).
HIV, Place, and Space
HIV is tied to place, space, and region in im-
portant ways. The more income inequality in a
state, the higher the AIDS case rate (Holtgrave
& Crosby 2003). The largest number of people
living with HIV resides in the South, but ac-
counting for population size the Northeast has
Watkins-Hayes
the highest number of cases per 100,000 people
living with HIV infections. Largely an urban
disease in the United States, most HIV cases
occur in cities with 500,000 or more people.
The legacy and contemporary effects of
racial residential segregation have had an im-
measurable impact on the AIDS epidemic in
this country, compounding racial and class
differences in health. The CDC (2010) esti-
mates that 2.1% of heterosexuals living in high-
poverty urban areas in the United States are
HIV-positive, a rate well above the 1% that
designates a generalized epidemic. Residents of
these communities overwhelmingly are black
and Latino (Massey & Denton 1993, Wilson
1987). Consequently, although gay and bisex-
ual men continue to represent the majority of
new infections, the CDC identifies poverty as
“the single most important demographic fac-
tor associated with HIV infection among inner-
city heterosexuals” (CDC 2010, p. 1). Singer
et al. (2006) and others have developed the
concept of “syndemics” to describe the over-
lapping and mutually reinforcing epidemics of
substance abuse, violence, and HIV that arise
under conditions of severe health and social dis-
parities that we see among inner-city and other
vulnerable populations.
Why have neighborhood conditions be-
come so important in HIV transmission?
Neighborhood and resident characteristics
likely mutually reinforce each other and
contribute to health outcomes (Cummins
et al. 2007). Regarding HIV among inner-
city blacks, neighborhoods that experienced
decades of racial segregation through formal
and informal policies and practices throughout
the twentieth century were dealt a critical eco-
nomic blow with the decline of manufacturing
jobs, the rise of a low-wage and less-stable
service sector, the movement of higher-paying
jobs to predominately white suburban areas
and overseas, and public policies that reduced
resources for community health as well as
financial assistance (Massey & Denton 1993,
Wilson 1987). These shifts increased economic
vulnerability, diminished collective efficacy
and political clout, and spawned underground
 SO40CH20-Watkins-Hayes ARI 1 July 2014 10:2
economies for drug- and sex-based exchanges
(Forbes 1993, Fullilove et al. 1993). These
communities perpetually battle a perfect storm
of historical and contemporary economic, po-
litical, and social disadvantages, creating condi-
tions that enable an “exogenous shock” such as
an infectious disease epidemic to have a massive
impact.
As a symbolic and actual assault on lives
and livelihoods, the AIDS epidemic in poor
black communities demonstrates how commu-
nity and neighborhood factors affect health out-
comes. The volatility of state budgetary en-
vironments contributed to a slow response to
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HIV and limited availability of HIV testing and
prevention services in the early years (Arnold
et al. 2009). A weak community health-care
system continues to undermine regular health
screenings and also affects services for men-
tal illnesses, which can increase the likelihood
of high-risk sexual or drug-related behaviors
(Chow et al. 2003).
Over the last 30 years, the war on drugs and
get-tough-on-crime measures have massively
increased both the size of the prison population
and the cycling in and out of these institutions,
disproportionately impacting black and Latino
communities (Alexander 2010). Evidence
suggests that this mass incarceration boom
has contributed to a social context in which
HIV and other STIs proliferate ( Johnson &
Raphael 2006, Kim et al. 2002) by linking
two institutions (prisons and neighborhoods)
and producing long-term health consequences
not only for prisoners but also for their
intimate partners and other family members
(Freudenberg & Ramaswamy 2009, Schnittker
et al. 2011, Wacquant 2001): “Homosexual
contact and STD and HIV outbreaks have been
documented among men in protective custody
settings, the HIV infection rate is 5 times higher
in prisons than in the general population, and
fewer than 1% of correctional facilities nation-
ally permit the distribution of latex condoms”
(Millett et al. 2006, p. 1014; see also Braithwaite
& Arriola 2003, Lichtenstein 2000). Black
MSM are also more likely than other MSM
to report a history of incarceration. There
www.annualreviews.org • Intersectionality and the Sociology of HIV/AIDS
is growing consensus among scholars that
most HIV-infected prisoners are not infected
while in prison (Braithwaite & Arriola 2003,
CDC 2006) but instead become infected in the
community because these individuals are more
likely to engage in risky behaviors (Blankenship
et al. 2005). It does not help that cycling in and
out of correctional facilities undermines the
stability of relationships between inmates and
their partners: “The partner entering prison
is now at risk of forming new (sometimes
coercive) sexual connections with a pool of
individuals [prone to] high-risk behaviors, HIV
infection, and other STIs. . . . The partner who
remains behind . . . forfeits the social and sexual
companionship of the incarcerated partner
and may pursue other partnerships to satisfy
those needs” (Adimora & Schoenbach 2005,
p. S119; also see Kim et al. 2002). There is also
evidence to suggest a high prevalence of both
HIV risk behaviors and HIV infection among
imprisoned female populations (Kramer &
Comfort 2011, McClelland et al. 2002).
Neighborhood conditions also foster net-
work dynamics that drive the epidemic. Like
other social networks, sexual and drug networks
can confine or spread HIV infection within
and across communities in ways that paral-
lel social and economic exchanges (Laumann
et al. 1994, 2004). This phenomenon is com-
pounded by a lack of resources, which may
hamper the widespread distribution of preven-
tion and treatment efforts. Thus, even if in-
dividual behaviors match those of the general
population, in a network with a higher HIV-
infection rate, the risk of new infection in-
creases. In the well-known HIV Epidemiol-
ogy Research Study (HERS) of HIV-positive
women and women at risk for HIV, a surprising
one-third of respondents report having mul-
tiple family members with HIV/AIDS (Fiore
et al. 2001). This suggests that social ties not
only exacerbate the spread of HIV but also af-
fect how individuals make sense of the infection.
All of these dynamics reveal the mechanisms by
which neighborhoods are linked to structural
and institutional forces in ways that leave resi-
dents physically vulnerable.
441
 SO40CH20-Watkins-Hayes ARI 1 July 2014 10:2

