Ann O'Leary · Paula M. Frew Editors Poverty in the United States Women’s Voices Poverty in the United States Ann O’Leary • Paula M. Frew Editors Poverty in the United States Women’s Voices Editors Ann O’Leary Paula M. Frew Atlanta, GA, USA Emory University School of Medicine Department of Medicine Division of Infectious Diseases Atlanta, GA, USA Emory University, Rollins School of Public Health Hubert Department of Global Health & Department of Behavioral Sciences and Health Education Atlanta, GA, USA ISBN 978-3-319-43831-3 ISBN 978-3-319-43833-7 (eBook) DOI 10.1007/978-3-319-43833-7 Library of Congress Control Number: 2016960578 © Springer Science+Business Media New York 2017 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. Printed on acid-free paper This Springer imprint is published by Springer Nature The registered company is Springer Science+Business Media LLC The registered company address is: 233 Spring Street, New York, NY 10013, U.S.A. Foreword I am honored to introduce Poverty in the United States: Women’s Voices written by strong and committed HIV Prevention Trial Network investigators and coedited by Drs. Ann O’Leary and Paula M. Frew. The editors are two scholars who have dedi- cated their scientific journeys to advocating for the needs of women and for the design and implementation of scientifically based multilevel interventions for women in the USA and globally. If you have followed Drs. O’Leary and Frew’s research as I have, you will not be surprised to learn that they have produced this unique book. Poverty in the United States: Women’s Voices has a powerful message that although numerous biomedical and behavioral prevention and treatment approaches have been used to slow the public health crises of AIDS, without addressing poverty and food insecurity, which constitute the major drivers of HIV among women, we will not witness the end of AIDS or other public health epidem- ics in our country. This book arose from an HIV-focused study whose investigators wished to con- textualize the study’s HIV incidence findings. One out of five new HIV infections in the USA is among women, and women of color, particularly African American women, are disproportionately affected by HIV. Unfortunately, how the social struc- tural forces of poverty that have shaped the HIV epidemic and other health prob- lems among women of color has been understudied. These women represent the most marginalized segments of our society in terms of economic strength, political force, social status, and access to legal systems. While most individuals in the USA have met or learned about someone who has suffered from hunger and poverty, few of us acknowledge that this is happening in the wealthiest nation in the world. We think that hunger and poverty occurs primar- ily in underdeveloped countries. The reality is that the latest Census Income, Poverty, and Health Insurance Data released in September 2015 show that in 2014 about 46.7 million Americans (15.0 %) lived below the poverty line ($24,250 for a family of four in 2014). Women in America are 32 % more likely to be poor than men. Employed women are more likely to be poor than employed men, and women are more likely to be poor at every level of educational attainment than men. African Americans have been found to have the highest poverty rate. African Americans are v vi Foreword disproportionately affected by poverty, food insecurity, and unemployment and are also more likely to receive food assistance than any other ethnic group in the USA. Women make up over 90 % of adult Temporary Assistance to Needy Families (TANF) recipients. Moreover, TANF, the country’s main cash assistance program, does not provide sufficient support to prevent hunger, homelessness, and substan- dard living conditions, such as living with utility cut-offs. Unfortunately, the anti- poverty and safety net programs in the USA have eroded over the past two decades and continue to neglect providing sufficient provisions for helping women and their families escape poverty. Women face not only poverty but also the circumstances that cause them to remain mired in it. They cannot break the cycle of poverty despite their formidable reservoirs of resilience. Poverty in the United States: Women’s Voices is a timely book and one that is urgently needed. A growing number of calls to action have called for addressing structural and policy drivers, such as poverty and food insecurity, in preventing and treating the spread of HIV among women most at risk for infection who live in inner city and rural communities in the USA that have high poverty and extremely high rates of HIV. One of the novel contributions of this book is the use of qualitative methods to capture the life experiences of such women and how poverty, food insecurity, lim- ited educational opportunities, class, unemployment, policing, incarceration and criminal justice involvement, and community violence have shaped the HIV epi- demic in this population. Each of these social structural drivers has, unfortunately, been ignored in the fight against AIDS and other diseases faced by women in the USA. This book is characterized by its rigorous research methods, strong science, and the collective voices it captures that underscore the need for changes to be made in our HIV prevention and treatment interventions and policies. Poverty in the United States: Women’s Voices makes clear that solutions must avoid individually oriented paradigms to resolve the AIDS crisis. Each chapter has inte- grated science and advocacy strategies to provide the reader with steps that need to be taken to enact large-scale societal changes to end poverty co-occurring issues. The book forcefully argues how social and political drivers of diseases such as HIV, drug use, mental illness, and gender-based and gun violence will remain with us for many years to come, if social and structural drivers are not addressed. One must not focus on “blaming the victim” ideologies, but on ideologies and approaches that target structural drivers of diseases and social problems which are affecting a large number of women across the USA. I couldn’t agree more with the core underlying messages of the book