Gendered Racial Microaggressions, Self-silencing, Substance Use, and HIV Outcomes Among Black Women Living with HIV: A Structural Equation Modeling Approach

Overview

Journal AIDS Behav

Specialty Infectious Diseases

Date 2023 Aug 29

PMID 37642823

Authors

Naysha N Shahid

Sannisha K Dale

Affiliations

Soon will be listed here.

Abstract

To better understand factors that may contribute to HIV outcomes experienced by Black women living with HIV (BWLWH), the present study examined the relationships among gendered racial microaggressions (GRM; subtle daily insults due to racism and sexism), self-silencing, substance use, antiretroviral therapy (ART) medication adherence, and viral suppression using structural equation modeling and path analysis. Self-silencing and substance use were examined as potential mediators. Participants were 119 BWLWH residing in South Florida. Results of this study showed that GRM was directly and positively associated with self-silencing and indirectly and negatively associated with medication adherence via self-silencing. GRM was directly related to higher alcohol use disorder severity. Self-silencing was directly and negatively associated with medication adherence. Medication adherence was directly and negatively related to viral suppression. The model fit the data well. Identifying the negative consequences of GRM in conjunction with self-silencing and substance use may help inform prevention and intervention strategies to improve mental health and HIV-related outcomes among BWLWH.

Citing Articles

Using network analysis to elucidate the relationships among support systems, trauma and depressive symptoms, self-silencing, and risk of HIV viral non-suppression among black women living with HIV.

Boga D, Juste R, Etienne K, Dale S J Behav Med. 2024; .

PMID: 39580576 DOI: 10.1007/s10865-024-00530-1.

A Pilot Randomized Control Trial of the Striving Towards EmPowerment and Medication Adherence (STEP-AD) Intervention for Black Women Living with HIV.

Dale S, Wright I, Madhu A, Reid R, Shahid N, Wright M AIDS Behav. 2024; 28(10):3483-3497.

PMID: 39012452 PMC: 11427489. DOI: 10.1007/s10461-024-04408-w.

References

Vu M, Li J, Haardorfer R, Windle M, Berg C . Mental health and substance use among women and men at the intersections of identities and experiences of discrimination: insights from the intersectionality framework. BMC Public Health. 2019; 19(1):108. PMC: 6345035. DOI: 10.1186/s12889-019-6430-0. View

Dale S, Safren S . Gendered Racial Microaggressions Associated with Depression Diagnosis among Black Women Living with HIV. J Urban Health. 2020; 97(3):377-386. PMC: 7305274. DOI: 10.1007/s11524-020-00432-y. View

Brody L, Stokes L, Dale S, Kelso G, Cruise R, Weber K . Gender Roles and Mental Health in Women With and at Risk for HIV. Psychol Women Q. 2014; 38(3):311-326. PMC: 4258411. DOI: 10.1177/0361684314525579. View

Stevens-Watkins D, Perry B, Pullen E, Jewell J, Oser C . Examining the associations of racism, sexism, and stressful life events on psychological distress among African-American women. Cultur Divers Ethnic Minor Psychol. 2014; 20(4):561-9. PMC: 4197405. DOI: 10.1037/a0036700. View

Lu M, Safren S, Skolnik P, Rogers W, Coady W, Hardy H . Optimal recall period and response task for self-reported HIV medication adherence. AIDS Behav. 2007; 12(1):86-94. DOI: 10.1007/s10461-007-9261-4. View

Turan B, Rice W, Crockett K, Johnson M, Neilands T, Ross S . Longitudinal association between internalized HIV stigma and antiretroviral therapy adherence for women living with HIV: the mediating role of depression. AIDS. 2019; 33(3):571-576. PMC: 6362840. DOI: 10.1097/QAD.0000000000002071. View

DeMarco R, Lanier L . The concept of "silencing the self" in low-income, aging, HIV-infected African American women: a 10-year community-based participatory program of research with results. J Assoc Nurses AIDS Care. 2013; 25(2):112-22. DOI: 10.1016/j.jana.2012.12.003. View

Sullivan K, Messer L, Quinlivan E . Substance abuse, violence, and HIV/AIDS (SAVA) syndemic effects on viral suppression among HIV positive women of color. AIDS Patient Care STDS. 2014; 29 Suppl 1:S42-8. PMC: 4283071. DOI: 10.1089/apc.2014.0278. View

Reid R, Dale S . Structural equation modeling of microaggressions, religious and racism-related coping, medication adherence, and viral load among Black women living with HIV. J Behav Med. 2023; 46(5):837-848. PMC: 11493454. DOI: 10.1007/s10865-023-00403-z. View

10.