Other Populations in the in 2010 were 55 years of age or older, includ-

AIDS Epidemic ing those “aging with HIV” as well as the 5%
of newly diagnosed individuals in this cohort.
Near-universal testing of pregnant women,
Members of this latter group often have lim-
treatment for mothers and babies, and avoid-
ited knowledge about HIV and how to prevent
ance of breastfeeding by HIV-infected moth-
transmission, may use condoms inconsistently,
ers have virtually eliminated mother-to-child
and are frequently diagnosed later in the course
transmission in the United States (De Cock
of the disease because of a lack of testing.
et al. 2013). As researchers make significant
The epidemic among young people is now
strides in documenting the demographics of
also receiving increased focus. Youth ages 13
HIV/AIDS and the social dimensions of risk,
to 24 comprised 16% of the US population in
other highly affected groups are rightly receiv-
2010 yet accounted for 26% of all new infec-
ing increased scholarly attention. Sex workers
tions (CDC 2013f ). Given these numbers, so-
face high HIV infection rates in part because of
ciological research on HIV among youth is ur-
Annu. Rev. Sociol. 2014.40:431-457. Downloaded from www.annualreviews.org

inconsistent condom use, high numbers of part-

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gently needed. In their analysis of data from

ners, and drug use, as well as circumstances that
the National Longitudinal Study of Adoles-
may hinder access to HIV prevention resources
cent Health, Mojola & Everett (2012) find that
such as stigma, mental health issues, lack of ac-
sexual-minority young women in each racial
cess to health care and other social services,
and ethnic group have a higher prevalence
and poverty (Campbell 1999, CDC 2013g,
of risky sexual behaviors than their hetero-
McMahon et al. 2006). Scholars have also iden-
sexual counterparts. Young MSM in all racial
tified higher exposure to HIV risk among in-
and ethnic groups are significantly more likely
dividuals working in settings where sex is indi-
than heterosexual white men to report hav-
rectly sold, such as massage parlors and exotic
ing received an STI diagnosis, a risk factor
dance clubs (Sherman et al. 2011).
for HIV infection, and young black MSM are
Discrimination and social stigma likely con-
seven times more likely to have an undiag-
tribute to the high HIV rates among trans-
nosed HIV infection than other young MSM
gender women (male-to-female). Estimates
(CDC 2012, Millett et al. 2012). Between 2008
based on meta-analysis of biological data sug-
and 2010, new infections increased 20% among
gest that this population has an HIV sero-
black MSM ages 13 to 24, representing 45%
prevalance of 28%, with extremely high sero-
of all new infections among black MSM (CDC
prevalence (56%) among African American
2013a).
transgender women (Herbst et al. 2008). In
These trends signal once again the need
a study conducted in New York City from
for an intersectional perspective that addresses
2007 to 2011, 51% of transgender women di-
how race, sexuality, and age may limit the
agnosed with HIV had documentation in their
available resources to prevent HIV transmis-
medical records of substance use, commercial
sion. Like other populations that experience se-
sex work, homelessness, incarceration, and/or
vere marginalization, young MSM, especially
sexual abuse, compared with 31% for other
those of color, may be disconnected from their
HIV-positive people who were not transgen-
families as well as resources such as hous-
der (CDC 2013d). Several scholars have called
ing, employment, and health care in ways that
for multicomponent interventions that also ad-
make them vulnerable to engaging in survival-
dress the syndemic interactions between sub-
focused behaviors that increase their HIV risk.
stance abuse, mental health, poverty, and HIV
Higher rates of family rejection among lesbian,
risk behaviors among this population (Brennan
gay, or bisexual (LGB) youth are significantly
et al. 2012, Operario & Nemoto 2010).
associated with poorer health outcomes, includ-
According to the CDC (2013c), 19% of in-
ing being 3.4 times more likely to report hav-
dividuals living with HIV in the United States
ing engaged in unprotected sexual intercourse

