Daily Microaggressions and Related Distress among Black Women Living with HIV during the Onset of the COVID-19 Pandemic and Black Lives Matter Protests

HIV-related microaggressions and depressive symptoms among people living with HIV: the mediating roles of internalised stigma and coping with shame

OBJECTIVES

Overtly experienced HIV-related stigma is associated with depressive symptoms for people living with HIV (PLWH). Research suggests that an important mediating mechanism in this association is internalised stigma, where PLWH accept negative societal views about HIV, apply them to themselves and develop a negative view of themselves. Microaggressions are subtle and indirect discriminatory behaviours and, like overtly experienced stigma, may also contribute to depressive symptoms. We tested this hypothesis and examined the mediating roles of internalised stigma and maladaptive ways of coping with shame in the association between microaggressions and depressive symptoms among PLWH in Türkiye.

METHODS

This study examines the serial mediating roles of internalised HIV stigma and shame-related coping strategies (ie, withdrawal and self-attack) in the association between HIV-related microaggressions and depressive symptoms among PLWH. PLWH in Izmir, Türkiye (N=308) completed validated scales measuring experiences of microaggressions, internalised HIV stigma, coping strategies related to shame and depression symptoms.

RESULTS

Structural equation modelling results suggest that internalised HIV stigma significantly mediates the relationship between HIV-related microaggressions and depression symptoms. Furthermore, serial mediation analysis suggests that withdrawal and self-attack strategies of coping with shame mediate the association between internalised HIV stigma and depressive symptoms. Thus, internalised HIV stigma and shame-related coping strategies may partially stem from experiencing HIV-related microaggressions and may negatively affect the mental health of PLWH.

CONCLUSIONS

Findings highlight the importance of assessing subtle forms of discrimination (ie, microaggressions) given their negative impact on the self-concept of PLWH. In addition to addressing negative attitudes and behaviours against PLWH in society, interventions that help PLWH cope with shame-related experiences might improve their mental health.

Testing for Measurement Invariance (MI): Do the Structures of Microaggression, Discrimination, and Resilience Among Black Women Living with HIV Remain the Same Across Time?

Assessing measurement invariance and the interplay of discrimination, microaggressions, and resilience among Black women living with HIV (BWLWH) across time utilizing latent class and repeated measure analysis may provide novel insights. A total of 151 BWLWH in a southeastern U.S. city completed surveys focused on multiple forms of microaggressions and discrimination (race, gender, sexual orientation, or HIV-related) and resilience factors (social support, self-efficacy, post-traumatic growth) at baseline, 3 months, and 6 months. To capture the psychosocial domains of discrimination, microaggressions, and resilience, three latent factors were developed and measured across three time points. Latent class analysis was also conducted to identify and compare meaningful subgroups based on varying levels of discrimination, microaggressions, and resilience reported. Three latent classes were created. MI testing suggested that measurement invariance was partially met (established metric invariance and scalar invariance), and it is possible to compare factor means of discrimination, microaggressions, and resilience across time. Latent factor mean scores of microaggressions and discrimination decreased after 3 and 6 months and increased for resilience after 6 months and varied over time across the three latent classes identified. The subgroup with the lowest level of discrimination and microaggressions and the highest level of resilience reported at baseline, experienced increases in resilience after months 3 and 6. Clinical interventions, research, and policies aimed at promoting resilience and reducing structural and social barriers linked to racism, sexism, HIV stigma, and classism are needed to improve the health and well-being of BWLWH.

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.

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

Despite the disproportionate impact of HIV, microaggressions, and discrimination among Black women living with HIV (BWLWH), BWLWH have demonstrated resilience by mobilizing religious and other coping strategies. The current study sought to examine whether racism-related or religious coping moderates the relationship between latent gendered racial microaggressions (GRMs), antiretroviral therapy (ART) adherence and viral load (VL) among 119 BWLWH. Data was collected via self-report measures of GRMs and coping. ART adherence was measured via self-report and electronic monitoring and VL was measured via blood specimens. Structural equation modeling showed significant main effects of religious coping on adherence and VL. Furthermore, GRMs × racism-related coping and GRMs × religious coping significantly predicted adherence and VL. Our findings indicate the unique and culturally salient role of religious and racism-related coping among BWLWH in the context of GRMs. Such findings may be optimized in the development of culturally relevant multilevel interventions for BWLWH.

Measuring health-related stigma: Exploring challenges and research priorities to improve assessment

Despite the advances in stigma research, measuring health-related stigma continues to be challenging and knowledge gaps remain. This study gained insight into challenges and research priorities related to the assessment of health-related stigma. Interviews were conducted with 14 stigma researchers, followed by a survey that was completed by 36 respondents. The findings showed a diverse range of research priorities. Among the top ranked priorities were the need for robust measurement properties of existing scales (content validity, responsiveness, validation across settings), exploration and assessment of subtle changes in stigma, and investigation on ways to assess actual behaviour and discrimination. Various challenges with the cross-cultural use of measures were identified, along with a research opportunity to shorten the cross-cultural validation process. Other identified research priorities related to: studying multi-level intersectional stigma; focusing on positive features that counter stigma; rephrasing negative and offending scale items; developing generic measures; and, the further development of practical tools to support researchers with scale implementation. The defined research priorities can guide future studies to advance stigma measurements and, as our ability to measure is critical for our understanding, enhance our knowledge about the complex stigma processes.

Social and Behavioral Impacts of COVID-19 on People Living with HIV: Review of the First Year of Research

PURPOSE OF THE REVIEW

The SARS-CoV-2 (COVID-19) pandemic brought unprecedented social change with the most severe impacts on the most vulnerable populations, including people living with HIV (PLWH). This review examined findings from empirical studies of social and behavioral impacts of COVID-19 on PLWH in the first year of the pandemic.

RECENT FINDINGS

Impacts of COVID-19 on PLWH fit within an HIV syndemics framework, with overlapping COVID-19 and HIV comorbid conditions concerning mental health and structural inequality. Early impacts of COVID-19 on social isolation, emotional distress, stigma, and substance use varied across studies with few consistent patterns. Structural inequalities, particularly impacts on food security and housing stability, were observed more consistently and globally. COVID-19 intersects with HIV infection along with multiple interlocking comorbidities that are best characterized and understood within a syndemics framework.