In Holding On anthropologist Alyson O’Daniel analyzes the abstract debates about health policy for the sickest and most vulnerable Americans as well as the services designated to help them by taking readers into the daily lives of poor African American women living with HIV at the advent of the 2006 Treatment Modernization Act. At a time when social support resources were in decline and publicly funded HIV/AIDS care programs were being re-prioritized, women’s daily struggles with chronic poverty, drug addiction, mental health, and neighborhood violence influenced women’s lives in sometimes unexpected ways.

An ethnographic portrait of HIV-positive black women and their interaction with the U.S. healthcare system, Holding On reveals how gradients of poverty and social difference shape women’s health care outcomes and, by extension, women’s experience of health policy reform. Set among the realities of poverty, addiction, incarceration, and mental illness, the case studies in Holding On illustrate how subtle details of daily life affect health and how overlooking them when formulating public health policy has fostered social inequality anew and undermined health in a variety of ways.