442 Watkins-Hayes
 SO40CH20-Watkins-Hayes ARI 1 July 2014 10:2
compared with LGB peers who reported no or
low levels of family rejection (Ryan et al. 2009).
Mojola (2013) has prescribed a life course per-
spective to examine these issues more closely,
charting the fluctuation of HIV risk at various
stages of life.
As a result of sociologically driven inquiry,
researchers are increasingly advocating struc-
tural HIV prevention, which consists of not
only “targeted interventions fostering changes
in individual behaviour, but also interventions
creating local environments conducive to, and
supportive of, individual and community-level
behavior change” (Rhodes et al. 2005, p. 1027).
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Although men and women of diverse sexual ori-
entations and racial and socioeconomic back-
grounds engage in risk behaviors such as un-
protected sex, the infection rates among MSM,
women, blacks, and the poor (and especially
those in intersecting categories) suggest that
groups that have been socially or economically
marginalized are particularly vulnerable to HIV
infection. The research overwhelmingly sug-
gests that people are differentially exposed to
HIV on the basis of their social locations in
ways that mirror exposure and vulnerability to
damaging structures of inequality, requiring ap-
proaches that account for the epidemic’s inter-
sectional inequalities.
LIVING WITH HIV/AIDS: THE
MEDICAL, SOCIAL, AND
ECONOMIC TRIAD
How do social group memberships, and the sta-
tuses that they confer, have the potential to
shape not only the social context of risk but also
how individuals live with HIV? HIV interacts
with already existing social advantages or dis-
advantages, becoming a component of identity
that intersects with race, class, gender, and sex-
uality. Together, these interlocking positions
produce social meaning; limit or grant power;
and interact with structures, institutions, and
individuals to shape the experience of being
HIV positive.
We can imagine the management of HIV
requiring at least a three-pronged approach—
www.annualreviews.org • Intersectionality and the Sociology of HIV/AIDS
medical, social, and economic—with each com-
ponent having practical and symbolic elements.
In recent years, advances in and access to
treatment—including effective drug therapies
and better monitoring of viral loads and T cell
counts—have greatly improved the capacity of
HIV-positive people to carry out their normal
routines and experience longer life expectan-
cies. But the medical management of HIV chal-
lenges individuals to manage their physical and
mental health within a social context that can
be stigmatizing or limited in resources. Medi-
cation adherence can reflect the compromises
made while resolving contradictory demands
regarding how medications are to be taken and
the realities of work and social lives (Adam et al.
2003). Many utilize complementary or alterna-
tive therapies, which are increasingly viewed as
important tools for inserting personal agency
into treatment practices and coping with the
uncertainty of illness symptoms and the side
effects of traditional medications (Foote-Ardah
2003).
Yet effective management of HIV requires
access to and relationships with medical insti-
tutions and representatives, which are uneven
across populations (Chase 2011). As Arnold and
colleagues (2009, p. 121) explain, “the health
and longevity benefits of antiretroviral ther-
apy (ART) for persons living with AIDS have
not been equally distributed across racial/ethnic
groups in the United States.” Non-Hispanic
blacks have a lower survival rate after an AIDS
diagnosis, likely due to a lack of timely treat-
ment. Arnold and colleagues (2009) link these
treatment disparities to neighborhood effects.
Yet scholars have been unable to disentan-
gle whether the mechanisms driving blacks’
higher AIDS mortality rates are physical and
social stressors in these communities (Ellen
et al. 2001, Kirby & Kaneda 2005); individ-
uals’ material circumstances (Boardman 2004,
Ironson et al. 2008); lack of access to and trust
in the health-care system (Altice et al. 2001,
Espinoza et al. 2007, King et al. 2004); or so-
cial networks that adversely influence health-
related behaviors, attitudes, and norms. Some
scholars have also suggested that HIV stigma
443
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444
ARI 1 July 2014 10:2
and concerns about anonymity when access-
ing HIV/AIDS services may reduce residents’
utilization (Lichtenstein et al. 2005, Wingood
et al. 2007).
Sociologists have been keenly interested in
the social management of HIV, addressing is-
sues such as stigma, disclosure, social sup-
port, and the social significance of both HIV-
positive status and the larger AIDS epidemic
(Ciambrone 2003). Coping with HIV has often
meant simultaneously managing its physical de-
mands and experiencing a social status that can
diminish connections, existing resources, and
social standing (Derlega & Barbee 1998). Indi-
viduals with HIV often seek to reclaim a “safe”
moral identity by looking for social meaning in
their diagnosis and heavily controlling the con-
ditions under which they disclose their status
(Stanley 1999).
Now that people are living longer with
HIV, building families, establishing friend-
ships, creating intimate relationships, and other
forms of social support are associated with
fewer reported negative changes, less depres-
sion, greater adherence to HAART, improved
consistency of medical care, and greater op-
timism among those living with HIV/AIDS
(Updegraff et al. 2002, Wagner et al. 2002).
Social support networks derived from ties to
AIDS service providers can support a con-
ceptual framework for understanding what it
means to have HIV, language in which to talk
about the condition, and networks and other re-
sources to begin restructuring life in the wake of
a diagnosis (Watkins-Hayes et al. 2012). How-
ever, HIV-positive women are often expected
to manage both their own health and that of
their intimate partners, which can undermine
household stability (Wright 2003).
Finally, economic issues can be critically im-
portant for HIV-positive individuals. At first,
when postdiagnosis life expectancy with HIV
was limited, there were marked declines in la-
bor force participation among HIV-positive in-
dividuals (Ezzy et al. 1999, Massagli et al. 1994,
Yelin et al. 1991). With the advent of HAART,
although many express a desire to return to
work (Ghaziani 2004), a range of factors can
Watkins-Hayes
discourage such a move: the unpredictability
of positive drug effects, potentially debilitating
medication side effects, the potential for be-
ing unable to secure disability insurance cov-
erage should a relapse occur, difficulties with
transitioning back into the labor force after a
long absence, non-health-related employment
instability, HIV-related symptoms, the effects
of long work hours and work stress on health,
potentially unhealthy work environments, dif-
ficulty in managing medical appointments and
elaborate drug regimens while working, and the
fear that disclosure might result in losing one’s
job (Brooks et al. 2004, Ferrier & Lavis 2003,
Nixon & Renwick 2003, Timmons & Fesko
2004). The powerful tension between an indi-
vidual’s desires, financial needs, and fears in-
volved in working while living with HIV/AIDS
generates a calculus that involves economic
and personal considerations when an individ-
ual considers remaining in the labor force or
returning after an extended absence.
Nevertheless, for a subsegment of HIV-
positive individuals, some of the very circum-
stances, histories, barriers, and behaviors that
