Neighborhood Characteristics, Intersectional Discrimination, Mental Health, and HIV Outcomes Among Black Women Living With HIV, Southeastern United States, 2019‒2020

Abstract

Objectives. To examine the effects of within-neighborhood and neighboring characteristics on discrimination, stigma, mental health, and HIV outcomes among Black women living with HIV (BWLWH). Methods. A total of 151 BWLWH in a southeastern US city provided baseline data (October 2019‒January 2020) on experienced microaggressions and discrimination (race-, gender-, sexual orientation-, or HIV-related), mental health (e.g., depression, posttraumatic stress disorder), and HIV outcomes (e.g., viral load, antiretroviral therapy adherence). Neighborhood characteristics by census tract were gathered from the American Community Survey and the National Center for Charitable Statistics. Spatial econometrics guided the identification strategy, and we used the maximum likelihood technique to estimate relationships between a number of predictors and outcomes. Results. Within-neighborhood and neighboring characteristics (employment, education, crime, income, number of religious organizations, and low-income housing) were significantly related to intersectional stigma, discrimination, mental health, HIV viral load, and medication adherence. Conclusions. Policy, research, and interventions for BWLWH need to address the role of neighborhood characteristics to improve quality of life and HIV outcomes. (Am J Public Health. 2022;112(S4):S433–S443. https://doi.org/10.2105/AJPH.2021.306675 )

“We Take Care of Our Young, No Matter What,” Experiences of Engagement in HIV Care Among Black Mothers Parenting Dependent Children in Southwestern Pennsylvania: A Retrospective Descriptive Qualitative Study

“…Participants were compensated $55.00 for their time in completing the interview. This rate of compensation is similar to other HIV studies among Black women with HIV (Dale et al, 2019;Wright et al, 2022).…”

Multilevel Resilience and HIV Virologic Suppression Among African American/Black Adults in the Southeastern United States

“…Given that the majority of the analytic sample in this study was male and Models accounted for virologic suppression outcomes being correlated within neighborhoods defined by census tract at enrollment, which should account for clustering of repeated virologic suppression outcomes within individuals assuming that the repeated outcomes for an individual are nested within the same census tract at enrollment 73 . Models were specified using an independent working correlation structure a Controlling for time interval, age at enrollment, gender at enrollment, sexual orientation at enrollment, neighborhood disadvantage at enrollment, neighborhood murder index at enrollment, neighborhood assault index at enrollment, health insurance at enrollment, at-risk alcohol use at or in the year prior to enrollment, drug use at or in the 3 months prior to enrollment, depression at or in the 2 weeks prior to enrollment, panic syndrome at or in the 4 weeks prior to enrollment, other mental health diagnoses at or in the 4 weeks prior to enrollment, AIDS-defining illnesses at or in the 2 years prior to enrollment, time since ART initiation, last CD4 cell count in the 2 years prior to enrollment, and last virologic suppression status in the 2 years prior to enrollment b Global P value for assessment of effect measure modification c The coefficients for the tertile measure of endorsement of multilevel resilience resources and time interval product terms were 0.008 and 0.04 (global P value = 0.76) in the unadjusted model and 0.01 and 0.04 (global P value = 0.81) in the adjusted model heterosexual and was virally suppressed prior to enrollment, additional research using the MRM is needed to examine the resilience-virologic suppression relationship by level of the neighborhood risk environment among populations who historically have been more disproportionately affected by the HIV epidemic, such as African American/Black women (transgender and cisgender) living with HIV [2,84], African American/Black men who have sex with men [2], and African American/Black adults with lower ART adherence [85]. In summary, to the best of our knowledge, this study is the first to rigorously examine the longitudinal relationship between multilevel resilience resources and HIV virologic suppression among African American/Black adults and to explore this relationship by levels of the neighborhood risk environment.…”

Structural equation model of intersectional microaggressions, discrimination, resilience, and mental health among black women with hiv.

“…Fourth, the cross-sectional nature of the data prevented proper assessment of mediation and limited interpretation of the results and conclusions. Fifth, the intersectional discrimination and microaggressions and resilience resources addressed in this manuscript are only some of the factors that may be relevant to the mental health of BWLWH (Wright et al, 2022). Despite these limitations, this paper presents novel findings on the relationships between intersectional discrimination and microaggressions, resilience, and mental health outcomes among BWLWH, and findings are critical to identify opportunities for intervention to improve HIV outcomes among BWLWH.…”