Intersectinality An The Sociology in HIV/AIDS

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Celeste Watkins-Hayes
Departments of Sociology and African American Studies, Northwestern University,
Evanston, Illinois 60208; email: [email protected]
Annu. Rev. Sociol. 2014. 40:431–57 Keywords

The Annual Review of Sociology is online at
soc.annualreviews.org HIV/AIDS, intersectionality, inequality, health
This article’s doi: Abstract
10.1146/annurev-soc-071312-145621
This review focuses on three topics that have dominated the sociologi-
Copyright c 2014 by Annual Reviews.
All rights reserved 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
INTRODUCTION ues to play a significant role in determining

who is most at risk of infection, who is most
The United States will become a place where
likely to receive life-saving treatment, and how
new HIV infections are rare, and when they do
the epidemic disproportionately affects certain
occur, every person, regardless of age, gender,
communities. HIV increasingly operates as a
race/ethnicity, sexual orientation, gender identity
concentrated epidemic in the United States,
or socio-economic circumstance, will have unfet-
with high rates among specific subpopulations.
tered access to high quality, life-extending care,
Unlike many other illnesses, it has a particu-
free from stigma and discrimination.
lar cultural significance that obliges its carri-
—President Barack Obama, July 13, 2010 ers, and those most intimately involved in their
lives, to grapple with weighty and contentious
Since the first cases over 30 years ago, the hu- social issues: sex, sexuality, drugs, class, race,
man immunodeficiency virus (HIV) has caused gender, and inequality of exposure to harm.
a pandemic that has produced devastating HIV/AIDS intersects with long-standing social
consequences and is now seared into our social hierarchies that seemingly render some groups
fabric. HIV attacks specific cells of the immune more expendable than others. After all, many
system, known as CD4 cells or T cells, and believe that this infection is a kind of punish-
reduces the body’s ability to fight infections ment, complete with sympathetic and unsym-
and disease. HIV progresses to acquired immu- pathetic victims. As such, HIV/AIDS is not only
nodeficiency syndrome (AIDS) when too many a medical epidemic but also a social and cul-
T cells have been destroyed, and it can be fatal tural Rorschach test that pushes our views about
if left untreated. Although HIV resides per- difference and complex inequalities to center
manently in the body following infection, the stage.
advent of highly active antiretroviral therapy Research on HIV/AIDS has emphasized
(HAART) in the mid-1990s has dramatically randomized controlled trials, clinic-based re-
prolonged the lives of many HIV-infected search, and evaluations that assess the efficacy
people and reduced their chances of infecting of the field’s latest biomedical and behavioral
others. Today, an HIV-positive individual can interventions in HIV prevention and treatment
enjoy nearly normal life expectancy if diag- and in the pursuit of a cure. Sociologists have
nosed and treated early. As a result, although participated in such intervention work (Adam
the Centers for Disease Control (CDC) find et al. 2011, Baker et al. 2003, Comfort et al.
that there remain around 1.1 million people 2000) and have stridently advocated for re-
with HIV/AIDS in the United States, fewer search approaches that address the structural,
and fewer are dying of AIDS (CDC 2013f ). institutional, neighborhood, network, and cul-
Nevertheless, approximately 50,000 new HIV tural factors that influence individual behavioral
infections occur every year in this country, outcomes. Consequently, social drivers are now
and of the 1.1 million currently infected, about more widely recognized as “both influence[ers]
16% do not know their status. of HIV transmission . . . and possible points of
The transformation of HIV/AIDS from an intervention at the societal level” (Auerbach
inevitable death sentence to a chronic illness et al. 2009, p. 3). Therefore, although I include
has produced new social and cultural realities. research conducted by scholars from other dis-
The goal of an AIDS-free generation seems ciplines, in this review I emphasize the work of
attainable in well-resourced countries like the sociologists contributing to the understanding
United States, and experts now publicly con- of HIV/AIDS as well as work that most closely
template “the beginning of the end of AIDS.” speaks to sociological concerns.
However, President Obama’s statement as he Sociologists believe that group cate-
unveiled a national HIV/AIDS strategy hinted gories, and the social meanings and resources
at the vexing reality that social status contin- historically and presently assigned to them, are
432 Watkins-Hayes
foundational for understanding HIV/AIDS. (whites, blacks, and Latinos). These areas of fo-
Thus, in this review I synthesize this litera- cus reflect the largest bodies of work in the field
ture while looking through an intersectional and provide a landscape through which to pin-
lens. First advanced by feminists of color, the point the unique contributions of the sociology
paradigm of intersectionality challenges single- of HIV/AIDS.
category thinking about identity and group It is important to note that sociologists have
status and emphasizes approaches that inter- contributed to the vast research examining the
rogate how race, class, gender, sexuality, and AIDS pandemic all over the globe (Mojola
other social locations operate simultaneously in 2011, Swidler & Watkins 2007). According to
social life (Collins 1990, Crenshaw 1991, King the World Health Organization (2013), an es-
1988). An intersectional approach seeks to timated 34 million people are living with HIV
make interlocking power dynamics visible and globally, and several recent literature reviews
to highlight how they are shaped by sameness examine the AIDS pandemic in various re-
and difference (Cho et al. 2013). Scholars have gions (De Cock et al. 2013, Mahajan et al.
conceptualized intersectionality as a theory of 2008), including sub-Saharan Africa (Foster

power relations, a methodological imperative & Williamson 2000, Heimer 2007), home to
to uncover interlocking inequalities, and a more than two-thirds of the world’s HIV infec-
political assertion that sometimes embraces tions, and China (Hong & Li 2009). Although
modes of resistance (Choo & Ferree 2010, multilayered inequalities aggressively influence
Cohen 1997, McCall 2005). The concept the pandemic in all parts of the world, coun-
operates in several disciplines including so- tries with generalized epidemics face very dif-
ciology, public health, ethnic studies, gender ferent issues from those faced by the United
studies, queer studies, history, psychology, States in terms of the most common modes
social work, and anthropology. I argue that of transmission, the medical and social reali-
HIV/AIDS is an epidemic of intersectional ties of HIV-infected individuals, and the polit-
inequality fueled by racial, gender, class, and ical responses to AIDS from the grass roots to
sexual inequities at the macro-structural, the upper echelons of government (Decoteau
meso-institutional, and micro-interpersonal 2013). In some countries, the ravages of AIDS
levels. These inequalities shape the likelihood are so widespread that they threaten the sta-
of exposure to the virus; the realities of living bility of families, communities, and even labor
with HIV; and our medical, programmatic, forces (Heimer 2007). Given these complexi-
political, and social-scientific responses. ties, and the practicalities of space constraints, I
After briefly charting the sociology of focus this review on the epidemic in the United
HIV/AIDS as an area of study, this review States. However, the development of more in-
focuses on three topics that have dominated ternational or cross-cultural frameworks for the
the sociological literature on HIV/AIDS in the study of HIV/AIDS is a fertile direction for fu-
United States: (a) the demographics of the epi- ture research.
demic and the dynamics of multilayered risk
(e.g., structural-, institutional-, neighborhood-,
network-, and individual-level risk); (b) the lived CHARTING THE SOCIOLOGY
experiences of HIV-positive people; and (c) the OF HIV/AIDS
collective response to the epidemic through Despite the contributions of sociologists of
community-based services, political activism HIV/AIDS to policy, scholarship, and com-
and social movements, and public policy. I in- munity responses to the epidemic, this im-
clude work on the epidemic’s impact on both portant area of study remains at the periph-
men and women, with an emphasis on the three ery of “mainstream sociology.” Starting in the
racial groups with the highest numbers of peo- mid-1980s, pioneers such as Judith Auerbach
ple living with HIV/AIDS in the United States et al. (1994), Benjamin Bowser (1989), Samuel
www.annualreviews.org • Intersectionality and the Sociology of HIV/AIDS 433

