Monitoring Microaggressions and Adversities to Generate Interventions for Change (MMAGIC) for Black Women Living with HIV

背景：黑人妇女是美国全国和迈阿密当地最大的艾滋病毒感染妇女群体。 艾滋病毒中心; 40%的人没有受到病毒抑制。此外，他们生活在多种边缘化身份的交叉点 以及每天都在付出代价的社会结构中。每天都有微攻击，通过评论，笑话， 和贬低边缘化群体的行为（如黑人、妇女、艾滋病毒感染者， LGBTQ+）。尽管他们的频率和潜在的重要性，微侵略在很大程度上被忽视的科学 关于感染艾滋病毒的黑人妇女的文学（BWLWH）。此外，虽然学者们开始研究宏观侵略， （歧视行为，如拒绝提供住房）和创伤/暴力，他们往往只是 尽管它们在该种群中具有重复发生的性质，但很少捕获（例如每年）。前期工作我们有 进一步证明了通过R56研究BWLWH中微攻击的重要性，R56支持1年的 这项为期4年的提案将建立在研究的基础上。我们发现BWLWH的微攻击率很高， 其他不利因素，如歧视（宏观行为）和反复发生的暴力。这些因素与心理健康有关 症状和健康行为，但随着时间的推移，需要更多的数据来了解它们之间的关系，特别是 病毒抑制此外，我们开始了解恢复力、COVID-19和 美国目前的种族气候。概念模型：项目MMAGIC（监测）的概念模型 Microaggressions and Adjuvant to Generate Interventions for Change）关注的是微观侵略和其他 逆境作为由心理健康症状介导的HIV病毒抑制的阴性预测因子（主要结局）， 健康行为（ART依从性和参与护理）。我们将纵向研究这两种潜在的直接影响 和适度的弹性因素在个人（如自我效能），人际（如社会支持），和 社区层面（如社区卫生中心）。通过阐明BWLWH中病毒抑制的这些途径， 并与社区合作伙伴持续接触，我们的调查结果将直接为干预措施提供信息。这项建议是 与NIH艾滋病毒/艾滋病（高）研究优先级完全一致，以支持研究，以减少健康差距， 艾滋病毒感染者的治疗结果。研究计划：将在迈阿密入组300例BWLWH（151例入组[4例丢失]） 通过R56补助金），并随访4年以上。将在每3个月的评估访视时收集数据， 微观攻击，歧视/宏观攻击，创伤和暴力，心理健康症状，药物治疗 坚持，参与护理，病毒抑制和弹性因素。鉴于微攻击的日常性质， 我们将使用一种创新的短信生态瞬时评估方法，该方法已被证明是可行的（99%）。 在我们的R56中的响应率。每年，我们将从公共数据源收集信息（使用邮政编码）， 邻里层面的弹性资源，如数量和距离社区卫生中心和国内 暴力庇护所影响：本研究发生在COVID-19的背景下，并提高了对 种族主义在美国提出了一个不幸的，但无与伦比的重要机会，研究BWLWH在艾滋病毒震中。

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.