This ethnographic study will examine the use of mental health services among a group of HIV+ Puerto Rican women in the Newark, New Jersey AIDS community. The project will examine 1 ) the decision making processes that guide the selection of treatment services, 2 ) the barriers to treatment encountered and strategies for overcoming these barriers, and 3 ) those factors that lead to the use of complementary modalities of treatment among this group of individuals. The study will investigate what these women perceive as symptoms requiring treatment and explain how they decide what health care options to access in treating particular mental and medical manifestations of distress. By examining both barriers to treatment and the decision making process from the perspective of HIV+ Puerto Rican women, this study will evaluate the hypothesis that among some HIV+ women of color, complementary modalities of treatment channel patient dissatisfaction with dominant biomedical paradigms, clinical experiences and stigmatizing social metaphors. Kleinman's Cross-cultural model of 'the health care system' and-Rogler and Cortes' Concept of help- seeking pathways will be used to articulate the symbolic and behavioral contexts in which HIV+ individuals seek to assemble a toolkit of useful resources with which to treat their illnesses. Through the use of participant-observation, semistructured interviews, freelisting and pilesorting techniques, focus groups, and the construction of case histories, the ethnographer will clarify the conditions that discourage HIV+ women of color from pursuing conventional treatment and document the help-seeking strategies that they actually employ. A total of 60 HIV+ Puerto- Rican women utilizing the public health system will be recruited. A second sample of 20 health care providers will be drawn from the group of professional and alternative health care providers who interact with the women enrolled in the study.
