The social construction of HIV: A narrative study of Israeli Arabs.

"Social determinants of health"-that is, nonmedical care-related factors, forces, and structures that have a strong influence on health-play a vital role in HIV prevention and treatment. In this study, we focused on one such key factor: culture. Israeli Arabs, the largest minority group in Israel, share a unique culture. Although the incidence of HIV/AIDS is lower among Israeli Arabs than among Jews, Arabs account for only 1% of HIV tests in Israel and report poorer HIV-related knowledge, whereas the majority of newly diagnosed Arabs are usually diagnosed with full-blown AIDS. This study explored how HIV/AIDS is socially constructed in Israeli Arab society. A sample of 31 HIV-negative Israeli Arab participants wrote stories about a man living with HIV. Thematic analysis was used to analyze the data. The analysis identified two themes. The first, "HIV and 'forbidden' sexual practices," constructed HIV/AIDS as a sexually transmitted disease associated primarily with premarital sex (a norm transgression in Arab culture). The second theme, "living with HIV," involved two opposing subthemes: "life goes on" and "a ruined life." The former portrayed the life of men with HIV as moving on, at times into a successful future. The latter depicted the point of diagnosis as signifying a turn for the worst-a bleak and hopeless future. The findings suggest that HIV/AIDS is stigmatized among Israeli Arabs and the nature and extent of the stigma corresponds with cultural norms, stressing the importance of designing culturally informed interventions for HIV/AIDS prevention and treatment.