Friedman (see Marmor et al. 1984), Martin ence: AIDS, Activism, and the Politics of Knowledge
Levine (1989), Beth Schneider (1988), and Rose (Epstein 1996) and Moving Politics: Emotion and
Weitz (1987, 1991) began publishing work ACT UP’s Fight Against AIDS (Gould 2009).
on AIDS in important social science journals
such as Social Problems, teaching sociology of
HIV/AIDS classes in colleges and universities, INTERSECTIONALITY AND THE
organizing sessions on HIV/AIDS at annual SOCIOLOGY OF HIV/AIDS
meetings of various sociological associations, Although most HIV/AIDS researchers do
and building the Sociologists AIDS Network of not explicitly engage the concept of intersec-
the American Sociological Association (ASA). tionality in their work, most understand that
Nevertheless, articles on HIV/AIDS are scarce HIV/AIDS involves a multifaceted blend of
in sociology’s flagship journals, appearing only interlocking group memberships (Schneider
within the last decade and focusing on the epi- 1992). Identities and statuses based on race,
demic in countries other than the United States. sexual orientation, class, gender, and other
The American Sociological Review published categories serve as organizing principles and
studies examining how uncertainty about HIV help to determine how power is distributed,
status shapes decision making about childbear- (im)balanced, maintained, and challenged
ing among young adults in southern Malawi (Watkins-Hayes 2008). Various forms of
(Trinitapoli & Yeatman 2011) and measuring inequality rendered through racism, sexism,
the transformation of international intellectual class subordination, heterosexism, and other
property protections for AIDS drugs (Chorev forms of exclusion intersect and interact with
2012). The American Journal of Sociology pub- one another, creating what Collins (1990) calls
lished a study on cultural interpretations of interlocking systems of oppression. As individ-
AIDS campaigns in Accra, Ghana (McDonnell uals navigate their social worlds and encounter
2010). Carol Heimer’s Annual Review of Sociol- privileges or disadvantages by virtue of their
ogy paper on HIV/AIDS in sub-Saharan Africa various social group memberships, they affirm,
appeared in 2007. In a 2001 article published in acquiesce to, resist, or create alternatives to
the ASA newsletter Footnotes, Bronwen Licht- dominant ways of thinking and behaving.
enstein observes, “The dearth of AIDS-related Intersectionality is therefore a conceptual
articles in the reviewed journals suggests that framework that acknowledges how multiple,
AIDS has never truly been perceived to be a simultaneous, and structurally embedded
sociological issue.” social locations influence the life experiences,
Sociologists studying HIV/AIDS have had opportunities, investments, and constraints of
a much more prominent voice in interdisci- individuals and groups (Choo & Ferree 2010,
plinary health journals, publishing numerous Collins 1990, Glenn 2000, McCall 2005). It
articles in outlets such as Social Science and calls upon us not only to attend to difference,
Medicine, AIDS and Behavior, AIDS Care, Jour- subjectivities, and categories of identity, but
nal of Health and Social Behavior, and the Sociol- also to consider how dimensions and dynamics
ogy of Health and Illness. They have also con- of dominance generate and sustain structural,
tributed to widely read sociology and social group, and interpersonal inequalities.
science journals such as Social Problems, Social Intersectionality has much to offer
Forces, and the Annals of the American Academy of HIV/AIDS studies because it encourages
Political and Social Science and frequented public “the inclusion of perspectives, not only
health journals including the American Journal persons, from the margins of society[,] . . .
of Public Health. Monographs on HIV/AIDS in problematize[s] relationships of power for
the United States have experienced more main- unmarked categories, such as whiteness and
stream success, including two books on AIDS masculinity[,] . . . and treat[s] inequalities as
activism that received ASA awards, Impure Sci- multiply-determined and intertwined” (Choo
434 Watkins-Hayes
& Ferree 2010, p. 131; see also Bredstrom of the US population yet comprising 44% of
2006). An intersectional approach has perhaps both new HIV infections and people living with
been most prominently deployed in both HIV/AIDS in 2010 (CDC 2013f ).
scholarship and activism related to HIV/AIDS Bodies and sexuality have historically served
among blacks (Berger 2004, Cohen 1999, as domains for advancing stereotypes about
Hammonds 1995, Mackenzie 2013). More marginalized groups, and these preoccupations
recently, Collins and colleagues (2008) used have been a continuous thread in the pub-
intersectionality to illuminate multifaceted lic’s response to the AIDS epidemic. Simulta-
interconnections between race, ethnicity, gen- neous and interlocking sexual and racial anxi-
der, class, and mental illness as they influence eties have manifested through attacks on white
sexuality and HIV risk among Latinas in New gay men for existing outside of the boundaries
York City. The associated systems of power, of normative heterosexual whiteness (Carbado
Collins et al. (2008, p. 390) write, “might 2013), through silences within black communi-
include laws that determine access to welfare, ties about the epidemic’s impact for fear of fur-
Medicaid, or housing; rules in a residential ther demonization (Cohen 1999), and through
facility that govern sexual activity; traditions media obsession with black men on the “down
in a local community that privilege male low” (men who have sex with men and women,
sexual desire and power; or a community’s or MSMW, who do not identify as gay or bisex-
reinforcement of stereotypes of women who ual) who encapsulate the public’s simultaneous
are black and Latina with mental illness as hav- fear and fetishization of black masculinity and
ing uncontrollable sexual urges or dangerous sexuality (Mackenzie 2013, McCune 2014).
aggression.” The resulting reduced social and Social group identity, however, is not a
economic power can limit women’s abilities proxy for HIV risk. As Treichler (1999) and
to dictate the terms of sexual relationships, others have noted, the risks of HIV are as-
increasing their vulnerability to HIV infection. sociated with behavior rather than inherent
demographic characteristics, challenging the
notion that certain groups are somehow “con-
THE DEMOGRAPHICS OF taminated” and “contaminating.” In the United
HIV/AIDS AND THE SOCIAL States, the virus is most commonly transmit-
DIMENSIONS OF INFECTION ted through unprotected sex and the sharing of
RISK drug injection equipment, but these risk behav-
Most HIV infections in the United States have iors occur in a context that unequally distributes
occurred, and still occur, through male-to-male both vulnerability and protective resources.
sexual contact (CDC 2012). In 2010, men who Watkins-Hayes (2008, pp. 41–42) reflects:
have sex with men (MSM) were estimated to
make up approximately 4% of the male US pop- [Sociological] research has encouraged a
ulation yet accounted for 78% of new HIV in- more nuanced understanding of the social
fections among males (CDC 2012, Purcell et al. context of risk and highlighted the danger of
2012). Individuals infected through heterosex- directly linking certain individuals or groups
ual sex made up 25% of all new HIV infections to health outcomes without appreciating the
that year. This is the reported mode of trans- interrelationship between individual attitudes
mission for most HIV-positive women, who and behaviors and environmental opportunity
accounted for approximately 20% of the esti- structures and constraints. . . . When our anal-
mated 47,500 new infections. In 2010, 8% of yses of individual behaviors and experiences
new infections were attributed to intravenous become inextricably linked to the structural,
drug use (IDU) (CDC 2012, 2013f ). Compared historical, and situational context of people’s
with other racial groups, blacks face the most lives, this allows us to extrapolate larger so-
severe burden of HIV, making up only 12% ciological and epidemiological lessons while

