Background: Both nationally and particularly in Miami, FL, an HIV epicenter in the U.S., Black women represent the largest group of women living with HIV and 42% are not virally suppressed. In our ongoing research with Black women living with HIV (BWLWH) in Miami, we are seeing that microaggressions and adversities such as trauma/violence fluctuate rapidly over time and impact mental health and health behaviors. Microaggressions are everyday and subtle insults via comments, jokes, and behaviors that are demeaning to a marginalized group (e.g. Black individuals, women, people living with HIV). While scholars are beginning to investigate macroaggressions (discrimination such as denial of housing) and trauma/violence among women living with HIV, variables are often captured infrequently (e.g. once annually) despite the re-occurring nature of these adversities, and no prior study has investigated microaggressions. Hence, greater scientific rigor is needed to capture the temporal fluctuation in key stressors in the lives of Black women and how they relate to HIV viral suppression. Small-scale cross-sectional studies conducted by this PI (Dale) and colleagues suggest that gendered racial microaggressions experienced by BWLWH significantly predict PTSD symptoms, depression diagnosis, barriers to care, and ART adherence, and that microaggression contributes uniquely to these outcomes above and beyond race- and HIV- related discrimination/macroaggressions. Conceptual Model: The conceptual model for Project MMAGIC (Monitoring Microaggressions and Adversities to Generate Interventions for Change) focuses on microaggressions and other adversities as predictors negatively impacting HIV viral suppression (main outcome) through mental health symptoms and health behaviors (ART adherence and engagement in care), with potential direct effects and moderation by resilience factors at the individual (i.e. self-efficacy), interpersonal (i.e. social support), and neighborhood level (i.e. community health centers). MMAGIC findings will elucidate the pathways through which microaggressions and other adversities impact viral suppression among BWLWH and directly inform interventions through engagement with BWLWH and community stakeholders. This proposal is therefore aligned with the NIH HIV/AIDS (high) Research Priority for supporting research to reduce health disparities in treatment outcomes of those living with HIV/AIDS. Research Plan Overview: 300 BWLWH will be enrolled in Miami, Florida and followed over 4 years. Data will be collected at assessment visits conducted every 3 months on microaggressions, discrimination, trauma and violence, mental health symptoms, medication adherence, engagement in care, viral suppression (main outcome), and resilience factors. Given the daily nature of microaggressions, information on microaggressions will also be collected via one short daily text message. On an annual basis we will also gather information (using zip codes) from public data sources on neighborhood level resilience resources such as number and distance to community health centers and domestic violence shelters.
|Effective start/end date||8/15/19 → 8/14/20|
- National Institutes of Health: $677,248.00