increased their risk of infection might also make
them less employable. They may be so disad-
vantaged that they find that their economic for-
tunes actually stabilize following an HIV diag-
nosis due to their increased access to services
through state and nonprofit entities (Collins
et al. 2008, Crane et al. 2002, Dickson-Gomez
et al. 2011, Watkins-Hayes 2013). Institutional
ties become important to help highly econom-
ically marginalized HIV-positive people avoid
situations that will likely further endanger their
health such as homelessness, drug addiction,
and risky sexual relationships that may never-
theless yield resources.
In short, many HIV-positive individuals
confront what Berger (2004) terms “intersec-
tional stigma,” marginalization based on HIV
status and other disadvantaged statuses. Stres-
sors associated with institutional and inter-
personal racism, sexism, and economic hard-
ships compound the psychological distress of
people living with, or at higher risk for con-
tracting, HIV/AIDS (Battle 1997, Catz et al.
 SO40CH20-Watkins-Hayes ARI 1 July 2014 10:2
2002, Chase 2011, Ciambrone 2003, Gilbert
& Wright 2003, Hammonds 1995, Zierler &
Krieger 1997). We therefore cannot talk about
a lived experience with HIV without consider-
ing how interlocking oppressions can circum-
scribe how individuals work, love, and live. For
some, confronting HIV includes becoming en-
gaged politically to challenge dominant nar-
ratives that frame them as powerless, socially
dysfunctional, irresponsible, and unable to con-
tribute because of their social group member-
ships (Berger 2004, Epstein 1996, Gould 2009,
Stockdill 2003). By offering this range of expe-
riences of HIV-positive people, scholars have
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produced a more complex, nuanced, and accu-
rate story about the AIDS epidemic.
With research in this area moving forward,
new questions will emerge as the epidemic con-
tinues to evolve. A growing consensus finds that
early initiation of HAART not only improves
individual patient outcomes but also reduces
the risk of HIV transmission to uninfected part-
ners. Sociologists can use ethnographic, survey,
mixed-method, comparative, and other meth-
ods to explicate the barriers to the widespread
adoption of this promising development. Pre-
vious research has focused a great deal on the
patients in this equation, but medical providers
can be pivotal in determining whether and
when an HIV-positive individual starts treat-
ment (Laws et al. 2013). Further, in this era of
growing income inequality, sociologists would
be wise to focus on the widening gap in medical,
social, and economic experiences among HIV-
positive people. Lastly, as the goals of the Na-
tional HIV/AIDS Strategy, as outlined by Pres-
ident Obama, intersect with massive changes in
the health-care system through the Affordable
Care Act, sociological research can track dy-
namics around how AIDS treatment and pre-
vention services are distributed. This is particu-
larly important in the wake of potential changes
to the Ryan White Act, which has historically
funded numerous medical and social service ef-
forts against HIV. Scholars are well positioned
to gauge whether a national focus on disease
prevention and increased access to affordable
care indirectly and directly contributes to im-
www.annualreviews.org • Intersectionality and the Sociology of HIV/AIDS
proved quality of life for people living with
HIV/AIDS.
CONFRONTING HIV/AIDS:
SERVICES, ACTIVISM, AND
PUBLIC POLICY
The synergistic relationship between the
HIV/AIDS research, clinical, programmatic,
and activist communities is noteworthy for its
commitment to praxis, the merging of theory
and action so that ideas are engaged and ap-
plied. These networks operate in many of the
same professional spaces and constantly chal-
lenge each other to notice blind spots. Sci-
entific information can then be distributed to
those doing HIV prevention and treatment
work on the ground, and lessons learned from
activists and service providers can help the sci-
entific and clinical communities better respond
to the constantly changing dynamics of the epi-
demic. This was a hard-fought relationship, es-
pecially in the early stages when activists and
HIV-positive individuals found themselves on
the margins of professionalized AIDS knowl-
edge production (Epstein 1996) and, as Gould
(2009) demonstrates in her “emotional his-
tory” of the AIDS Coalition to Unleash Power
(ACT UP), the targets of “aggressive indiffer-
ence, extreme negligence, and punitive poli-
cies regarding AIDS” (p. 45). Nevertheless, the
AIDS research-clinical-programmatic-activist
community relationship now demonstrates that
research can illuminate how power is embedded
in HIV as a medical problem, a social issue, and
an area of inquiry.
AIDS has always been a fraught political is-
sue in part because of its relationship to con-
troversial and intractable debates. Cultural crit-
ics such as Susan Sontag (2001), Randy Shilts
(1987), and Paula Treichler (1999) were early
observers of these connections. When AIDS
emerged in the United States, gay men and in-
travenous drug users represented the bulk of re-
ported cases, fueling a disease narrative that em-
phasized individual behavior and stigmatized
identities. As “the modern plague” (Sontag
2001), HIV was linked not only to death but
445
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446
ARI 1 July 2014 10:2
also to homosexuality, promiscuity, and ille-
gal drugs, casting it as divine punishment for
“deviant behavior” (Adam 1989). Exceptions
such as the youngster Ryan White and tennis
pro Arthur Ashe were presented as “victims”
of the disease infected through blood transfu-
sions rather than sexual behavior. Groups such
as the Gay Men’s Health Crisis, ACT UP, and
others mobilized, fighting not only a medical
condition but also its stigmatized associations
that limited funding for research, prevention
education, and treatment (Cohen 1999, Epstein
1996, Gamson 1989, Gould 2009, Shilts 1987,
Stockdill 2003). Countering this narrative,
white gay men worked vigorously to present
the impact of AIDS on their communities, of-
fering detailed, eloquent, and sympathetic me-
dia portrayals to “reveal to the larger hetero-
sexual world the emotional toll that AIDS has
taken in gay communities while breaking down
stereotypes about gay life” (Hammonds 1995,
p. 438). A population that had been hidden,
maligned, and poorly understood was able to
tell its stories, revealing some of the “junctures
and disjunctures in our beliefs about sexuality
and sexual practices as well as the anxieties in
American life about sex and morality” (p. 438).
These strategies sought to keep gays from being
“scripted out of narratives of American national
belonging” ( Jenkins 2007, p. 5).
The ability to couple aggressive political
mobilization with economic capital, highly re-
sourced social networks, and the authority be-
stowed through racial privilege translated into
focused attention on the challenges faced by
(mostly) white gay middle-class men and ex-
posed deep societal homophobia. However,
their stories came overwhelmingly to repre-
sent the universal experience of HIV/AIDS,
marginalizing the struggles of other groups who
were having different experiences by virtue of
race, gender, class, and sexuality. Presenting
sexual orientation as almost the sole category of
significance at the outset obscured how racial,
gender, and class inequalities were also pow-
erfully shaping the epidemic. In reality, the
community of individuals mounting a collective
response to AIDS through community-based
Watkins-Hayes
services, political activism and social move-