appreciating the complexity and distinctive- abuse (Arreola et al. 2005). These experiences
ness of individuals. increase the likelihood of high-risk sexual be-
havior later in life (Barnshaw & Letukas 2010).
If HIV transmission can be prevented, why In a study of gay and bisexual Latino men in
do an estimated 50,000 new infections oc- three US cities, Arreola and colleagues (2009)
cur annually in the United States? Why does find that those who reported childhood sexual
HIV prevalence differ by race, gender, sex- abuse were significantly more likely to report
uality, and class? We can begin addressing sexual situations that involved drug and/or al-
these questions by considering previous re- cohol use, an escape from loneliness or depres-
search, mostly epidemiological in nature, that sion, or a non-monogamous partner than were
emphasizes individual risk behaviors and then those who reported no history of childhood sex-
pivot to sociological research that places those ual abuse.
behaviors in a larger social context. The lat- Sociologists explicate the broader social
ter considers the role of risk environments in norms, environments, and discourses that may
HIV transmission, factors exogenous to the fuel conditions for HIV transmission. Sev-
individual that may contribute to HIV risk eral studies point to the significance of so-
(Rhodes et al. 2005), suggesting that physi- cial networks in shaping sex norms, as men
cal and social spaces generate relationships be- who perceive strong social support and risk
tween structural-, community-, and individual- reduction norms among peers are less likely
level HIV risk. As I discuss further below, to practice unprotected sex (McKechnie et al.
these relationships are largely shaped by a com- 2013). Ghaziani & Cook (2005) generated a
plex array of public policies, macroeconomic conceptual framework to explain the hypoth-
changes, racialized and gendered organizing esized link between “circuit party” attendance
principles, dynamics of sexual and drug net- by self-identified gay and bisexual men and
works, neighborhood resources and deficits, new HIV infections. Although intended to
and individual behaviors. promote HIV/AIDS awareness and encourage
gay community-building and promote cultural
identity, these weekend-long parties may in-
Male-to-Male Sex and HIV advertently encourage the spread of HIV by
Transmission creating an environment in which unprotected
MSM accounted for 52% of all people liv- sex frequently occurs. “Circuit parties,” the au-
ing with HIV infection in 2009 (CDC 2013a). thors write, “may be caught in a tension be-
According to the CDC (2013a), unprotected tween building community and undermining
receptive anal sex carries the highest risk for the basis for that very same community . . . by
HIV acquisition. Simultaneously, “homopho- endangering its collective health” (Ghaziani &
bia, stigma, and discrimination can put MSM Cook 2005, pp. 42–43).
at risk for multiple physical and mental health Other scholars incorporate structural ex-
problems and affect whether MSM seek and planations for HIV risk. Diaz and colleagues
are able to obtain high-quality health services” (2004) encourage scholars to think about HIV
(CDC 2013a). MSM are more likely than other risk as an outcome of social oppression, show-
men to experience clinical depression and anxi- ing that experiences of social discrimination and
ety disorders, potentially increasing risk behav- financial hardship among gay Latino men are
iors (Wolitski & Fenton 2011). Several studies strongly correlated with encountering risky sex-
also find that MSM have elevated rates of child- ual situations that place them at risk for HIV
hood sexual abuse relative to the US population transmission such as sex involving drug or alco-
and heterosexual men (Paul et al. 2001), and hol use or partners who resist condom use (also
Latino MSM are twice as likely as non-Latino see Mizuno et al. 2012). In line with this social
MSM to report a history of childhood sexual oppression framework, Ayala and colleagues
436 Watkins-Hayes
(2012) find that reported experiences with ho- explore the relationship between sexual health
mophobia, racism, financial hardship, and lack and migration that is directly or indirectly mo-
of social support were associated with unpro- tivated by the sexuality of those who migrate.
tected anal intercourse with a serodiscordant or “Assertions,” he argues, “are often made mostly
sero-unknown partner in a study of both black on the basis of the authors’ own perceptions
and Latino MSM. of Latino sexual culture and gender norms”
Not all sociologists have emphasized the (p. 67).
cultural and structural dimensions of HIV. In Black MSM are currently experiencing the
his work on sexual narratives of Mexican gay highest HIV/AIDS infection rates relative to
and bisexual immigrant men in San Diego, their share of the population. In 2010, black
Fontdevila (2009) focuses on the micro-level MSM represented an estimated 72% of new in-
interactions that facilitate HIV transmission, fections among all black men and 36% of an
emphasizing protective versus trusting frames estimated 29,800 new HIV infections among
during sexual encounters. Protective cooper- all MSM (CDC 2012). Millett and colleagues
ative frames promote self-protective barriers (2006) published one of the most comprehen-
such as condom use, whereas trusting cooper- sive analyses of HIV infection rates among
ative frames depend on trust, trustworthiness, black MSM. The authors find little empirical
and reciprocity of information about HIV sta- evidence that high infection rates among this
tus between sexual partners. Individuals often group are due to riskier sexual behaviors, the re-
move between frames during sexual encoun- luctance to adopt a nongay identity or disclose
ters, reacting to contextual cues and deciding sexuality, or reported use of alcohol or illicit
in the moment whether to use condoms. substances, as “most studies have found compa-
Fontdevila’s research contributes to the rable, if not lower, self-reported rates of unpro-
growing body of work on HIV among Latinos, tected anal intercourse for black MSM relative
who represented 16% of the US population to other MSM” (Millett et al. 2006, p. 1008).
but accounted for 21% of new HIV infections Millett et al.’s (2006) review of the research
in 2010 (CDC 2013f ). As we consider future attributes high rates of HIV infection among
research directions, the literature yields several black MSM to a high prevalence of sexually
contradictory findings that highlight a need for transmitted infections (STIs) that facilitate
additional research and meta-analyses to parse HIV transmission. Network analysis by
results. For example, studies have produced Laumann & Youm (1999) points to higher
mixed findings about whether cultural values rates of STIs among blacks relative to whites in
such as machismo, collectivity, and familism general, driven by sexual networks that include
encourage or discourage risky sexual behavior lower rates of interracial mixing and higher
in Latino communities (Alvarez et al. 2009, levels of mixing among individuals exhibiting
Organista et al. 2004). Research also suggests high-risk versus low-risk behavior within the
that migration and subsequent acculturation to population (also see Bingham et al. 2003,
the host country decrease the likelihood of HIV Morris et al. 2009). In addition to such network
transmission, perhaps owing to sexual modesty factors, undetected or late HIV diagnoses
or a commitment to self-determination that due to infrequent or delayed testing are also
results in less risky sexual behavior (Marı́n thought to be key drivers of high infection
2003). Other studies find the opposite—higher rates among black MSM (Millett et al. 2006).
levels of risk among recent immigrants or less Men who are unaware of their HIV-positive
acculturated Latinos(as)—hypothesizing that status are more likely to transmit the virus
immigration disrupts previous sexual relation- to HIV-negative partners than are men who
ships and increases adventurism in a new sexual know their positive status (Colfax et al. 2002).
culture (Organista et al. 2004). This has led In addition, black MSM who are HIV-positive
Carrillo (2004) to call on scholars to further report less access to and use of medical care

