“You Lost Her, But You Have Me”: Loss, Grief, Social Change, and Behavioral Reorganization Among Structurally Vulnerabilized Sexually Minoritized Women

Abstract Background Sexually minoritized women (SMW) experience disproportionate exposure to structural and social challenges that shape health, social relationships, and HIV vulnerability. Although research has examined grief among sexual and gender minority populations, less is known about how loss intersects with structural vulnerability to shape social and behavioral trajectories among SMW. Methods We conducted a secondary qualitative analysis of 14 semi-structured interviews from a parent study of 25 structurally vulnerabilized cisgender SMW at increased risk for HIV in greater Baltimore, Maryland. Interviews were conducted between June and October 2021 and addressed social support, resource access, mental health, and HIV-related vulnerability. Using a hybrid inductive–deductive approach informed by reflexive thematic analysis, we examined how participants described loss, changes in social relationships, and behavioral responses. Results Participants described loss broadly, including death, relationship dissolution, family rejection, and loss of affirming communities and institutions. Loss functioned as a catalyst for social and behavioral change within contexts of existing structural vulnerability. Socially, loss contributed to both contraction and strengthening of relationships. Some participants described reductions in social networks, diminished trust, emotional withdrawal, and decreased access to affirming support, while others described deeper relationships, mutual care, and chosen-family support. Behavioral responses similarly diverged, including increased substance use and sexual risk-taking alongside self-care and treatment engagement. Conclusions Loss may function as a period of social and behavioral reorganization rather than a discrete event with uniform consequences. Grief-informed care for structurally vulnerabilized SMW should recognize diverse forms of loss and attend to the social and structural resources that may facilitate pathways toward connection and recovery.