Dale S, Pierre-Louis C, Bogart L, OCleirigh C, Safren S . Still I rise: The need for self-validation and self-care in the midst of adversities faced by Black women with HIV. Cultur Divers Ethnic Minor Psychol. 2017; 24(1):15-25. PMC: 5726949. DOI: 10.1037/cdp0000165. View

11.

Thomas M, Michaels E, Reeves A, Okoye U, Price M, Hasson R . Differential associations between everyday versus institution-specific racial discrimination, self-reported health, and allostatic load among black women: implications for clinical assessment and epidemiologic studies. Ann Epidemiol. 2019; 35:20-28.e3. PMC: 7179332. DOI: 10.1016/j.annepidem.2019.05.002. View

12.

Dale S, Nelson C, Wright I, Etienne K, Lazarus K, Gardner N . Structural equation model of intersectional microaggressions, discrimination, resilience, and mental health among black women with hiv. Health Psychol. 2023; 42(5):299-313. PMC: 10167554. DOI: 10.1037/hea0001275. View

13.

Bradley E, Williams A, Green S, Lima A, Geter A, Chesson H . Disparities in Incidence of Human Immunodeficiency Virus Infection Among Black and White Women - United States, 2010-2016. MMWR Morb Mortal Wkly Rep. 2019; 68(18):416-418. PMC: 6542192. DOI: 10.15585/mmwr.mm6818a3. View

14.

Lewis J, Neville H . Construction and initial validation of the Gendered Racial Microaggressions Scale for Black women. J Couns Psychol. 2015; 62(2):289-302. DOI: 10.1037/cou0000062. View

15.

Illangasekare S, Burke J, Chander G, Gielen A . The syndemic effects of intimate partner violence, HIV/AIDS, and substance abuse on depression among low-income urban women. J Urban Health. 2013; 90(5):934-47. PMC: 3795184. DOI: 10.1007/s11524-013-9797-8. View

16.

Geter A, Sutton M, Armon C, Buchacz K . Disparities in Viral Suppression and Medication Adherence among Women in the USA, 2011-2016. AIDS Behav. 2019; 23(11):3015-3023. DOI: 10.1007/s10461-019-02494-9. View

17.

Bruck-Segal D, Schwartz R, Cohen M, Weber K, Burke-Miller J, Kassaye S . The Costs of Silencing the Self and Divided Self in the Context of Physical Abuse, Racial/Ethnic Identity, and Medication Adherence in Women Living with HIV. Sex Roles. 2020; 82(11-12):716-730. PMC: 7731516. DOI: 10.1007/s11199-019-01086-0. View

18.

Geter A, Sutton M, Armon C, Durham M, Palella Jr F, Tedaldi E . Trends of racial and ethnic disparities in virologic suppression among women in the HIV Outpatient Study, USA, 2010-2015. PLoS One. 2018; 13(1):e0189973. PMC: 5749722. DOI: 10.1371/journal.pone.0189973. View

19.

Dale S, Pan Y, Gardner N, Saunders S, Wright I, Nelson C . Daily Microaggressions and Related Distress among Black Women Living with HIV during the Onset of the COVID-19 Pandemic and Black Lives Matter Protests. AIDS Behav. 2021; 25(12):4000-4007. PMC: 8158077. DOI: 10.1007/s10461-021-03321-w. View

20.

Haberer J, Kahane J, Kigozi I, Emenyonu N, Hunt P, Martin J . Real-time adherence monitoring for HIV antiretroviral therapy. AIDS Behav. 2010; 14(6):1340-6. PMC: 2974938. DOI: 10.1007/s10461-010-9799-4. View