that posit maintaining the status quo of huge and growing economic and attendant disparities that have befallen the USA over the past decades which have disproportionately affected women is fueling a public health crisis and creating an enormous risk to our nation. The book underscores that public health can be traced to the impact of pov- erty and social inequities and cannot be stopped with solutions that do not address the original drivers of the problems. Foreword vii I urge you to read this powerful book to understand women’s lives and struggles. This book will be an eye opening experience for many. The book presents insights, suggestions for innovative and strategic policy reform, such as approaches for expanding reproductive health care, as well as pri- mary health care in general and sexually transmitted diseases and HIV in particular. Women need to get the services they deserve. It also addresses that access to care must be guided by rights-based ideology, where social and economic rights are obtained through government commitment and public policies. Finally, when you complete reading this book, you will not only have learned about the scope of poverty and its consequences among some of the most vulnerable populations in our society, but also have deepened your understanding about the role of poverty and food insecurity and other drivers of health and social problems. No disease can be reduced or eliminated without addressing these structural drivers. This book is important for researchers, policy makers, advocates, and service providers. Collectively, the authors make it very clear that women who are poor are not responsible for the conditions and diseases they experience on a daily basis. The book highlights the message that the poor are not responsible for their own fates and systematically demonstrates how this belief is a major obstacle to economic redis- tribution, the creation of services and “safety nets” that are essential for reducing health disparities and achieving the end game of lifting women out of poverty. Each of us needs to have a better grasp of the many sorrows and stresses that poverty manifests in the daily lives of poor women who are often challenged with intersec- tions of other marginal identities, gender and race most specifically. This book serves as a way to engage with the life experiences of those who are often left voiceless, hearing both their traumas and their successes and resiliency. The book sends a message to politicians and policy makers to avoid blaming the women who are victims of life’s poor conditions. This valuable book sends the mes- sage to people who have little experience with poverty and may not realize the degree to which Americans suffer hunger, violence, addiction, community, and gun violence. This book calls for the reader to look for and embrace points of transformation in the systems which facilitate the attitudes, narratives, and policies that fuel the conditions of poverty. Professor at the School of Social Work Nabila El-Bassel, PhD Columbia University, New York, NY Preface The tendency to attribute blame to the unfortunate is very common in the case of people living in poverty (Cozzarelli, Wilkinson, & Tagler, 2001; Rice, 2015). Historically, economic status was perceived by many to be reflective of the indi- vidual’s ability and industry, and many still believe this to be true. Others believe poverty to be caused by economic unfairness and discrimination. In editing this book, we were aware of the possibility that readers might take much of the con- tent—substance use, unemployment, and violence—to be indicative that the poor participants in our study were in some way responsible for their plight. In an effort to contextualize these topics in the chapters, we asked authors to start each chapter with a sociohistorical description of how current conditions came to be and to end with a section on policy recommendations. One personal factor that has been studied as a contributor to people’s tendencies to attribute blame to the unfortunate generally and the poor specifically is the “just world” hypothesis (Lerner, 1970). This refers to the belief that the world is just and people get what they deserve. It is a specific example of the “fundamental attribu- tion error” marked by a tendency to attribute one’s own fate to external factors and those of others to internal traits (Ross, 1977). This belief system is believed to be motivated by fear that the person themselves may fall prey to the same misfortune if causes are seen as being random or systemically caused (as US poverty, by and large, is). The notion that people are responsible for their own fates is a major impediment to economic redistribution and the creation of services and “safety nets” for the disadvantaged (Lane, 2001). A substantial body of research has documented people’s tendencies to apply the just world hypothesis to victims of misfortune. These include victims of sexual assault (Patel, 2009), economic inequality following Hurricane Katrina (Belle, 2006), as well as poverty (Cozzarelli et al., 2001; Shapiro, 2003). Further, individu- als who believe in a just world have been shown to have more negative attitudes toward poverty and the poor (Shapiro, 2003). Interventions have been developed that attempt to reduce these attitudes (Ioannou, Kouta, & Andreou, 2015). ix x Preface These attitudes however are not, in and of themselves, a slight on the character of those who believe them; in fact, they are emblematic of the challenges of living in a diverse nation, a nation where, in order to achieve equity for all citizens, we can have no room for assumptions about the lived experiences and the status of the well- being of others. It is about competence, not character. Many Americans will never be given the opportunity to understand the crippling angst and stress that poverty manifests in the daily lives of the impoverished. Moreover, socioeconomic status is oftentimes further complicated at the intersections of other marginal identities, gen- der, and race most specifically. Complicated by our nation’s challenges with knowl- edgably engaging in and navigating racial and gendered dynamics is