and HAART, which may keep them more have decreased, whereas heterosexual transmis-
infectious longer (Millett et al. 2006). sion cases have increased (Espinoza et al. 2007).
Men on the so-called “down low” gained Infections among women account for much of
widespread media and scholarly attention in the this rise, as heterosexual sex is the predomi-
last decade, in part because of speculation link- nate mode of HIV infection among this group
ing them to rising HIV infection rates among (Espinoza et al. 2007, Hader et al. 2001). By the
black women in particular. Using survey data end of 2010, women represented one in four
from the Urban Men’s Health Study, Barnshaw people living with HIV infection in the United
& Letukas (2010) studied a sample of 2,881 States (CDC 2013e). Over the last 30 years, the
white, black, and Latino MSM in four major US epicenter of the epidemic among women has
cities, finding significant percentages of whites shifted from injection drug–using women in the
(3.5) and nonwhites (2.3) who identify as “het- urban Northeast to women at high heterosex-
erosexual/straight” or something other than ual risk in the South, a region with some of the
homosexual (2.8% whites, 5.9% nonwhites) yet highest STI rates in the country (Hader et al.
have sex with men. 2001, Inrig 2011, Whetten & Pence 2013).
The research linking these practices of sex- HIV is more efficiently transmitted from
ual self-identification to HIV rates is complex. men to women during vaginal or anal in-
Millett et al. (2006) conclude that several stud- tercourse than vice versa, owing to women’s
ies overwhelmingly indicate that black MSM longer exposure to infectious fluids and in-
are less likely than white MSM to identify as gay creased risk of tissue injury (Bolan et al. 1999,
and are less likely to disclose their sexual iden- Nicolosi et al. 1994). Nevertheless, research
tity or behavior to associates. However, they overwhelmingly suggests that the social di-
find little evidence that having a nongay identity mensions of gender roles and hierarchies are
increases HIV risk-taking behavior with male also key drivers of the dramatic increase in HIV
sexual partners among black MSM and may in prevalence among women. As Farmer and col-
fact be associated with lower sexual risk-taking leagues (1996) note, those hurt most by gender
(see also Millett et al. 2005). Nevertheless, inequality, racism, and stigma worldwide are
Mutchler et al. (2008) find that HIV-positive the most vulnerable to the vagaries of the epi-
MSMW who are less connected to a homosex- demic (see also Adimora et al. 2013, Campbell
ual identification had a greater probability of 1999, Schneider & Stoller 1995). Women are
engaging in unprotected sex with female part- more likely to be forced into survival-focused
ners without disclosing their HIV status, and behaviors such as transactional sex for money,
black and Latino MSMW were more likely to housing, protection, employment, and other
report unprotected sex with a female partner basic needs; power-imbalanced relationships
without HIV status disclosure than were white with older men; and other partnerings in which
men (also see Zellner et al. 2009). This sug- they cannot dictate the terms of condom use,
gests that MSMW who fail to disclose their sex- monogamy, or HIV testing (Farmer et al.
ual histories to female partners may account for 1996, Gupta 2004). There is also evidence
some of the rise in HIV infection rates among that sexual violence places female victims at
women, but more research is needed to assess risk for HIV infection (Bensley et al. 2000,
the magnitude of this relationship and ensure Wyatt et al. 2002). Childhood sexual abuse
that it is not overstated. is a predictor for later nonconsensual sexual
contact as well as substance abuse, multiple
sex partners, and failure to self-protect (Cohen
Heterosexual Sex and HIV et al. 2000, Voisin 2005, Wyatt et al. 2002).
Transmission HIV prevalence is also much higher among
Recent trends show that US AIDS cases trans- women suffering from mental illness; the
mitted by male-to-male sexual contact and IDU mental instability and limited power that this
438 Watkins-Hayes
diminished and stigmatized social standing Scholars have, however, warned against em-
often produces makes them vulnerable (Collins bracing what Higgins and colleagues (2010)
et al. 2008, Meade & Sikkema 2005). term “the vulnerability paradigm,” which sug-
In 2010, the rate of new HIV infections gests that women are universally oppressed
among black women was 20 times that of and men are a powerful, monolithic group.
white women (CDC 2013e). Immigrant sta- Although biological differences and patriar-
tus, poverty, and traditional ideas about gen- chal social structures are important drivers of
der roles and skin tone hierarchies can also the epidemic among women, the vulnerability
work against the abilities of Latinas—whose paradigm fails to recognize heterosexual men as
rate of new HIV infections was 4.2 times potential agents of prevention:
the rate of white females in 2010—to pro-
tect themselves (Collins et al. 2008). Black The paradigm assumes not only that women
women who are diagnosed HIV-positive of- (but not men) want to prevent HIV but lack
ten have no identified or reported risk fac- the power to do so, but also that men are more
tors and are more likely than white women to likely than women to bring HIV into the part-
have acquired HIV through heterosexual sex nership. . . . The vulnerability paradigm can
rather than illicit drug use (Hader et al. 2001). also mask women’s power and agency. Sim-
Collins (1990) points to “sexualized racism” ilarly, men, but not women, are presumed
as an important driver, producing conditions to engage deliberately in risky practices.
in which multiple systems of power frame (Higgins et al. 2010, p. 435)
black women’s sexual options and decision-
making (Gilbert & Wright 2003, Hammonds Challenging the vulnerability paradigm pro-
1995). Such cultural–historical frames—driven vides a more nuanced view of the drivers of het-
by stereotypical assumptions, assaults to black erosexual HIV transmission. Sobo (1995) cap-
women’s self and societal worth, and silences tures the complexity of women’s sexual agency
that ignore threats to their health—collide with in Choosing Unsafe Sex, arguing that the expec-
material and epidemiological realities that in- tations and understandings that undergird het-
crease their risk of exposure to HIV. For ex- erosexual unions encourage unprotected sex.
ample, among racial groups, blacks are the Women may be more vulnerable due to “wish-
least likely to receive treatment, resulting in ful thinking engendered by women’s hopes for
greater risk of transmission within the popu- their relationships and their desires to preserve
lation (Arnold et al. 2009). The sex ratio in status and self-esteem” (Sobo 1995, p. 1). Such
many black communities contributes to dense risk denial is inextricably linked to the need to
social-sexual networks within an economically believe that their unions meet expectations, that
and racially segregated context (Adimora & they are wise enough to parse risk, and that the
Schoenbach 2005, Wilson 1987), as “the short- men in their lives are monogamous.
age of men places women at a disadvantage in As heterosexual men grapple with norms
negotiating and maintaining mutually monog- of masculinity that shape their sexuality, they,
amous relationships” (Adimora & Schoenbach too, confront risky situations (CDC 2013b).
2005, p. S118). In an analysis of data from four As Bowleg & Raj (2012, p. S173) point out
nationally representative US surveys, Morris in a commentary on HIV prevention for black
and colleagues (2009) find consistent support heterosexual men (BHM), “Black heterosexual
for the hypothesis that higher levels of con- women and BHM live, work, socialize, worship,
current sexual partnerships among blacks, cou- and form romantic and sexual relationships in
pled with race-specific patterns of homophily, the same communities, and as epidemiological
may help to explain the disproportionately high data document, share sexual risk within their
prevalence of HIV and other STIs among communities.” In research on Mexican day la-
blacks. borers, Organista (2007) finds that men who

