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

背景：黑人妇女是美国迈阿密最大的艾滋病毒携带者群体，无论是在全国还是在当地。 艾滋病毒的中心；40%的人没有受到病毒抑制。此外，他们生活在多个边缘化身份的交汇点 在每天都要付出代价的社会结构中。微攻击是每天都有的，通过评论、笑话和微妙的侮辱， 以及贬低边缘群体(例如黑人个人、妇女、艾滋病毒携带者、 LGBTQ+)。尽管它们的频率和潜在的重要性，微侵袭在很大程度上被忽视在科学 关于感染艾滋病毒的黑人妇女的文献(BWLWH)。此外，当学者们开始研究宏观侵略性时 (歧视行为，如拒绝提供住房)和艾滋病毒携带者妇女的创伤/暴力，它们往往只是 很少被捕获(例如每年捕获)，尽管它们在这一种群中反复出现。前期工作。我们有 通过支持1年的R56进一步展示了研究BWLWH中微侵袭的重要性 这项为期4年的提案将建立在研究的基础上。我们发现BWLWH的微侵袭率很高，而且 其他不利情况，如歧视(宏观行为)和再次发生的暴力。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，我们开始了解韧性、新冠肺炎和 当前美国的种族氛围。概念模型：项目MMAGIC(监控)的概念模型 微攻击性和不利因素以产生变革干预措施)侧重于微攻击性和其他 逆境作为HIV病毒抑制的负面预测因子(主要结果)由心理健康症状和 健康行为(坚持艺术和参与护理)。我们将纵向考察这两种潜在的直接影响 通过个人的弹性因素(如自我效能)、人际关系(如社会支持)和 社区一级(如社区卫生中心)。通过阐明BWLWH中病毒抑制的这些途径 通过与社区合作伙伴的持续接触，我们的研究结果将直接为干预提供信息。这项建议是 完全符合美国国立卫生研究院艾滋病毒/艾滋病(高)研究优先事项，以支持减少#年健康差距的研究 艾滋病毒携带者的治疗结果。研究计划：300名BWLWH将在迈阿密招收(151名招收[4名遗失] 通过R56赠款)，并随访超过4年。数据将在每3个月的评估访问中收集 微侵犯、歧视/大侵犯、创伤和暴力、精神健康症状、药物治疗 坚持性、对护理的投入、病毒抑制和弹性因素。鉴于微侵袭的日常性质， 我们将使用一种创新的短信生态即时评估方法，证明是可行的(99% 响应率)。每年，我们将从公共数据来源收集信息(使用邮政编码) 社区级别的恢复力资源，如到社区卫生中心和国内的数量和距离 暴力庇护所。影响：本研究，发生在新冠肺炎的背景下，并提高了对 美国的种族主义提供了一个不幸但无与伦比的重要机会，可以在艾滋病毒中心研究BWLWH。

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.