ments, and public policy has been vast and
diverse (Stockdill 2003). Groups such as Sis-
terlove, the Well Project, the Positive Women’s
Network, and the Black AIDS Institute have
been confronting not only the epidemic itself
but also the social and political inequalities that
drive it. They also challenge racism and sex-
ism within the AIDS advocacy community, con-
stantly pushing a deeper analysis of dimensions
of privilege that influence issues ranging from
the policy and programmatic interventions cho-
sen to stem the epidemic to the ways in which
AIDS organization funding is distributed.
These advocates work to ensure that resources
are both administered by and reach people of
color, who operate through trusted relation-
ships in the hardest hit communities, but lack
the resources of wealthier institutions to sustain
the services (Wilson 2014). In addition, women,
largely neglected as the focus of research, treat-
ment, and education in the epidemic’s earliest
stages (Goldstein & Manlowe 1997, Higgins
et al. 2010, Roth 1998), have organized into
“workable sisterhoods” to combat stereotypes
and politically advocate for increased attention
and resources (Berger 2004). As a result, con-
fronting intersectional stigma through politi-
cal and social engagement has been shown to
have status-enhancing effects for HIV-positive
activists (Berger 2004, Watkins-Hayes 2013).
Internal challenges have reduced or delayed
AIDS activism among some subpopulations
most affected by the epidemic. In her influential
book, The Boundaries of Blackness: AIDS and the
Breakdown of Black Politics, Cohen (1999) writes
of silence inside black communities about
the epidemic’s impact due to a commitment
to a politics of racial respectability among
black leaders, black media, and others (see also
Quimby & Friedman 1989). Cohen (1999)
argues that religious beliefs and class divisions
likely fueled this dynamic as community leaders
were reluctant to rally behind those most likely
to be infected—gay men, intravenous drug
users, low-income women, and sex workers.
Coupled with a slow response to the rising
HIV infection rates among blacks by the CDC,
 SO40CH20-Watkins-Hayes ARI 1 July 2014 10:2
many white-dominated HIV advocacy organi-
zations, and the general public, the epidemic
has been able to gain a foothold that black
communities are still struggling to loosen.
Despite these difficulties, HIV-focused sup-
port groups, social service agencies, and ad-
vocacy groups located all over the country
have been critically important in helping peo-
ple cope with their diagnoses (Watkins-Hayes
et al. 2012, Watkins-Hayes 2013). Their work
has also educated the public and expanded the
advocacy network by engaging other kinds of
institutions such as drug and alcohol rehabilita-
tion centers, churches, ballroom communities,
Annu. Rev. Sociol. 2014.40:431-457. Downloaded from www.annualreviews.org
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and correctional facilities in AIDS-related work
(Bailey 2013, Bowleg & Raj 2012, Grinstead
et al. 2001, Linnan & Ferguson 2007). In her
recent book, Live Long and Prosper: How Black
Megachurches Address HIV/AIDS and Poverty in
the Age of Prosperity Theology, Barnes (2013)
demonstrates that black churches offer a vari-
ety of responses to the epidemic through AIDS
ministries. As a result of these mobilization ef-
forts, significant progress has been made to
combat AIDS stigma, increase treatment op-
tions, create a network of AIDS services, and
expand AIDS education.
In coming years HIV/AIDS will remain an
important case study in coalition politics and
new questions will emerge. As disparate groups
battle this epidemic of intersectional inequal-
ity, will their organizational power dissolve or
change as the medical and social realities of
the epidemic shift with new scientific develop-
ments? As the US AIDS epidemic continues to
slip from the national consciousness, will its em-
bedded inequalities deepen? In addition, new
frontiers in the study of the political response
to the AIDS epidemic must examine how these
fault lines shape emerging policy and legal bat-
tles. Adam (1989, p. 2) writes, “It is proba-
bly fair to say that no one objects to the con-
trol and eradication of the causative agent(s) of
AIDS, but AIDS control policy has always been
much more and has inevitably raised the ques-
tion of the supervision and regulation of sex-
uality.” For example, Hoppe’s (2013a,b) work
on laws requiring individuals to disclose their
www.annualreviews.org • Intersectionality and the Sociology of HIV/AIDS
HIV-positive status to their sexual partners un-
derscores the “criminalization of sickness” in
ways that Hoppe argues are less about public
health concerns and more about framing HIV
as a moral infection requiring interdiction and
punishment. These and other issues represent
the next frontier in the sociology of HIV/AIDS.
CONCLUSION: FUTURE
DIRECTIONS IN THE
SOCIOLOGY OF HIV/AIDS
As we ponder the possibility of the beginning of
the end of HIV/AIDS in the United States, the
moment can be characterized by both optimism
about the scientific possibilities and persistent
concerns about the 1.1 million people who
struggle daily against the virus, the several mil-
lion who experience complex inequalities that
disproportionately place them at risk for infec-
tion, and the ongoing social divisions that ren-
der certain groups “expendable” and “disease-
worthy” when serious health threats emerge. As
the Lancet (2012, p. 1967) points out, “Eradicat-
ing a disease goes far beyond scientific advances,
which will go unrealized without strong social
support and public health actions as well as sub-
stantial and sustainable investments. . . . End-
ing stigma and discrimination against people
living with HIV, men who have sex with men,
sex workers, and people who inject drugs—as
well as improving these peoples’ access to and
uptake of HIV services—[are] the underlying
principles [necessary] to fulfil the vision.”
In summary, the sociology of HIV/AIDS
can be credited with at least three important
contributions to the scholarly, policy, and pro-
grammatic response to the AIDS epidemic as
well as the field of sociology. First, scholars
have systematically challenged the overempha-
sis on biomedical and individual behavioral ap-
proaches to HIV and successfully advanced a
focus on the social dimensions of HIV. This has
blossomed into an emphasis on racial inequal-
ity, economic conditions, public policies, social
networks, neighborhood dynamics, and cul-
tural norms to explicate the multi-dimensional
nature of HIV risk, the lived experiences of
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448
ARI 1 July 2014 10:2
HIV-positive people, and the collective re-
sponse to the epidemic. Second, sociologists
have contributed to the expanding use of in-
tersectional approaches in the study of health.
Not only has HIV status powerfully interacted
with race, class, gender, and sexuality in shap-
ing identity and meaning-making, but sociolog-
ical work has also demonstrated how HIV re-
flects contours of power in transmission risk,
lived experiences, and politics. Third, the so-
ciology of HIV/AIDS represents an important
model demonstrating how research can be con-
ducted that respectfully but rigorously exam-
ines all aspects of human behavior, including
behaviors that fall outside of traditional norms.
In all of the reviewed research, scholars have
had to grapple with the inherent complexities
and power imbalances associated with launch-
ing inquiry into some of the most intimate as-
pects of people’s lives.
Perhaps sociologists’ most important con-