report a stressful and vulnerable state of des- the highest number of cases per 100,000 people
peration due to their economic and social strug- living with HIV infections. Largely an urban
gles and difficult work conditions in the United disease in the United States, most HIV cases
States are more likely to engage in risky sex occur in cities with 500,000 or more people.
(also see Organista et al. 2004). Nevertheless, The legacy and contemporary effects of
Higgins et al. (2010) observe that, although racial residential segregation have had an im-
heterosexual sex is the leading means of HIV measurable impact on the AIDS epidemic in
transmission worldwide, programs and policies this country, compounding racial and class
largely fail to include the prevention needs of differences in health. The CDC (2010) esti-
men who have sex with women. 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
Intravenous Drug Use and HIV designates a generalized epidemic. Residents of
Transmission these communities overwhelmingly are black
Sociological approaches have also been adopted and Latino (Massey & Denton 1993, Wilson
to consider HIV risk through IDU, which was 1987). Consequently, although gay and bisex-
the reported mode of transmission for 16% of ual men continue to represent the majority of
those living with HIV in 2009 (CDC 2012, new infections, the CDC identifies poverty as
2013f ). Arnold et al. (2009) find that IDU is “the single most important demographic fac-
a significant predictor of delayed or no medi- tor associated with HIV infection among inner-
cal treatment as well as higher mortality among city heterosexuals” (CDC 2010, p. 1). Singer
people living with HIV/AIDS. Non-Hispanic et al. (2006) and others have developed the
blacks are overrepresented among users, and concept of “syndemics” to describe the over-
this likely contributes to disparities in treat- lapping and mutually reinforcing epidemics of
ment take-up between HIV-positive blacks and substance abuse, violence, and HIV that arise
the rest of the population. In 2005 several lead- under conditions of severe health and social dis-
ing scholars, including Tim Rhodes, Philippe parities that we see among inner-city and other
Bourgois, and Samuel Friedman, published a vulnerable populations.
review of literature on the social-structural Why have neighborhood conditions be-
production of HIV risk associated with IDU come so important in HIV transmission?
(Rhodes et al. 2005). Factors that appear to in- Neighborhood and resident characteristics
crease the availability and use of contaminated likely mutually reinforce each other and
needles and thus increase vulnerability to HIV contribute to health outcomes (Cummins
transmission include the presence of shooting et al. 2007). Regarding HIV among inner-
galleries, severe neighborhood disadvantage, city blacks, neighborhoods that experienced
neighborhood transitions produced by gentri- decades of racial segregation through formal
fication that disrupt social networks, and pop- and informal policies and practices throughout
ulation movement that facilitates the transport the twentieth century were dealt a critical eco-
of drugs (also see Ciccarone & Bourgois 2003). nomic blow with the decline of manufacturing
jobs, the rise of a low-wage and less-stable
service sector, the movement of higher-paying
HIV, Place, and Space jobs to predominately white suburban areas
HIV is tied to place, space, and region in im- and overseas, and public policies that reduced
portant ways. The more income inequality in a resources for community health as well as
state, the higher the AIDS case rate (Holtgrave financial assistance (Massey & Denton 1993,
& Crosby 2003). The largest number of people Wilson 1987). These shifts increased economic
living with HIV resides in the South, but ac- vulnerability, diminished collective efficacy
counting for population size the Northeast has and political clout, and spawned underground
440 Watkins-Hayes
economies for drug- and sex-based exchanges is growing consensus among scholars that
(Forbes 1993, Fullilove et al. 1993). These most HIV-infected prisoners are not infected
communities perpetually battle a perfect storm while in prison (Braithwaite & Arriola 2003,
of historical and contemporary economic, po- CDC 2006) but instead become infected in the
litical, and social disadvantages, creating condi- community because these individuals are more
tions that enable an “exogenous shock” such as likely to engage in risky behaviors (Blankenship
an infectious disease epidemic to have a massive et al. 2005). It does not help that cycling in and
impact. out of correctional facilities undermines the
As a symbolic and actual assault on lives stability of relationships between inmates and
and livelihoods, the AIDS epidemic in poor their partners: “The partner entering prison
black communities demonstrates how commu- is now at risk of forming new (sometimes
nity and neighborhood factors affect health out- coercive) sexual connections with a pool of
comes. The volatility of state budgetary en- individuals [prone to] high-risk behaviors, HIV
vironments contributed to a slow response to infection, and other STIs. . . . The partner who
HIV and limited availability of HIV testing and remains behind . . . forfeits the social and sexual
prevention services in the early years (Arnold companionship of the incarcerated partner
et al. 2009). A weak community health-care and may pursue other partnerships to satisfy
system continues to undermine regular health those needs” (Adimora & Schoenbach 2005,
screenings and also affects services for men- p. S119; also see Kim et al. 2002). There is also
tal illnesses, which can increase the likelihood evidence to suggest a high prevalence of both
of high-risk sexual or drug-related behaviors HIV risk behaviors and HIV infection among
(Chow et al. 2003). imprisoned female populations (Kramer &
Over the last 30 years, the war on drugs and Comfort 2011, McClelland et al. 2002).
get-tough-on-crime measures have massively Neighborhood conditions also foster net-
increased both the size of the prison population work dynamics that drive the epidemic. Like
and the cycling in and out of these institutions, other social networks, sexual and drug networks
disproportionately impacting black and Latino can confine or spread HIV infection within
communities (Alexander 2010). Evidence and across communities in ways that paral-
suggests that this mass incarceration boom lel social and economic exchanges (Laumann
has contributed to a social context in which et al. 1994, 2004). This phenomenon is com-
HIV and other STIs proliferate ( Johnson & pounded by a lack of resources, which may
Raphael 2006, Kim et al. 2002) by linking hamper the widespread distribution of preven-
two institutions (prisons and neighborhoods) tion and treatment efforts. Thus, even if in-
and producing long-term health consequences dividual behaviors match those of the general
not only for prisoners but also for their population, in a network with a higher HIV-
intimate partners and other family members infection rate, the risk of new infection in-
(Freudenberg & Ramaswamy 2009, Schnittker creases. In the well-known HIV Epidemiol-
et al. 2011, Wacquant 2001): “Homosexual ogy Research Study (HERS) of HIV-positive
contact and STD and HIV outbreaks have been women and women at risk for HIV, a surprising
documented among men in protective custody one-third of respondents report having mul-
settings, the HIV infection rate is 5 times higher tiple family members with HIV/AIDS (Fiore
in prisons than in the general population, and et al. 2001). This suggests that social ties not
fewer than 1% of correctional facilities nation- only exacerbate the spread of HIV but also af-
ally permit the distribution of latex condoms” fect how individuals make sense of the infection.
(Millett et al. 2006, p. 1014; see also Braithwaite All of these dynamics reveal the mechanisms by
& Arriola 2003, Lichtenstein 2000). Black which neighborhoods are linked to structural
MSM are also more likely than other MSM and institutional forces in ways that leave resi-
to report a history of incarceration. There dents physically vulnerable.

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-
inconsistent condom use, high numbers of part-

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
compared with LGB peers who reported no or medical, social, and economic—with each com-
low levels of family rejection (Ryan et al. 2009). ponent having practical and symbolic elements.
Mojola (2013) has prescribed a life course per- In recent years, advances in and access to
spective to examine these issues more closely, treatment—including effective drug therapies
charting the fluctuation of HIV risk at various and better monitoring of viral loads and T cell
stages of life. counts—have greatly improved the capacity of
As a result of sociologically driven inquiry, HIV-positive people to carry out their normal
researchers are increasingly advocating struc- routines and experience longer life expectan-
tural HIV prevention, which consists of not cies. But the medical management of HIV chal-
only “targeted interventions fostering changes lenges individuals to manage their physical and
in individual behaviour, but also interventions mental health within a social context that can
creating local environments conducive to, and be stigmatizing or limited in resources. Medi-
supportive of, individual and community-level cation adherence can reflect the compromises
behavior change” (Rhodes et al. 2005, p. 1027). made while resolving contradictory demands
Although men and women of diverse sexual ori- regarding how medications are to be taken and
entations and racial and socioeconomic back- the realities of work and social lives (Adam et al.
grounds engage in risk behaviors such as un- 2003). Many utilize complementary or alterna-
protected sex, the infection rates among MSM, tive therapies, which are increasingly viewed as
women, blacks, and the poor (and especially important tools for inserting personal agency
those in intersecting categories) suggest that into treatment practices and coping with the
groups that have been socially or economically uncertainty of illness symptoms and the side
marginalized are particularly vulnerable to HIV effects of traditional medications (Foote-Ardah
infection. The research overwhelmingly sug- 2003).
gests that people are differentially exposed to Yet effective management of HIV requires
HIV on the basis of their social locations in access to and relationships with medical insti-
ways that mirror exposure and vulnerability to tutions and representatives, which are uneven
damaging structures of inequality, requiring ap- across populations (Chase 2011). As Arnold and
proaches that account for the epidemic’s inter- colleagues (2009, p. 121) explain, “the health
sectional inequalities. and longevity benefits of antiretroviral ther-
apy (ART) for persons living with AIDS have
not been equally distributed across racial/ethnic
LIVING WITH HIV/AIDS: THE groups in the United States.” Non-Hispanic
MEDICAL, SOCIAL, AND blacks have a lower survival rate after an AIDS
ECONOMIC TRIAD diagnosis, likely due to a lack of timely treat-
How do social group memberships, and the sta- ment. Arnold and colleagues (2009) link these
tuses that they confer, have the potential to treatment disparities to neighborhood effects.
shape not only the social context of risk but also Yet scholars have been unable to disentan-
how individuals live with HIV? HIV interacts gle whether the mechanisms driving blacks’
with already existing social advantages or dis- higher AIDS mortality rates are physical and
advantages, becoming a component of identity social stressors in these communities (Ellen
that intersects with race, class, gender, and sex- et al. 2001, Kirby & Kaneda 2005); individ-
uality. Together, these interlocking positions uals’ material circumstances (Boardman 2004,
produce social meaning; limit or grant power; Ironson et al. 2008); lack of access to and trust
and interact with structures, institutions, and in the health-care system (Altice et al. 2001,
individuals to shape the experience of being Espinoza et al. 2007, King et al. 2004); or so-
HIV positive. cial networks that adversely influence health-
We can imagine the management of HIV related behaviors, attitudes, and norms. Some
requiring at least a three-pronged approach— scholars have also suggested that HIV stigma

