Microaggressions and Discrimination Relate to Barriers to Care Among Black Women Living with HIV

Abstract

In the United States, black women living with HIV (BWLWH) represent the highest proportion of women living with HIV and dying from HIV-related illnesses when compared with women of other racial/ethnic groups. These disparities may be linked to social and structural factors faced by BWLWH, including race-and HIV-related discrimination, and gendered racial microaggressions (GRMs). GRMs are everyday insults that black women experience due to being both black and female (e.g., comments about their body). Commonly assessed barriers to HIV-related care (e.g., transportation, finance, community stigma) do not include personal experiences of race-and HIV-related discrimination and GRM. We present the cross-sectional associations between racial discrimination, HIV-related discrimination, GRM, and barriers to care. One hundred BWLWH in a large city in the Southeast United States completed baseline assessments as part of an intervention development study. At baseline assessments BWLWH completed measures on racial discrimination, HIVrelated discrimination, GRM (frequency and appraisal), and barriers to care. Hierarchical multiple linear regressions controlling for age, education, and income indicated that higher race-related discrimination (b = 0.23, p < 0.05), higher HIV-related discrimination (b = 0.26, p < 0.01), and higher GRM (frequency: b = 0.31, p < 0.01; appraisal: b = 0.21, p < 0.05) significantly predicted higher total barriers to care. When all predictors were entered together GRMs contributed uniquely to total barriers to care and two subscales, while racial discrimination contributed uniquely toward one subscale. These findings further emphasize that for BWLWH interventions and policy efforts need to address racial discrimination, HIV-related discrimination, and GRM concurrently with other barriers to care, with special attention being given to daily GRM.

Digitized HIV/AIDS Treatment Adherence Interventions: A Review of Recent SMS/Texting Mobile Health Applications and Implications for Theory and Practice

“…Cross-sectional studies have also reported these differences. Young adult (13 to 29 years old) African American women, for example, were found to have the lowest rates of sustained viral suppression (Dale et al, 2019).…”

“…Among women, disengagement from HIV care leads to non-adherence to cART (Okawa et al, 2015) and detrimental health effects, including death (Watts et al, 2013). U.S. ethnic minority women report discrimination and gendered racial microaggressions (subtle forms of discrimination), which is directly related to adherence to care (Dale et al, 2019). Barriers to medication adherence include perceived stigma and fear of unintended disclosure of the HIV positivity (Madiba and Josiah, 2019).…”

“…Historically, an HIV/AIDS diagnosis is a highly stigmatized condition in the U.S. (Earnshaw et al, 2013) and elsewhere (Purnomo et al, 2018), and PLWH experience discrimination because of this (Dale et al, 2019). HIV stigma, in turn, results in non-disclosure to family members, older children, and intimate partners (Labrique et al, 2013;Taylor et al, 2020) point to the introduced risks to those living with HIV/AIDS that could result in social marginalization, psychological stress, invasion of privacy or breach of confidentiality, due to a loss in privacy or confidentiality.…”

Daily Microaggressions and Related Distress among Black Women Living with HIV during the Onset of the COVID-19 Pandemic and Black Lives Matter Protests

“…Black women represented over 60% of women living with HIV in the U.S. and Black women living with HIV (BWLWH) face unique adversities including microaggressions based on race, gender, HIV-status, and sexual orientation (for those who are sexual minorities) [1][2][3] that may negatively impact viral suppression via mental health struggles/distress and disruption of healthy behaviors (e.g. medication adherence) [1,4]. Microaggressions are daily subtle insults, behaviors, and comments that are meant to devalue or demean marginalized groups [5][6][7].…”

“…denied housing, denied employment, assault, distruction of property) based on race, HIV-status, and sexual orientation are negatively related to medication adherence, engagement in care, and viral suppression [18,19]. Crosssectional work among BWLWH has found associations between gendered racial microaggressions and HIV-related barriers to care engagement [4,20]. While engagement in care and HIV medication adherence are necessary behaviors in order to achieve viral suppression, ultimately viral suppression is the end goal [21].…”