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Cited by 67HIV/AIDS Research and InterventionsRacial and Ethnic Identity ResearchGender, Health, and Social Inequality

Microaggressions and Discrimination Relate to Barriers to Care Among Black Women Living with HIV

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Dale, Sannisha K., Dean, Taquesha, Sharma, Ratanpriya, Reid, Rachelle, Saunders, Sherene, Safren, Steven A.·2019·AIDS Patient Care and STDs
DOI 10.1089/apc.2018.0258PMC PMC6459277
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Abstract

In the United States, black women living with HIV (BWLWH) represent the highest proportion of women living with HIV and dying from HIV-related illnesses when compared with women of other racial/ethnic groups. These disparities may be linked to social and structural factors faced by BWLWH, including race- and HIV-related discrimination, and gendered racial microaggressions (GRMs). GRMs are everyday insults that black women experience due to being both black and female (e.g., comments about their body). Commonly assessed barriers to HIV-related care (e.g., transportation, finance, community stigma) do not include personal experiences of race- and HIV-related discrimination and GRM. We present the cross-sectional associations between racial discrimination, HIV-related discrimination, GRM, and barriers to care. One hundred BWLWH in a large city in the Southeast United States completed baseline assessments as part of an intervention development study. At baseline assessments BWLWH completed measures on racial discrimination, HIV-related discrimination, GRM (frequency and appraisal), and barriers to care. Hierarchical multiple linear regressions controlling for age, education, and income indicated that higher race-related discrimination (β = 0.23, p < 0.05), higher HIV-related discrimination (β = 0.26, p < 0.01), and higher GRM (frequency: β = 0.31, p < 0.01; appraisal: β = 0.21, p < 0.05) significantly predicted higher total barriers to care. When all predictors were entered together GRMs contributed uniquely to total barriers to care and two subscales, while racial discrimination contributed uniquely toward one subscale. These findings further emphasize that for BWLWH interventions and policy efforts need to address racial discrimination, HIV-related discrimination, and GRM concurrently with other barriers to care, with special attention being given to daily GRM.

