Structural equation modeling of microaggressions, religious and racism-related coping, medication adherence, and viral load among Black women living with HIV

A network analysis of positive psychosocial factors and indication of suboptimal HIV care outcomes among Black women living with HIV

Black women living with HIV (BWLWH) face barriers that impact health outcomes. However, positive psychosocial indicators may influence HIV care outcomes. Among this cross-sectional study of 119 BWLWH, a network analysis was utilized to examine relationships between positive psychosocial factors and HIV-related health outcomes. A preliminary polychoric analysis was conducted to examine correlations between the variables, and the network analyzed connections between resilience, self-efficacy, self-esteem, perceived social support, religious coping, post-traumatic growth, and an indicator variable for suboptimal HIV care outcomes (low medication adherence, detectable viral load, and missed HIV-related health visits) and determined the centrality measures within the network. Seven significant associations were found among the factors: self-efficacy and self-esteem, post-traumatic growth and resilience, post-traumatic growth and self-efficacy, post-traumatic growth and religious coping, perceived social support and resilience, self-esteem and resilience, self-esteem and perceived social support (bootstrapped 95% CI did not contain zero). Self-efficacy was the strongest indicator associated with the other factors. Although not statistically significant, the indicator for suboptimal HIV care outcomes was negatively associated with perceived social support and religious coping. Future interventions incorporating self-efficacy may be beneficial to the overall well-being of Black women.

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

Black women living with HIV (BWLWH) face adversities associated with lower HIV medication adherence, viral non-suppression, and mental health symptoms (e.g., post-traumatic stress disorder) such as trauma/violence, racism, HIV-related discrimination/stigma, and gender-related stressors. We developed the first intervention based in cognitive behavioral therapy and culturally congruent coping for BWLWH to increase medication adherence and decrease PTSD symptoms by enhancing resilience, self-care, engagement in care, and coping for trauma, racism, HIV-related discrimination/stigma, and gender-related stressors. A pilot randomized control trial was conducted with BWLWH and histories of trauma who were at risk for their HIV viral load remaining or becoming detectable (i.e., below 80% medication adherence, detectable viral load in the past year, and/or missed HIV-related appointments). 119 BWLWH were assessed at baseline and 70 met inclusion criteria, completed one session of Life-Steps adherence counseling, and were randomized to either nine sessions of STEP-AD (Striving Towards EmPowerment and Medication Adherence) or ETAU (enhanced treatment as usual consisting of biweekly check-ins). Women completed a post intervention follow up assessment (3 months post baseline) and 3-month post intervention follow-up (6 months post baseline). Via STATA the difference-in-difference methodology with mixed models compared STEP-AD to ETAU on changes in outcomes over time. BWLWH in STEP-AD compared to E-TAU had significantly higher ART adherence (estimate = 9.36 p = 0.045) and lower likelihood of being clinically diagnosed with PTSD (OR = .07, estimate = - 2.66, p = 0.03) as well as borderline significance on higher CD4 count (estimate = 161.26, p = 0.05). Our findings suggest preliminary efficacy of STEP-AD in improving ART adherence, mental health, and immune function.

The Lived Experience of Racism in the Sikh Community

The Sikh community may be more visible and vulnerable to racism than other religious groups, and previous research has documented the racism targeted at Sikh men and women in the United States. Relatively few studies have, however, addressed the racism experienced by Sikh communities in other countries, where racism may be less closely connected to the events of 9/11. The present study investigates the lived experience of racism in Sikh adults living in the United Kingdom. Six participants (5 male, 1 female) aged 19 to 30 years (M = 24.17, SD = 3.98) were recruited via advertisements placed on social media. Both Amritdhari Sikhs (n = 4) who had undertaken the Amrit Sanskar initiation ceremony or commitment and Sahajdhari Sikhs (n = 2) who had not undertaken the initiation participated. Semi-structured interviews were conducted (totaling 372 minutes of interview data), covering a range of subjects including personal experiences of racism and subsequent responses to the racist abuse. Interpretative Phenomenological Analysis of the interview transcripts identified five superordinate themes. These were (1) Appearance and Visibility; (2) Inevitability and Normalization; (3) Coping and Conformity (Religion as Support, Fitting In, Internalization); (4) Education and Understanding; and (5) Bystander Behavior (Experiences of Intervention, Religious Duty to Intervene, Consequences of Intervention). Findings highlight the extent to which racism occurs and the increased vulnerability of the Sikh community (e.g., appearance being the focus of racist abuse). Findings also highlight the importance of religion as a source of support and cultural pride and the significance of education and bystander behavior. Future research should further investigate these themes and introduce interventions to support the safety and well-being of members of the Sikh community experiencing racist abuse.

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

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.