tribution will be to continue revealing how be-
haviors and events that appear at first glance
to be solely bodily and biological are actually
socially driven. For example, the opportunity
and decision to wear a condom to prevent HIV
transmission is not simply a precautionary med-
ical act but a negotiated behavior that may be
grounded in power dynamics between sexual
partners, investments in gender respectability,
and the freedom to realize and assert a particu-
lar sexual identity. Infection risk exists in a con-
text in which social networks, including sexual,
economic, and drug networks, are embedded
in racialized, gendered, and economic environ-
ments that produce uneven capacities and re-
sources. It is clear that interlocking inequalities
both directly and indirectly drive the epidemic
within the wide matrix of identity and power.
Having identified substantive directions in
which the sociology of HIV/AIDS might move
throughout this article, in what follows I iden-
tify four key considerations for intersectional
approaches to the field. First, the objective of
intersectionality studies is not to offer a stan-
dardized method (Cho et al. 2013, Hankivsky
2012). Sociologists of HIV/AIDS who adopt
Watkins-Hayes
an intersectional framework should feel free
to use all the tools at our disposal—such as
network analysis, surveys, and ethnography—
to carry out our work. Although large-scale
randomized controlled trials are still consid-
ered the gold standard in HIV/AIDS research,
other techniques that capture the interplay be-
tween social categories should continue to be
deployed (Mustanski 2001). Community par-
ticipatory research in which those being stud-
ied help to formulate research questions, gather
and analyze data, and report findings is not un-
common in the area of HIV, operationalizing
the values so central to intersectionality studies
of situated knowledge (Collins 1990) and break-
ing down researcher–researched power dynam-
ics. Intersectionality also encourages us to con-
sider how the identities of the researchers may
inform the intellectual pursuit. The national
HIV/AIDS strategy calls for diversifying the
HIV workforce and increasing culturally rel-
evant HIV prevention interventions as strate-
gies for reducing HIV-related health dispar-
ities. In their discussion of the CDC-funded
Minority HIV/AIDS Research Initiative, Sut-
ton and colleagues (2013, p. 2207) contend that
these efforts “may increase the credibility of
research findings and confidence in research-
driven initiatives among minority communities
who have a history of medical research-related
distrust.”
Second, although multiple identities inform
social experience, certain categories are likely to
dominate in specific contexts, spaces, and mo-
ments. Race will likely continue to be a crit-
ical category of analysis in the sociology of
HIV/AIDS given the disparities. Racial con-
sciousness, identities, and cultural practices
and production, as well as racial systems and
structures, ideologies, and inequalities, can be-
come hegemonic, whereas other identities not
only remain salient but are shaped by and
through racialized encounters (Moore 2012).
As such, more work is needed on HIV/AIDS
among Native Americans, Asian Americans,
and Pacific Islanders (Wilson & Yoshikawa
2004). Future work might also adopt a cross-
 SO40CH20-Watkins-Hayes ARI 1 July 2014 10:2
national perspective to explicate the dynamics
of HIV/AIDS in different racial contexts. For
example, in a recent meta-analysis examining
differences in HIV infection among black men
in the United States, Canada, and the United
Kingdom, Millett and colleagues (2012) find
that black MSM are as likely as other MSM
to engage in serodiscordant unprotected sex,
but HIV-positive black MSM in each coun-
try are less likely (22% in the United Kingdom
and 60% in the United States) to begin HAART
than other HIV-positive MSM. In addition, fu-
ture research can examine whether and how
less-analyzed categories of identity and dif-
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ference such as disability, citizenship, and
religion matter when chronicling the AIDS
epidemic.
Third, HIV/AIDS research and activism
that adopt an intersectional perspective have
been at the forefront of affirming, and some-
times creating, alternative terminologies that il-
luminate and contest the power dynamics and
modes of inequality that language often ob-
scures. For example, the term “sex worker”
rather than “prostitute” is widely used in the
field to highlight the labor, class, and gendered
dimensions of the exchange. In addition, the
wide use among researchers of the term “MSM”
rather than “gay” upends the notion that be-
havior and identity are inextricably linked, re-
minding us that they can trigger separable social
relations that must be taken into consideration
when examining the epidemic.
Lastly, this article has revealed how an inter-
sectional approach requires us to examine po-
sitions of privilege just as we examine locations
of disadvantage. “Framing intersectionality as
only about women of color gives masculin-
ity, whiteness, and maleness an intersectional
pass,” Carbado (2013, p. 841) writes. Privileged
or high-status intersectionalities go unnamed
and uninterrogated, “further naturalizing white
male heterosexuality as the normative baseline
against which the rest of us are intersection-
ally differentiated” (p. 841). The sociology of
HIV/AIDS must now take up questions that
explicitly consider the role of whiteness, het-
erosexuality, and middle- and upper-class status
www.annualreviews.org • Intersectionality and the Sociology of HIV/AIDS
in the epidemic. For example, Watkins-Hayes
(2013) compares the experiences of low-income
and middle-class women living with HIV/AIDS
to examine the role of socioeconomic status
in accessing AIDS service providers and HIV-
related social capital. She finds, counterintu-
itively, that middle-class HIV-positive women
are less likely to have extensive social connec-
tions to other people with HIV/AIDS, effec-
tively placing them at a disadvantage in terms
of their HIV-related networks and social capital
relative to low-income women who often cul-
tivate these ties in the course of pursuing med-
ical and social services through AIDS service
providers. In addition, an HIV diagnosis ap-
pears to heighten the sense of financial vulner-
ability for middle-income women while lower-
ing this sense for low-income women who have
increased access to services.
As a result of bringing both a sociological
and an intersectional lens to the study of and
response to HIV/AIDS, the complex and mul-
tilayered risk factors, lived experiences, and po-
litical goals and activism of those most directly
affected are no longer overlooked in academic
scholarship, policies and programs, or political
activism. As Cho and colleagues (2013, p. 796)
remind us:
The future of intersectionality studies will
thus be dependent on the rigor with which
scholars harness the most effective tools of
their trade to illuminate how intersecting axes
of power and inequality operate to our col-
lective and individual disadvantage and how
these very tools, these ways of knowing, may
also constitute structures of knowledge pro-
duction that can themselves be the object of
intersectional critique.
Intersectionality informs how we talk about,
mobilize around, and study HIV. Sociologists
are uniquely poised to offer evidence-based re-
search that recognizes HIV as an epidemic
of intersectional inequality and to bring that
knowledge to bear on conceptual frameworks,
methodological tools, and the integration of
theory and action.
449
 SO40CH20-Watkins-Hayes ARI 1 July 2014 10:2