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  1. [1]1. Centers for Disease Control and Prevention. HIV Surveillance Report, 2016. 2017;28:125 [Google Scholar]
  2. [5]5. Lambert CC, Mugavero MJ, Najjar YS, Enah C, Guthrie BJ. The state of adherence to HIV care in Black Women. J Assoc Nurses AIDS Care 2018;29:487–503 [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. [6]6. Sangaramoorthy T, Jamison AM, Dyer TV. HIV stigma, retention in care, and adherence among older black women living With HIV. J Assoc Nurses AIDS Care 2017;28:518–531 [DOI] [PubMed] [Google Scholar]
  4. [7]7. Geter A, Herron AR, Sutton MY. HIV-related stigma by healthcare providers in the United States: A systematic review. AIDS Care 2018;32:418–424 [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. [8]8. Heckman TG, Somlai AM, Peters J, et al. Barriers to care among persons living with HIV/AIDS in urban and rural areas. AIDS Care 1998;10:365–375 [DOI] [PubMed] [Google Scholar]
  6. [9]9. Gender differences in HIV testing, diagnosis, and linkage to care in healthcare settings: Identifying African American women with HIV in Chicago. AIDS Patient Care STDs 2018;32:399–407 [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. [10]10. Colasanti J, Stahl N, Farber EW, del Rio C, Armstrong WS. An exploratory study to assess individual and structural level barriers associated with poor retention and re-engagement in care among persons living with HIV/AIDS. J Acquir Immune Defic Syndr 2017;74:S113. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. [11]11. Amutah-Onukagha N, Mahadevan M, Opara I, Rodriguez M, Trusdell M, Kelly J. Project THANKS: Examining HIV/AIDS-related barriers and facilitators to care in African American Women: A community perspective. AIDS Patient Care STDs 2018;32:119–128 [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. [12]12. Kelso GA, Cohen MH, Weber KM, Dale SK, Cruise RC, Brody LR. Critical consciousness, racial and gender discrimination, and HIV disease markers in African American Women with HIV. AIDS Behav 2014;18:1237–1246 [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. [13]13. Stevens-Watkins D, Perry B, Pullen E, Jewell J, Oser CB. Examining the associations of racism, sexism, and stressful life events on psychological distress among African American Women. Cultur Divers Ethnic Minor Psychol 2014;20:561–569 [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. [14]14. Sue DW, Capodilupo CM, Holder AMB. Racial microaggressions in the life experience of Black Americans. Prof Psychol Res Pract 2008;39:329–336 [Google Scholar]
  12. [15]15. Lewis JA, Neville HA. Construction and initial validation of the Gendered Racial Microaggressions Scale for Black women. J Couns Psychol 2015;62:289–302 [DOI] [PubMed] [Google Scholar]
  13. [16]16. Donovan RA, Galban DJ, Grace RK, Bennett JK, Felicié SZ. Impact of racial macro-and microaggressions in Black women's lives: A preliminary analysis. J Black Psychol 2013;39:185–196 [Google Scholar]
  14. [17]17. Gómez JM. Microaggressions and the enduring mental health disparity: Black Americans at risk for institutional betrayal. J Black Psychol 2015;41:121–143 [Google Scholar]
  15. [18]18. Perry BL, Pullen E, Oser CB. Too much of a good thing? Psychosocial resources, gendered racism, and suicidal ideation among low-SES African American Women. Soc Psychol Q 2012;75:334–359 [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. [20]20. Pieterse AL, Carter RT, Ray KV. Racism-related stress, general life stress, and psychological functioning among Black American women. J Multicult Couns Dev 2013;41:36–46 [Google Scholar]
  17. [21]21. Bogart LM, Wagner GJ, Galvan FH, Klein DJ. Longitudinal relationships between antiretroviral treatment adherence and discrimination due to HIV-serostatus, race, and sexual orientation among African-American men with HIV. Ann Behav Med Publ Soc Behav Med 2010;40:184–190 [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. [22]22. Rice WS, Crockett KB, Mugavero MJ, Raper JL, Atkins GC, Turan B. Association between internalized HIV-related stigma and HIV care visit adherence. J Acquir Immune Defic Syndr 1999 2017;76:482–487 [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. [23]23. Bogart LM, Galvan FH, Wagner GJ, Klein DJ. Longitudinal association of HIV conspiracy beliefs with sexual risk among black males living with HIV. AIDS Behav 2011;15:1180–1186 [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. [24]24. Ben J, Cormack D, Harris R, Paradies Y. Racism and health service utilisation: A systematic review and meta-analysis. PLoS One 2017;12:e0189900. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. [26]26. Dale SK, Pierre-Louis C, Bogart LM, O'Cleirigh C, Safren SA. Still I rise: The need for self-validation and self-care in the midst of adversities faced by Black women with HIV. Cultur Divers Ethnic Minor Psychol 2018;24:15–25 [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. [27]27. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009;42:377–381 [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. [28]28. Bogart LM, Wagner GJ, Galvan FH, Landrine H, Klein DJ, Sticklor LA. Perceived discrimination and mental health symptoms among Black Men with HIV. Cultur Divers Ethnic Minor Psychol 2011;17:295–302 [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. [30]30. Loutfy M, Johnson M, Walmsley S, et al. The association between HIV disclosure status and perceived barriers to care faced by women living with HIV in Latin America, China, Central/Eastern Europe, and Western Europe/Canada. AIDS Patient Care STDs 2016;30:435–444 [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. [31]31. Squires GD, Kubrin CE. Privileged places: Race, uneven development and the geography of opportunity in Urban America. Urban Stud 2005;42:47–68 [Google Scholar]
  26. [32]32. Hasnain-Wynia R, Baker DW, Nerenz D, et al. Disparities in health care are driven by where minority patients seek care: Examination of the Hospital Quality Alliance Measures. Arch Intern Med 2007;167:1233–1239 [DOI] [PubMed] [Google Scholar]
  27. [33]33. Kugelmass H. “Sorry, I'm Not Accepting New Patients”: An audit study of access to mental health care. J Health Soc Behav 2016;57:168–183 [DOI] [PubMed] [Google Scholar]
  28. [34]34. Kempf M-C, McLeod J, Boehme AK, et al. A qualitative study of the barriers and facilitators to retention-in-care among HIV-positive women in the rural Southeastern United States: Implications for targeted interventions. AIDS Patient Care STDs 2010;24:515–520 [DOI] [PubMed] [Google Scholar]
  29. [37]37. Pager D, Shepherd H. The sociology of discrimination: Racial discrimination in employment, housing, credit, and consumer markets. Annu Rev Sociol 2008;34:181–209 [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. [38]38. Corneille M, Lee A, Britton R, Barker J. “There's more to us than this”: A qualitative study of Black young adults' perceptions of media portrayals of HIV. J Health Disparities Res Pract 2015;8 Available from: https://digitalscholarship.unlv.edu/jhdrp/vol8/iss4/5 [Google Scholar]
  31. [39]39. Powell JA. Structural racism: Building upon the insights of John Calmore. N C Law Rev 2007;86:791 [Google Scholar]
  32. [40]40. Baicker K, Chandra A, Skinner JS, Wennberg JE. Who you are and where you live: How race and geography affect the treatment of medicare beneficiaries. Health Aff Proj Hope 2004;Suppl Variation:VAR33–44 [DOI] [PubMed] [Google Scholar]
  33. [41]41. Logie CH, James Ll, Tharao W, Loutfy MR. HIV, gender, race, sexual orientation, and sex work: A qualitative study of intersectional stigma experienced by HIV-positive women in Ontario, Canada. PLoS Med 2011;8:e1001124. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. [42]42. Varni SE, Miller CT, McCuin T, Solomon S. Disengagement and engagement coping with HIV/AIDS stigma and psychological well-being of people with HIV/AIDS. J Soc Clin Psychol 2012;31:123–150 [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. [43]43. Davey-Rothwell MA, Linas BS, Latkin CA. Sources of personal income and HIV risk among sexually active women. AIDS Educ Prev 2012;24:422–430 [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. [44]44. Logie CH, Jenkinson JIR, Earnshaw V, Tharao W, Loutfy MR. A structural equation model of HIV-related stigma, racial discrimination, housing insecurity and wellbeing among African and Caribbean Black women living with HIV in Ontario, Canada. PLoS One 2016;11:e0162826. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. [45]45. Newman PA, Williams CC, Massaquoi N, Brown M, Logie C. HIV prevention for Black women: Structural barriers and opportunities. J Health Care Poor Underserved 2008;19:829–841 [DOI] [PubMed] [Google Scholar]
  38. [46]46. Racial and Ethnic Differences in Access to Medical Care—Mayberry Robert M., Mili Fatima, Ofili Elizabeth, 2000. [cited September 26, 2018]. Available from: http://journals.sagepub.com/doi/abs/10.1177/1077558700057001S06 [DOI] [PubMed] Articles from AIDS Patient Care and STDs are provided here courtesy of SAGE Publications · DOI