and concerns about anonymity when access- discourage such a move: the unpredictability
ing HIV/AIDS services may reduce residents’ of positive drug effects, potentially debilitating
utilization (Lichtenstein et al. 2005, Wingood medication side effects, the potential for be-
et al. 2007). ing unable to secure disability insurance cov-
Sociologists have been keenly interested in erage should a relapse occur, difficulties with
the social management of HIV, addressing is- transitioning back into the labor force after a
sues such as stigma, disclosure, social sup- long absence, non-health-related employment
port, and the social significance of both HIV- instability, HIV-related symptoms, the effects
positive status and the larger AIDS epidemic of long work hours and work stress on health,
(Ciambrone 2003). Coping with HIV has often potentially unhealthy work environments, dif-
meant simultaneously managing its physical de- ficulty in managing medical appointments and
mands and experiencing a social status that can elaborate drug regimens while working, and the
diminish connections, existing resources, and fear that disclosure might result in losing one’s
social standing (Derlega & Barbee 1998). Indi- job (Brooks et al. 2004, Ferrier & Lavis 2003,
viduals with HIV often seek to reclaim a “safe” Nixon & Renwick 2003, Timmons & Fesko
moral identity by looking for social meaning in 2004). The powerful tension between an indi-
their diagnosis and heavily controlling the con- vidual’s desires, financial needs, and fears in-
ditions under which they disclose their status volved in working while living with HIV/AIDS
(Stanley 1999). generates a calculus that involves economic
Now that people are living longer with and personal considerations when an individ-
HIV, building families, establishing friend- ual considers remaining in the labor force or
ships, creating intimate relationships, and other returning after an extended absence.
forms of social support are associated with Nevertheless, for a subsegment of HIV-
fewer reported negative changes, less depres- positive individuals, some of the very circum-
sion, greater adherence to HAART, improved stances, histories, barriers, and behaviors that
consistency of medical care, and greater op- increased their risk of infection might also make
timism among those living with HIV/AIDS them less employable. They may be so disad-
(Updegraff et al. 2002, Wagner et al. 2002). vantaged that they find that their economic for-
Social support networks derived from ties to tunes actually stabilize following an HIV diag-
AIDS service providers can support a con- nosis due to their increased access to services
ceptual framework for understanding what it through state and nonprofit entities (Collins
means to have HIV, language in which to talk et al. 2008, Crane et al. 2002, Dickson-Gomez
about the condition, and networks and other re- et al. 2011, Watkins-Hayes 2013). Institutional
sources to begin restructuring life in the wake of ties become important to help highly econom-
a diagnosis (Watkins-Hayes et al. 2012). How- ically marginalized HIV-positive people avoid
ever, HIV-positive women are often expected situations that will likely further endanger their
to manage both their own health and that of health such as homelessness, drug addiction,
their intimate partners, which can undermine and risky sexual relationships that may never-
household stability (Wright 2003). theless yield resources.
Finally, economic issues can be critically im- In short, many HIV-positive individuals
portant for HIV-positive individuals. At first, confront what Berger (2004) terms “intersec-
when postdiagnosis life expectancy with HIV tional stigma,” marginalization based on HIV
was limited, there were marked declines in la- status and other disadvantaged statuses. Stres-
bor force participation among HIV-positive in- sors associated with institutional and inter-
dividuals (Ezzy et al. 1999, Massagli et al. 1994, personal racism, sexism, and economic hard-
Yelin et al. 1991). With the advent of HAART, ships compound the psychological distress of
although many express a desire to return to people living with, or at higher risk for con-
work (Ghaziani 2004), a range of factors can tracting, HIV/AIDS (Battle 1997, Catz et al.
444 Watkins-Hayes
2002, Chase 2011, Ciambrone 2003, Gilbert proved quality of life for people living with
& Wright 2003, Hammonds 1995, Zierler & HIV/AIDS.
Krieger 1997). We therefore cannot talk about
a lived experience with HIV without consider-
ing how interlocking oppressions can circum- CONFRONTING HIV/AIDS:
scribe how individuals work, love, and live. For SERVICES, ACTIVISM, AND
some, confronting HIV includes becoming en- PUBLIC POLICY
gaged politically to challenge dominant nar- The synergistic relationship between the
ratives that frame them as powerless, socially HIV/AIDS research, clinical, programmatic,
dysfunctional, irresponsible, and unable to con- and activist communities is noteworthy for its
tribute because of their social group member- commitment to praxis, the merging of theory
ships (Berger 2004, Epstein 1996, Gould 2009, and action so that ideas are engaged and ap-
Stockdill 2003). By offering this range of expe- plied. These networks operate in many of the
riences of HIV-positive people, scholars have same professional spaces and constantly chal-
produced a more complex, nuanced, and accu- lenge each other to notice blind spots. Sci-
rate story about the AIDS epidemic. entific information can then be distributed to
With research in this area moving forward, those doing HIV prevention and treatment
new questions will emerge as the epidemic con- work on the ground, and lessons learned from
tinues to evolve. A growing consensus finds that activists and service providers can help the sci-
early initiation of HAART not only improves entific and clinical communities better respond
individual patient outcomes but also reduces to the constantly changing dynamics of the epi-
the risk of HIV transmission to uninfected part- demic. This was a hard-fought relationship, es-
ners. Sociologists can use ethnographic, survey, pecially in the early stages when activists and
mixed-method, comparative, and other meth- HIV-positive individuals found themselves on
ods to explicate the barriers to the widespread the margins of professionalized AIDS knowl-
adoption of this promising development. Pre- edge production (Epstein 1996) and, as Gould
vious research has focused a great deal on the (2009) demonstrates in her “emotional his-
patients in this equation, but medical providers tory” of the AIDS Coalition to Unleash Power
can be pivotal in determining whether and (ACT UP), the targets of “aggressive indiffer-
when an HIV-positive individual starts treat- ence, extreme negligence, and punitive poli-
ment (Laws et al. 2013). Further, in this era of cies regarding AIDS” (p. 45). Nevertheless, the
growing income inequality, sociologists would AIDS research-clinical-programmatic-activist
be wise to focus on the widening gap in medical, community relationship now demonstrates that
social, and economic experiences among HIV- research can illuminate how power is embedded
positive people. Lastly, as the goals of the Na- in HIV as a medical problem, a social issue, and
tional HIV/AIDS Strategy, as outlined by Pres- an area of inquiry.
ident Obama, intersect with massive changes in AIDS has always been a fraught political is-
the health-care system through the Affordable sue in part because of its relationship to con-
Care Act, sociological research can track dy- troversial and intractable debates. Cultural crit-
namics around how AIDS treatment and pre- ics such as Susan Sontag (2001), Randy Shilts
vention services are distributed. This is particu- (1987), and Paula Treichler (1999) were early
larly important in the wake of potential changes observers of these connections. When AIDS
to the Ryan White Act, which has historically emerged in the United States, gay men and in-
funded numerous medical and social service ef- travenous drug users represented the bulk of re-
forts against HIV. Scholars are well positioned ported cases, fueling a disease narrative that em-
to gauge whether a national focus on disease phasized individual behavior and stigmatized
prevention and increased access to affordable identities. As “the modern plague” (Sontag
care indirectly and directly contributes to im- 2001), HIV was linked not only to death but