a racial and gendered illiteracy (Stevenson, 2013). It is at these identity intersections that we can see the synergy of multiple levels of systemic oppression and insufficient public policy, policy which orients itself toward a capitalist brand of efficiency rather than a politic of humanity. In twenty-first century America, from gentrification to water contamination and discrimination to congressional obstruction, the poor are often the victims of dis- placement, insecurity, and state-sponsored violence at all levels. These factors cre- ate a perfect storm of isolation and stress which is neatly tucked away from the American consciousness. This text should serve as a way to engage the narratives of those who are often left voiceless, hearing both their traumas and their triumphs. Acknowledging the resilience of their humanity and spirit despite their conditions will be instrumental in order to develop a desire to understand further the lives lived by those who are in poverty. In the face of tragic events, “conspiracy theories” are often voiced. However, sometimes conspiracy theories have truth to them. For example, many people believe that crack cocaine—a drug that decimated inner cities in the late 1980s and early 1990s—was intentionally distributed within inner cities (where it still exists today). Cheap and highly addicting, this form of cocaine was associated with extreme behavior (for extensive descriptions of the lifestyles of women who were addicted to crack, see Sharpe, 2005; Sterk, 1999). In fact, an investigation by the U.S. Department of Justice revealed that the anti-Sandinista Contras had been smuggling crack cocaine from Central America into the Los Angeles area and returned the cash profits to pay for automatic weapons. While the role of the CIA (Central Intelligence Agency) in this situation remains controversial, the explosion of crack cocaine in the urban USA is believed to have been sparked by this process (U.S. Department of Justice, 1997). It is our hope that this book will have the effect of preventing blaming of the victims described here by increasing awareness of the life conditions experienced by many poor women and that they will come to life for readers with their verba- tim quotes. We hope that the book will be read by people who have little experi- ence with poverty and may not realize the degree to which Americans suffer hunger, violence, addiction, and other factors that are topics of these chapters. We hope that educating the public in this way about the suffering caused by poverty will increase empathy and with it the desire to reform harmful policies and practices. Preface xi Beyond the narratives shared in this volume, developing this empathy will require that readers look both reflexively and introspectively at the conditions of poverty in relation to their own lives. For many, especially those who have little personal expe- rience with poverty, it is very easy and quite compelling to o verestimate the validity the assumptions made about opportunity, access, and ability in America. Despite this ease, we cannot neglect the emotional and psychological ramifications of poverty, wounds that can never truly be healed. We encourage our readers to probe more deeply, beyond “bootstrap” and “American Dream” narratives. We ask you to stand face to face with the historical and contemporary realities of our nation surrounding the dehumanization of our fellow citizens in our quest for wealth and power. We encourage our readers to vicariously engage with the trauma of intergenerational social exclusion, systemic inequity, and status quo deficitization that has shaped life trajectories of the poor and the common perspectives many have of their conditions. Moreover, developing this empathy will require that readers confront the con- crete realities of the vast racial, ethnic, and socioeconomic disparities in the domains of health, education, justice, and employment that affect the lived experiences of those who live in poverty. By taking a systemic and life course view of poverty, we can see that poverty is not a moment in time but is being shaped and made at all times, shaped and made by failing schools with underqualified teachers, schools which prioritize neoliberal labor-market educational aims over the concerted prepa- ration of students to thrive in an ever-changing world. The same schools contribute most egregiously to the school to prison pipeline and school-related trauma (Nasir, 2011). Poverty results from being embedded in communities where over-policing and over-incarceration tear apart households and limits family earning potential (Alexander, 2012). It affects both the psychological and corporal experience of those in its grasp at every moment of every day. We encourage our readers to endeavor to question their own assumptions about the nature of American life, survival, and opportunity. Are the conditions as they seem? If not, how can we even begin to blame the victim? Napier, Mandisodza, Andersen, and Jost (2006), in their analysis of reactions to the victims of Hurricane Katrina, invite us to consider where and why we attribute blame for issues which are at their root systemic. The authors note that in the wake of one of the most devastat- ing environmental disasters of the twenty-first century, people blamed the victims of the hurricane, despite the many failures of the local and national government to respond adequately to the warnings. Ask yourself what role these “victim-blaming attributions” (p. 64) play for us psychologically and emotionally? Do we engage them as a way to cope in an inequitable world? Do we lean on them to avoid grap- pling with the reality of our nation’s multisystemic challenges? How do we consider the role of systems and institutions in constructing and maintaining systems of pov- erty? These are the questions we must wrestle with. In this spirit, we also challenge our readers to look for sites of transformation in the systems which facilitate the attitudes, narratives, and policies that facilitate the conditions of poverty. It is at these sites that we will find possibility for transformation, the impetus for rehuman- ization, and paths out of poverty.