DISCLOSURE STATEMENT
The author is not aware of any affiliations, memberships, funding, or financial holdings that might
be perceived as affecting the objectivity of this review.

ACKNOWLEDGMENTS
The author thanks Diego Henriquez-Garcia and Kirstie (Kit) Riehle for their excellent research
assistance as well as Mignon Moore, Richard D’Aquila, Alida M. Bouris, and the Annual Review
of Sociology editors and reviewers for their thoughtful feedback on earlier drafts.

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 SO40-FrontMatter ARI 8 July 2014 6:42

Annual Review
of Sociology

Contents Volume 40, 2014

Prefatory Chapter
Making Sense of Culture
Orlando Patterson p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p 1
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Theory and Methods

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Endogenous Selection Bias: The Problem of Conditioning on a

Collider Variable
Felix Elwert and Christopher Winship p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p31
Measurement Equivalence in Cross-National Research
Eldad Davidov, Bart Meuleman, Jan Cieciuch, Peter Schmidt, and Jaak Billiet p p p p p p p p p55
The Sociology of Empires, Colonies, and Postcolonialism
George Steinmetz p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p77
Data Visualization in Sociology
Kieran Healy and James Moody p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p 105
Digital Footprints: Opportunities and Challenges for Online Social
Research
Scott A. Golder and Michael W. Macy p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p 129
Social Processes
Social Isolation in America
Paolo Parigi and Warner Henson II p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p 153
War
Andreas Wimmer p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p 173
60 Years After Brown: Trends and Consequences of School Segregation
Sean F. Reardon and Ann Owens p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p 199
Panethnicity
Dina Okamoto and G. Cristina Mora p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p 219
Institutions and Culture
A Comparative View of Ethnicity and Political Engagement
Riva Kastoryano and Miriam Schader p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p 241

v
 SO40-FrontMatter ARI 8 July 2014 6:42

Formal Organizations
(When) Do Organizations Have Social Capital?
Olav Sorenson and Michelle Rogan p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p 261
The Political Mobilization of Firms and Industries
Edward T. Walker and Christopher M. Rea p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p 281

Political and Economic Sociology

Political Parties and the Sociological Imagination:
Past, Present, and Future Directions
Stephanie L. Mudge and Anthony S. Chen p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p 305
Taxes and Fiscal Sociology
Isaac William Martin and Monica Prasad p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p 331
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Differentiation and Stratification

The One Percent
Lisa A. Keister p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p 347
Immigrants and African Americans
Mary C. Waters, Philip Kasinitz, and Asad L. Asad p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p 369
Caste in Contemporary India: Flexibility and Persistence
Divya Vaid p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p 391
Incarceration, Prisoner Reentry, and Communities
Jeffrey D. Morenoff and David J. Harding p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p 411
Intersectionality and the Sociology of HIV/AIDS: Past, Present,
and Future Research Directions
Celeste Watkins-Hayes p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p 431
Individual and Society
Ethnic Diversity and Its Effects on Social Cohesion
Tom van der Meer and Jochem Tolsma p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p 459
Demography
Warmth of the Welcome: Attitudes Toward Immigrants
and Immigration Policy in the United States
Elizabeth Fussell p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p 479
Hispanics in Metropolitan America: New Realities and Old Debates
Marta Tienda and Norma Fuentes p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p 499
Transitions to Adulthood in Developing Countries
Fatima Juárez and Cecilia Gayet p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p 521

vi Contents
 SO40-FrontMatter ARI 8 July 2014 6:42

Race, Ethnicity, and the Changing Context of Childbearing

in the United States
Megan M. Sweeney and R. Kelly Raley p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p 539
Urban and Rural Community Sociology
Where, When, Why, and For Whom Do Residential Contexts
Matter? Moving Away from the Dichotomous Understanding of
Neighborhood Effects
Patrick Sharkey and Jacob W. Faber p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p 559
Gender and Urban Space
Daphne Spain p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p 581
Policy
Annu. Rev. Sociol. 2014.40:431-457. Downloaded from www.annualreviews.org
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Somebody’s Children or Nobody’s Children? How the Sociological

Perspective Could Enliven Research on Foster Care
Christopher Wildeman and Jane Waldfogel p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p 599
Sociology and World Regions
Intergenerational Mobility and Inequality: The Latin American Case
Florencia Torche p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p 619
A Critical Overview of Migration and Development:
The Latin American Challenge
Raúl Delgado-Wise p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p 643

Indexes

Cumulative Index of Contributing Authors, Volumes 31–40 p p p p p p p p p p p p p p p p p p p p p p p p p p p 665

Cumulative Index of Article Titles, Volumes 31–40 p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p 669
Errata
An online log of corrections to Annual Review of Sociology articles may be found at
http://www.annualreviews.org/errata/soc

Contents vii
 Annual Reviews
It’s about time. Your time. It’s time well spent.

New From Annual Reviews:

