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Principal Investigator: Sannisha K Dale
Organization: UNIVERSITY OF MIAMI CORAL GABLES
Fiscal Year: 2024
Award: $72,588
Funding agency: National Institute of Mental Health
Background: Black women represent the largest group of women with HIV, both nationally, and locally in Miami, a U.S.
HIV epicenter; and 40% are not virally suppressed. Further, they live at the intersection of multiple marginalized identities
and within social structures that take a daily toll. Microaggressions are every day and subtle insults via comments, jokes,
and behaviors that are demeaning to a marginalized group (e.g. Black individuals, women, people living with HIV,
LGBTQ+). Despite their frequency and potential importance, microaggressions have largely been ignored in the scientific
literature on Black women living with HIV (BWLWH). Also, while scholars are beginning to investigate macroaggressions
(discrimination acts such as denial of housing) and trauma/violence among women living with HIV, they are often only
captured infrequently (e.g. annually) despite their re-occurring nature for this population. Preliminary work. We have
further demonstrated the importance of studying microaggressions among BWLWH via an R56 that supported 1 year of
research that this 4-year proposal will build on. We are finding high rates of microaggressions in BWLWH, and high rates
of other adversities such as discrimination (macro acts) and reoccurring violence. These factors relate to mental health
symptoms and health behaviors, but additional data over time is needed to understand their relationship specifically to
viral suppression. Additionally, we are starting to understand the role of factors such as resilience, COVID-19, and the
current U.S. racial climate. Conceptual Model: The conceptual model for Project MMAGIC (Monitoring
Microaggressions and Adversities to Generate Interventions for Change) focuses on microaggressions and other
adversities as negative predictors of HIV viral suppression (main outcome) mediated by mental health symptoms and
health behaviors (ART adherence and engagement in care). We will longitudinally examine both potential direct effects
and moderation by resilience factors at the individual (e.g. self-efficacy), interpersonal (e.g. social support), and
neighborhood level (e.g. community health centers). By elucidating these pathways to viral suppression among BWLWH
and having ongoing engagement with community partners, our findings will directly inform interventions. This proposal is
precisely aligned with the NIH HIV/AIDS (high) Research Priority for supporting research to reduce health disparities in
treatment outcomes of those living with HIV. Research Plan: 300 BWLWH will be enrolled in Miami (151 enrolled [4 lost]
via R56 grant), and followed over 4 years. Data will be collected at assessment visits every 3 months on
microaggressions, discrimination/macroaggressions, trauma and violence, mental health symptoms, medication
adherence, engagement in care, viral suppression, and resilience factors. Given the daily nature of microaggressions,
we will use an innovative text-message ecological momentary assessment methodology shown to be feasible (99%
response rate) in our R56. Annually, we will 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. Implications: The present study, occurring in the context of both COVID-19, and heighten visibility on
racism in the U.S. presents an unfortunate yet unmatched important opportunity to study BWLWH in an HIV epicenter.
Terms: <AIDS><AIDS Virus><AIDS/HIV><Acquired Immune Deficiency><Acquired Immune Deficiency Syndrome><Acquired Immune Deficiency Syndrome Virus><Acquired Immunodeficiency Syndrome><Acquired Immunodeficiency Syndrome Virus><Adherence><Apoplexy><Behavior><Black><Black Populations><Black group><Black individual><Black people><Black race><Blacks><Brain Vascular Accident><Buffers><COVID-19><CV-19><Caring><Caucasian Females><Caucasian Women><Cerebral Stroke><Cerebrovascular Apoplexy><Cerebrovascular Stroke><Cessation of life><Climate><Cognitive Discrimination><Comment><Commentary><Communities><Community Health Centers><Coronavirus Infectious Disease 2019><Data><Data Collection><Data Sources><Death><Decrease health disparities><Diagnosis><Discrimination><Domestic Violence><Ecological momentary assessment><Editorial Comment><Employment><Enrollment><Epidemic><Female><Female Groups><Florida><Frequencies><Funding><Future><Grant><HIV><HIV Seronegativities><HIV Seronegativity><HIV negative><HIV/AIDS><HTLV-III Seronegativities><HTLV-III Seronegativity><Hair><Health><Health behavior><Health disparity mitigation><Health disparity reduction><Housing><Human Immunodeficiency Viruses><Impoverished><Individual><Infection><Intervention><Intervention Strategies><Investigation><LAV-HTLV-III><LGBTQ><Lesbian Gay Bi-sexual Transgender Queer><Lesbian Gay Bisexual Transgender Queer><Literature><Longitudinal Studies><Lower health disparities><Lymphadenopathy-Associated Virus><Measures><Mediating><Mental Depression><Mental Health><Mental Hygiene><Meteorological Climate><Methodology><Mitigate health disparities><Modeling><Monitor><NIH><NIMH><National Institute of Mental Health><National Institutes of Health><Nature><Neighborhood Health Center><Neighborhoods><Outcome><PTSD><Pathway interactions><Persons><Population><Post-Traumatic Neuroses><Post-Traumatic Stress Disorders><Post-traumatic growth><Posttraumatic Neuroses><Posttraumatic growth><Poverty><Psychological Health><Published Comment><Race><Races><Reduce health disparities><Research><Research Priority><Research Resources><Research Support><Resources><Role><Self Efficacy><Shapes><Shelter facility><Social support><Spirituality><Stroke><Symptoms><Testing><Text Messaging><Time><Trauma><Treatment outcome><United States National Institutes of Health><Viewpoint><Violence><Viral><Virus-HIV><Visit><Voice><White Females><White Women><Woman><Women's Group><Women's study><Work><assaulted sexually><black female><black women><brain attack><cerebral vascular accident><cerebrovascular accident><climatic><community engaged intervention><community engagement><community informed intervention><community partners><community-based partners><community-partnered intervention><coronavirus disease 2019><coronavirus disease-19><coronavirus infectious disease-19><depression><develop therapy><disparities in treatment><drug adherence><drug compliance><engagement with communities><enroll><experience><female study><health related behavior><improved><inequality in treatment><information gathering><innovate><innovation><innovative><intervention development><interventional strategy><intimate partner violence><long-term study><longitudinal outcome studies><longterm study><marginalization><marginalized group><marginalized individual><marginalized people><marginalized population><medication adherence><medication compliance><microaggression><neglect><pathway><physical assault><physical attack><post-trauma stress disorder><posttrauma stress disorder><racial><racial background><racial origin><racism><recruit><resilience><resilience factor><resiliency factor><resilient><response><sexual assault><sexual attack><shelter><shelter housing><shelters><short message service><social role><social structural><social structure><social support network><socio-structural><sociostructural><stressor><stroked><strokes><study among females><study among women><study in females><study in women><study on females><study on women><study within women><substance use><substance using><success><texting><therapy development><trauma symptom><traumatic neurosis><treatment development><treatment disparity><treatment inequality><treatment inequity><violent><violent behavior>