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Authors
Dale, S. K., Dean, T., Sharma, R., Reid, R., Saunders, S., & Safren, S. A.
Affiliations
  • Harvard University (US)
  • Massachusetts General Hospital (US)
  • University of Miami (US)
Corresponding author
Dale, Sannisha K.
ORCID
Venue
AIDS Patient Care and STDs
Publisher
SAGE Publications
Published
2019-04
Volume
33
Issue
4
Pages
175-183
ISSN
  • 1087-2914 (ISSN-L)
  • 1557-7449
DOI
10.1089/apc.2018.0258
PMC
PMC6459277
OpenAlex
W2926072573
Cited by
67
References
4
Citations by year
2026: 3 · 2025: 9 · 2024: 19 · 2023: 13 · 2022: 11 · 2021: 6 · 2020: 5 · 2019: 1
FWCI
4.41
Type
journal article
Language
en
Open access
Licence
www.liebertpub.com/nv/resources-tools/text-and-data-mining-policy/121/ (tdm)
Locations
  • AIDS Patient Care and STDs (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health
  • National Institute of Mental Health (K23MH108439)
  • National Institute on Drug Abuse (K24DA040489)
Topics
  • Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
  • Social Sciences › Sociology and Political Science › Racial and Ethnic Identity Research
  • Social Sciences › Sociology and Political Science › Gender, Health, and Social Inequality
Keywords
racial discrimination, HIV discrimination, gendered racial microaggressions, barriers to HIV care, HIV disparities, intersectionality, HIV care access
MeSH terms
Adult, Aged, Black or African American, Cross-Sectional Studies, Female, Health Services Accessibility, Humans, Middle Aged, United States, Southeastern United States, HIV Infections, Young Adult, Social Stigma, Racism, Sexism

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