Annual Review of Organizational Psychology and Organizational Behavior
Volume 1 • March 2014 • Online & In Print • http://orgpsych.annualreviews.org
Editor: Frederick P. Morgeson, The Eli Broad College of Business, Michigan State University
The Annual Review of Organizational Psychology and Organizational Behavior is devoted to publishing reviews of
the industrial and organizational psychology, human resource management, and organizational behavior literature.
Topics for review include motivation, selection, teams, training and development, leadership, job performance,
Annu. Rev. Sociol. 2014.40:431-457. Downloaded from www.annualreviews.org
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strategic HR, cross-cultural issues, work attitudes, entrepreneurship, affect and emotion, organizational change
and development, gender and diversity, statistics and research methodologies, and other emerging topics.
Complimentary online access to the first volume will be available until March 2015.
Table of Contents:
• An Ounce of Prevention Is Worth a Pound of Cure: Improving • Perspectives on Power in Organizations, Cameron Anderson,
Research Quality Before Data Collection, Herman Aguinis, Sebastien Brion
Robert J. Vandenberg • Psychological Safety: The History, Renaissance, and Future
• Burnout and Work Engagement: The JD-R Approach, of an Interpersonal Construct, Amy C. Edmondson, Zhike Lei
Arnold B. Bakker, Evangelia Demerouti, • Research on Workplace Creativity: A Review and Redirection,
Ana Isabel Sanz-Vergel Jing Zhou, Inga J. Hoever
• Compassion at Work, Jane E. Dutton, Kristina M. Workman, • Talent Management: Conceptual Approaches and Practical
Ashley E. Hardin Challenges, Peter Cappelli, JR Keller
• Constructively Managing Conflict in Organizations, • The Contemporary Career: A Work–Home Perspective,
Dean Tjosvold, Alfred S.H. Wong, Nancy Yi Feng Chen Jeffrey H. Greenhaus, Ellen Ernst Kossek
• Coworkers Behaving Badly: The Impact of Coworker Deviant • The Fascinating Psychological Microfoundations of Strategy
Behavior upon Individual Employees, Sandra L. Robinson, and Competitive Advantage, Robert E. Ployhart,
Wei Wang, Christian Kiewitz Donald Hale, Jr.
• Delineating and Reviewing the Role of Newcomer Capital in • The Psychology of Entrepreneurship, Michael Frese,
Organizational Socialization, Talya N. Bauer, Berrin Erdogan Michael M. Gielnik
• Emotional Intelligence in Organizations, Stéphane Côté • The Story of Why We Stay: A Review of Job Embeddedness,
• Employee Voice and Silence, Elizabeth W. Morrison Thomas William Lee, Tyler C. Burch, Terence R. Mitchell
• Intercultural Competence, Kwok Leung, Soon Ang, • What Was, What Is, and What May Be in OP/OB,
Mei Ling Tan Lyman W. Porter, Benjamin Schneider
• Learning in the Twenty-First-Century Workplace, • Where Global and Virtual Meet: The Value of Examining
Raymond A. Noe, Alena D.M. Clarke, Howard J. Klein the Intersection of These Elements in Twenty-First-Century
• Pay Dispersion, Jason D. Shaw Teams, Cristina B. Gibson, Laura Huang, Bradley L. Kirkman,
• Personality and Cognitive Ability as Predictors of Effective Debra L. Shapiro
Performance at Work, Neal Schmitt • Work–Family Boundary Dynamics, Tammy D. Allen,
Eunae Cho, Laurenz L. Meier

Access this and all other Annual Reviews journals via your institution at www.annualreviews.org.

Annual Reviews | Connect With Our Experts

Tel: 800.523.8635 (us/can) | Tel: 650.493.4400 | Fax: 650.424.0910 | Email: service@annualreviews.org
 Annual Reviews
It’s about time. Your time. It’s time well spent.

New From Annual Reviews:

Annual Review of Statistics and Its Application
Volume 1 • Online January 2014 • http://statistics.annualreviews.org

Editor: Stephen E. Fienberg, Carnegie Mellon University

Associate Editors: Nancy Reid, University of Toronto
Stephen M. Stigler, University of Chicago
The Annual Review of Statistics and Its Application aims to inform statisticians and quantitative methodologists, as
Annu. Rev. Sociol. 2014.40:431-457. Downloaded from www.annualreviews.org

well as all scientists and users of statistics about major methodological advances and the computational tools that
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allow for their implementation. It will include developments in the field of statistics, including theoretical statistical
underpinnings of new methodology, as well as developments in specific application domains such as biostatistics
and bioinformatics, economics, machine learning, psychology, sociology, and aspects of the physical sciences.

Complimentary online access to the first volume will be available until January 2015.
table of contents:

• What Is Statistics? Stephen E. Fienberg
• A Systematic Statistical Approach to Evaluating Evidence
from Observational Studies, David Madigan, Paul E. Stang,
Jesse A. Berlin, Martijn Schuemie, J. Marc Overhage,
Marc A. Suchard, Bill Dumouchel, Abraham G. Hartzema,
Patrick B. Ryan
• The Role of Statistics in the Discovery of a Higgs Boson,
David A. van Dyk
• Brain Imaging Analysis, F. DuBois Bowman
• Statistics and Climate, Peter Guttorp
• Climate Simulators and Climate Projections,
Jonathan Rougier, Michael Goldstein
• Probabilistic Forecasting, Tilmann Gneiting,
Matthias Katzfuss
• Bayesian Computational Tools, Christian P. Robert
• Bayesian Computation Via Markov Chain Monte Carlo,
Radu V. Craiu, Jeffrey S. Rosenthal
• Build, Compute, Critique, Repeat: Data Analysis with Latent
Variable Models, David M. Blei
• Structured Regularizers for High-Dimensional Problems:
Statistical and Computational Issues, Martin J. Wainwright
• High-Dimensional Statistics with a View Toward Applications
in Biology, Peter Bühlmann, Markus Kalisch, Lukas Meier
• Next-Generation Statistical Genetics: Modeling, Penalization,
and Optimization in High-Dimensional Data, Kenneth Lange,
Jeanette C. Papp, Janet S. Sinsheimer, Eric M. Sobel
• Breaking Bad: Two Decades of Life-Course Data Analysis
in Criminology, Developmental Psychology, and Beyond,
Elena A. Erosheva, Ross L. Matsueda, Donatello Telesca
• Event History Analysis, Niels Keiding
• Statistical Evaluation of Forensic DNA Profile Evidence,
Christopher D. Steele, David J. Balding
• Using League Table Rankings in Public Policy Formation:
Statistical Issues, Harvey Goldstein
• Statistical Ecology, Ruth King
• Estimating the Number of Species in Microbial Diversity
Studies, John Bunge, Amy Willis, Fiona Walsh
• Dynamic Treatment Regimes, Bibhas Chakraborty,
Susan A. Murphy
• Statistics and Related Topics in Single-Molecule Biophysics,
Hong Qian, S.C. Kou
• Statistics and Quantitative Risk Management for Banking
and Insurance, Paul Embrechts, Marius Hofert

Access this and all other Annual Reviews journals via your institution at www.annualreviews.org.

Annual Reviews | Connect With Our Experts

Tel: 800.523.8635 (us/can) | Tel: 650.493.4400 | Fax: 650.424.0910 | Email: service@annualreviews.org