also to homosexuality, promiscuity, and ille- services, political activism and social move-
gal drugs, casting it as divine punishment for ments, and public policy has been vast and
“deviant behavior” (Adam 1989). Exceptions diverse (Stockdill 2003). Groups such as Sis-
such as the youngster Ryan White and tennis terlove, the Well Project, the Positive Women’s
pro Arthur Ashe were presented as “victims” Network, and the Black AIDS Institute have
of the disease infected through blood transfu- been confronting not only the epidemic itself
sions rather than sexual behavior. Groups such but also the social and political inequalities that
as the Gay Men’s Health Crisis, ACT UP, and drive it. They also challenge racism and sex-
others mobilized, fighting not only a medical ism within the AIDS advocacy community, con-
condition but also its stigmatized associations stantly pushing a deeper analysis of dimensions
that limited funding for research, prevention of privilege that influence issues ranging from
education, and treatment (Cohen 1999, Epstein the policy and programmatic interventions cho-
1996, Gamson 1989, Gould 2009, Shilts 1987, sen to stem the epidemic to the ways in which
Stockdill 2003). Countering this narrative, AIDS organization funding is distributed.
white gay men worked vigorously to present These advocates work to ensure that resources
the impact of AIDS on their communities, of- are both administered by and reach people of
fering detailed, eloquent, and sympathetic me- color, who operate through trusted relation-
dia portrayals to “reveal to the larger hetero- ships in the hardest hit communities, but lack
sexual world the emotional toll that AIDS has the resources of wealthier institutions to sustain
taken in gay communities while breaking down the services (Wilson 2014). In addition, women,
stereotypes about gay life” (Hammonds 1995, largely neglected as the focus of research, treat-
p. 438). A population that had been hidden, ment, and education in the epidemic’s earliest
maligned, and poorly understood was able to stages (Goldstein & Manlowe 1997, Higgins
tell its stories, revealing some of the “junctures et al. 2010, Roth 1998), have organized into
and disjunctures in our beliefs about sexuality “workable sisterhoods” to combat stereotypes
and sexual practices as well as the anxieties in and politically advocate for increased attention
American life about sex and morality” (p. 438). and resources (Berger 2004). As a result, con-
These strategies sought to keep gays from being fronting intersectional stigma through politi-
“scripted out of narratives of American national cal and social engagement has been shown to
belonging” ( Jenkins 2007, p. 5). have status-enhancing effects for HIV-positive
The ability to couple aggressive political activists (Berger 2004, Watkins-Hayes 2013).
mobilization with economic capital, highly re- Internal challenges have reduced or delayed
sourced social networks, and the authority be- AIDS activism among some subpopulations
stowed through racial privilege translated into most affected by the epidemic. In her influential
focused attention on the challenges faced by book, The Boundaries of Blackness: AIDS and the
(mostly) white gay middle-class men and ex- Breakdown of Black Politics, Cohen (1999) writes
posed deep societal homophobia. However, of silence inside black communities about
their stories came overwhelmingly to repre- the epidemic’s impact due to a commitment
sent the universal experience of HIV/AIDS, to a politics of racial respectability among
marginalizing the struggles of other groups who black leaders, black media, and others (see also
were having different experiences by virtue of Quimby & Friedman 1989). Cohen (1999)
race, gender, class, and sexuality. Presenting argues that religious beliefs and class divisions
sexual orientation as almost the sole category of likely fueled this dynamic as community leaders
significance at the outset obscured how racial, were reluctant to rally behind those most likely
gender, and class inequalities were also pow- to be infected—gay men, intravenous drug
erfully shaping the epidemic. In reality, the users, low-income women, and sex workers.
community of individuals mounting a collective Coupled with a slow response to the rising
response to AIDS through community-based HIV infection rates among blacks by the CDC,
446 Watkins-Hayes
many white-dominated HIV advocacy organi- HIV-positive status to their sexual partners un-
zations, and the general public, the epidemic derscores the “criminalization of sickness” in
has been able to gain a foothold that black ways that Hoppe argues are less about public
communities are still struggling to loosen. health concerns and more about framing HIV
Despite these difficulties, HIV-focused sup- as a moral infection requiring interdiction and
port groups, social service agencies, and ad- punishment. These and other issues represent
vocacy groups located all over the country the next frontier in the sociology of HIV/AIDS.
have been critically important in helping peo-
ple cope with their diagnoses (Watkins-Hayes
et al. 2012, Watkins-Hayes 2013). Their work CONCLUSION: FUTURE
has also educated the public and expanded the DIRECTIONS IN THE
advocacy network by engaging other kinds of SOCIOLOGY OF HIV/AIDS
institutions such as drug and alcohol rehabilita- As we ponder the possibility of the beginning of
tion centers, churches, ballroom communities, the end of HIV/AIDS in the United States, the
and correctional facilities in AIDS-related work moment can be characterized by both optimism
(Bailey 2013, Bowleg & Raj 2012, Grinstead about the scientific possibilities and persistent
et al. 2001, Linnan & Ferguson 2007). In her concerns about the 1.1 million people who
recent book, Live Long and Prosper: How Black struggle daily against the virus, the several mil-
Megachurches Address HIV/AIDS and Poverty in lion who experience complex inequalities that
the Age of Prosperity Theology, Barnes (2013) disproportionately place them at risk for infec-
demonstrates that black churches offer a vari- tion, and the ongoing social divisions that ren-
ety of responses to the epidemic through AIDS der certain groups “expendable” and “disease-
ministries. As a result of these mobilization ef- worthy” when serious health threats emerge. As
forts, significant progress has been made to the Lancet (2012, p. 1967) points out, “Eradicat-
combat AIDS stigma, increase treatment op- ing a disease goes far beyond scientific advances,
tions, create a network of AIDS services, and which will go unrealized without strong social
expand AIDS education. support and public health actions as well as sub-
In coming years HIV/AIDS will remain an stantial and sustainable investments. . . . End-
important case study in coalition politics and ing stigma and discrimination against people
new questions will emerge. As disparate groups living with HIV, men who have sex with men,
battle this epidemic of intersectional inequal- sex workers, and people who inject drugs—as
ity, will their organizational power dissolve or well as improving these peoples’ access to and
change as the medical and social realities of uptake of HIV services—[are] the underlying
the epidemic shift with new scientific develop- principles [necessary] to fulfil the vision.”
ments? As the US AIDS epidemic continues to In summary, the sociology of HIV/AIDS
slip from the national consciousness, will its em- can be credited with at least three important
bedded inequalities deepen? In addition, new contributions to the scholarly, policy, and pro-
frontiers in the study of the political response grammatic response to the AIDS epidemic as
to the AIDS epidemic must examine how these well as the field of sociology. First, scholars
fault lines shape emerging policy and legal bat- have systematically challenged the overempha-
tles. Adam (1989, p. 2) writes, “It is proba- sis on biomedical and individual behavioral ap-
bly fair to say that no one objects to the con- proaches to HIV and successfully advanced a
trol and eradication of the causative agent(s) of focus on the social dimensions of HIV. This has
AIDS, but AIDS control policy has always been blossomed into an emphasis on racial inequal-
much more and has inevitably raised the ques- ity, economic conditions, public policies, social
tion of the supervision and regulation of sex- networks, neighborhood dynamics, and cul-
uality.” For example, Hoppe’s (2013a,b) work tural norms to explicate the multi-dimensional
on laws requiring individuals to disclose their nature of HIV risk, the lived experiences of

