Abstract

Current data suggests that the U.S. is on track to end the HIV epidemic for white people but not for Black, Latine, and other people of color. National initiatives have emphasized diversifying the workforce as part of the response to inequities in HIV outcomes, and yet the field remains staffed predominantly by white service professionals. Moreover, diversifying the workforce without broader systems change will likely be insufficient to address inequities both for professionals and for oppressed communities. The goal of this dissertation was to examine racialization and interrelated systems of privilege and oppression within HIV service organizations, including public health agencies. The first aim described characteristics of the HIV, STI, and Hepatitis public health workforce and explored how intersecting race, gender, and supervisory status of professionals related to their reported level of engagement in addressing racism as a public health crisis. I used data from the 2021 administration of the nationally representative Public Health Workforce Interest and Needs Survey (N=3,200). Most employees were white, and both white men and women were overrepresented in supervisory roles compared to other groups. I fit a binary logistic regression model with the dependent variable of level of engagement in addressing racism as a public health crisis. About half of employees (51.5%) reported low engagement in efforts to address racism. Supervisors, Latine, and white employees had higher probabilities of engagement compared to non-supervisors and Black employees. The second aim examined how policies and everyday practices in HIV service organizations facilitate racialization interrelated with other axes of privilege and oppression. The third aim explored how HIV service professionals think about and experience whiteness, and its impact on their work. For the second and third aims, I conducted 23 relational and dialogic interviews with HIV service professionals and supervisors within HIV service organizations in St. Louis City and county who represented 8 service organizations. I used reflexive thematic analysis to examine interview data. For the second aim, participant experiences showed how multiple, interrelated systems of privilege and oppression operated to reproduce inequities for professionals. I drew on the oppressor/oppressed binary and secondary marginalization to examine complex manifestations of privilege and oppression among people who work in HIV settings. The findings also discuss how HIV service professionals resist existing inequitable structures that thwart their capacity to advance equity in their organizations. For the third aim, dominant narratives of the white cisheteropatriarchal frame demonstrated the potential harm of training models that emphasize cultural competency and limited opportunities for staff members to learn and develop shared accountability. Workers attempted to challenge this frame by seeking out alternative sources for self-guided learning. The findings also discuss how oppressive systems such as racial capitalism interfere with honoring the full humanity of workers, clients, and communities. My dissertation expands the knowledge of policies, practices, and structures within HIV service organizations that expose racialization interrelated with other systems of privilege and oppression in St. Louis and beyond. The findings suggest that an important part of the path toward ending the HIV epidemic for all is taking a step back to address these mechanisms that perpetuate inequity for HIV service professionals, clients, and communities. Anti-racism, anti-oppressive, structural competency, and critical dialogue approaches are available, effective tools that must be integrated into HIV organizational policies and practices.

Committee Chair

Virginia McKay

Committee Members

Sheretta Butler-Barnes; Theresa Anasti; Vanessa Fabbre; Victor Ray

Degree

Doctor of Philosophy (PhD)

Author's Department

Social Work

Author's School

Brown School

Document Type

Dissertation

Date of Award

5-13-2026

Language

English (en)

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