HIV-positive people, and the collective re- an intersectional framework should feel free
sponse to the epidemic. Second, sociologists to use all the tools at our disposal—such as
have contributed to the expanding use of in- network analysis, surveys, and ethnography—
tersectional approaches in the study of health. to carry out our work. Although large-scale
Not only has HIV status powerfully interacted randomized controlled trials are still consid-
with race, class, gender, and sexuality in shap- ered the gold standard in HIV/AIDS research,
ing identity and meaning-making, but sociolog- other techniques that capture the interplay be-
ical work has also demonstrated how HIV re- tween social categories should continue to be
flects contours of power in transmission risk, deployed (Mustanski 2001). Community par-
lived experiences, and politics. Third, the so- ticipatory research in which those being stud-
ciology of HIV/AIDS represents an important ied help to formulate research questions, gather
model demonstrating how research can be con- and analyze data, and report findings is not un-
ducted that respectfully but rigorously exam- common in the area of HIV, operationalizing
ines all aspects of human behavior, including the values so central to intersectionality studies
behaviors that fall outside of traditional norms. of situated knowledge (Collins 1990) and break-
In all of the reviewed research, scholars have ing down researcher–researched power dynam-
had to grapple with the inherent complexities ics. Intersectionality also encourages us to con-
and power imbalances associated with launch- sider how the identities of the researchers may
ing inquiry into some of the most intimate as- inform the intellectual pursuit. The national
pects of people’s lives. HIV/AIDS strategy calls for diversifying the
Perhaps sociologists’ most important con- HIV workforce and increasing culturally rel-
tribution will be to continue revealing how be- evant HIV prevention interventions as strate-
haviors and events that appear at first glance gies for reducing HIV-related health dispar-
to be solely bodily and biological are actually ities. In their discussion of the CDC-funded
socially driven. For example, the opportunity Minority HIV/AIDS Research Initiative, Sut-
and decision to wear a condom to prevent HIV ton and colleagues (2013, p. 2207) contend that
transmission is not simply a precautionary med- these efforts “may increase the credibility of
ical act but a negotiated behavior that may be research findings and confidence in research-
grounded in power dynamics between sexual driven initiatives among minority communities
partners, investments in gender respectability, who have a history of medical research-related
and the freedom to realize and assert a particu- distrust.”
lar sexual identity. Infection risk exists in a con- Second, although multiple identities inform
text in which social networks, including sexual, social experience, certain categories are likely to
economic, and drug networks, are embedded dominate in specific contexts, spaces, and mo-
in racialized, gendered, and economic environments. Race will likely continue to be a crit-
ments that produce uneven capacities and re- ical category of analysis in the sociology of
sources. It is clear that interlocking inequalities HIV/AIDS given the disparities. Racial con-
both directly and indirectly drive the epidemic sciousness, identities, and cultural practices
within the wide matrix of identity and power. and production, as well as racial systems and
Having identified substantive directions in structures, ideologies, and inequalities, can be-
which the sociology of HIV/AIDS might move come hegemonic, whereas other identities not
throughout this article, in what follows I iden- only remain salient but are shaped by and
tify four key considerations for intersectional through racialized encounters (Moore 2012).
approaches to the field. First, the objective of As such, more work is needed on HIV/AIDS
intersectionality studies is not to offer a stan- among Native Americans, Asian Americans,
dardized method (Cho et al. 2013, Hankivsky and Pacific Islanders (Wilson & Yoshikawa
2012). Sociologists of HIV/AIDS who adopt 2004). Future work might also adopt a cross-
448 Watkins-Hayes
national perspective to explicate the dynamics in the epidemic. For example, Watkins-Hayes
of HIV/AIDS in different racial contexts. For (2013) compares the experiences of low-income
example, in a recent meta-analysis examining and middle-class women living with HIV/AIDS
differences in HIV infection among black men to examine the role of socioeconomic status
in the United States, Canada, and the United in accessing AIDS service providers and HIV-
Kingdom, Millett and colleagues (2012) find related social capital. She finds, counterintu-
that black MSM are as likely as other MSM itively, that middle-class HIV-positive women
to engage in serodiscordant unprotected sex, are less likely to have extensive social connec-
but HIV-positive black MSM in each coun- tions to other people with HIV/AIDS, effec-
try are less likely (22% in the United Kingdom tively placing them at a disadvantage in terms
and 60% in the United States) to begin HAART of their HIV-related networks and social capital
than other HIV-positive MSM. In addition, fu- relative to low-income women who often cul-
ture research can examine whether and how tivate these ties in the course of pursuing med-
less-analyzed categories of identity and dif- ical and social services through AIDS service
ference such as disability, citizenship, and providers. In addition, an HIV diagnosis ap-
religion matter when chronicling the AIDS pears to heighten the sense of financial vulner-
epidemic. ability for middle-income women while lower-
Third, HIV/AIDS research and activism ing this sense for low-income women who have
that adopt an intersectional perspective have increased access to services.
been at the forefront of affirming, and some- As a result of bringing both a sociological
times creating, alternative terminologies that il- and an intersectional lens to the study of and
luminate and contest the power dynamics and response to HIV/AIDS, the complex and mul-
modes of inequality that language often ob- tilayered risk factors, lived experiences, and po-
scures. For example, the term “sex worker” litical goals and activism of those most directly
rather than “prostitute” is widely used in the affected are no longer overlooked in academic
field to highlight the labor, class, and gendered scholarship, policies and programs, or political
dimensions of the exchange. In addition, the activism. As Cho and colleagues (2013, p. 796)
wide use among researchers of the term “MSM” remind us:
rather than “gay” upends the notion that be-
havior and identity are inextricably linked, re- The future of intersectionality studies will
minding us that they can trigger separable social thus be dependent on the rigor with which
relations that must be taken into consideration scholars harness the most effective tools of
when examining the epidemic. their trade to illuminate how intersecting axes
Lastly, this article has revealed how an inter- of power and inequality operate to our col-
sectional approach requires us to examine po- lective and individual disadvantage and how
sitions of privilege just as we examine locations these very tools, these ways of knowing, may
of disadvantage. “Framing intersectionality as also constitute structures of knowledge pro-
only about women of color gives masculin- duction that can themselves be the object of
ity, whiteness, and maleness an intersectional intersectional critique.
pass,” Carbado (2013, p. 841) writes. Privileged
or high-status intersectionalities go unnamed Intersectionality informs how we talk about,
and uninterrogated, “further naturalizing white mobilize around, and study HIV. Sociologists
male heterosexuality as the normative baseline are uniquely poised to offer evidence-based re-
against which the rest of us are intersection- search that recognizes HIV as an epidemic
ally differentiated” (p. 841). The sociology of of intersectional inequality and to bring that
HIV/AIDS must now take up questions that knowledge to bear on conceptual frameworks,
explicitly consider the role of whiteness, het- methodological tools, and the integration of
erosexuality, and middle- and upper-class status theory and action.

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
Theory and Methods

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
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
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
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
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
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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
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• 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
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Annual Review of Statistics and Its Application
Volume 1 • Online January 2014 • http://statistics.annualreviews.org
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Associate Editors: Nancy Reid, University of Toronto
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The Annual Review of Statistics and Its Application aims to inform statisticians and quantitative methodologists, as
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• What Is Statistics? Stephen E. Fienberg • High-Dimensional Statistics with a View Toward Applications
• A Systematic Statistical Approach to Evaluating Evidence in Biology, Peter Bühlmann, Markus Kalisch, Lukas Meier
from Observational Studies, David Madigan, Paul E. Stang, • Next-Generation Statistical Genetics: Modeling, Penalization,
Jesse A. Berlin, Martijn Schuemie, J. Marc Overhage, and Optimization in High-Dimensional Data, Kenneth Lange,
Marc A. Suchard, Bill Dumouchel, Abraham G. Hartzema, Jeanette C. Papp, Janet S. Sinsheimer, Eric M. Sobel
Patrick B. Ryan • Breaking Bad: Two Decades of Life-Course Data Analysis
• The Role of Statistics in the Discovery of a Higgs Boson, in Criminology, Developmental Psychology, and Beyond,
David A. van Dyk Elena A. Erosheva, Ross L. Matsueda, Donatello Telesca
• Brain Imaging Analysis, F. DuBois Bowman • Event History Analysis, Niels Keiding
• Statistics and Climate, Peter Guttorp • Statistical Evaluation of Forensic DNA Profile Evidence,
• Climate Simulators and Climate Projections, Christopher D. Steele, David J. Balding
Jonathan Rougier, Michael Goldstein • Using League Table Rankings in Public Policy Formation:
• Probabilistic Forecasting, Tilmann Gneiting, Statistical Issues, Harvey Goldstein
Matthias Katzfuss • Statistical Ecology, Ruth King
• Bayesian Computational Tools, Christian P. Robert • Estimating the Number of Species in Microbial Diversity
• Bayesian Computation Via Markov Chain Monte Carlo, Studies, John Bunge, Amy Willis, Fiona Walsh
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• Build, Compute, Critique, Repeat: Data Analysis with Latent Susan A. Murphy
Variable Models, David M. Blei • Statistics and Related Topics in Single-Molecule Biophysics,
• Structured Regularizers for High-Dimensional Problems: Hong Qian, S.C. Kou
Statistical and Computational Issues, Martin J. Wainwright • Statistics and Quantitative Risk Management for Banking
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SO40CH20-Watkins-Hayes ARI 1 July 2014 10:2

Annu. Rev. Sociol. 2014. 40:431–57 Keywords

INTRODUCTION ues to play a signiﬁcant role in determining

conceptualized intersectionality as a theory of 2008), including sub-Saharan Africa (Foster

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

inconsistent condom use, high numbers of part-

gently needed. In their analysis of data from

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dance clubs in Baltimore, USA. Soc. Sci. Med. 73(3):475–81

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Contents Volume 40, 2014

Theory and Methods

Endogenous Selection Bias: The Problem of Conditioning on a

Political and Economic Sociology

Differentiation and Stratification

Race, Ethnicity, and the Changing Context of Childbearing

Somebody’s Children or Nobody’s Children? How the Sociological

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

New From Annual Reviews:

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New From Annual Reviews:

Editor: Stephen E. Fienberg, Carnegie Mellon University

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Editor: Stephen E. Fienberg, Carnegie Mellon University