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

监测微侵犯和逆境，为感染艾滋病毒的黑人妇女制定变革干预措施 (MMAGIC)

• 批准号: 10555269
• 负责人: Sannisha K. Dale
• 金额: $ 66.04万
• 依托单位: UNIVERSITY OF MIAMI CORAL GABLES
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-04-01 至 2025-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10555269
• 关键词: Acquired Immunodeficiency Syndrome; Adherence; Behavior; Black Populations; Black race; Buffers; COVID-19; Caring; Cessation of life; Climate; Communities; Data; Data Collection; Data Sources; Diagnosis; Discrimination; Domestic Violence; Ecological momentary assessment; Employment; Enrollment; Epidemic; Female; Florida; Frequencies; Funding; Future; Grant; HIV; HIV Seronegativity; HIV/AIDS; Hair; Health; Health behavior; Housing; Individual; Infection; Intervention; Investigation; Lesbian Gay Bisexual Transgender Queer; Literature; Longitudinal Studies; Measures; Mediating; Mental Depression; Mental Health; Methodology; Modeling; Monitor; National Institute of Mental Health; Nature; Neighborhood Health Center; Neighborhoods; Outcome; Pathway interactions; Persons; Population; Post-Traumatic Stress Disorders; Posttraumatic growth; Poverty; Published Comment; Race; Reduce health disparities; Research; Research Priority; Research Support; Resources; Role; Self Efficacy; Shapes; Shelter facility; Social support; Spirituality; Stroke; Symptoms; Testing; Text Messaging; Time; Trauma; Treatment outcome; United States National Institutes of Health; Violence; Viral; Visit; Voice; Woman; Women' s Group; Work; black women; experience; improved; information gathering; innovation; intimate partner violence; marginalization; marginalized population; medication compliance; microaggression; neglect; physical assault; racism; recruit; resilience; resilience factor; response; sexual assault; social structure; stressor; substance use; success; therapy development; trauma symptom; treatment disparity

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.

背景：黑人妇女代表着全国最大的艾滋病毒妇女，无论是在美国还是在美国的本地， 艾滋病中心；和40％的人没有被病毒抑制。此外，它们生活在多个边缘化身份的交汇处 在每天造成损失的社会结构中。微侵略是每天都是通过评论，笑话，微妙的侮辱 以及贬低边缘化群体的行为（例如，黑人，妇女，艾滋病毒感染者， LGBTQ+）。尽管它们的频率和潜在的重要性，但在科学中，微侵略在很大程度上被忽略了 关于艾滋病毒（BWLWH）的黑人妇女的文献。同时，学者们开始研究大型攻击 （歧视行为，例如拒绝住房）和艾滋病毒妇女的创伤/暴力，他们通常只是 尽管对这个人群重新出现了性质，但很少捕获（例如每年）。初步工作。我们有 进一步证明了通过支持1年的R56研究BWLWH之间的微攻击的重要性 研究这一四年提案将基础。我们发现BWLWH中的微侵略性率很高，并且率很高 在其他逆境中，例如歧视（宏观行为）和暴力行为。这些因素与心理健康有关 症状和健康行为，但需要随着时间的推移需要额外的数据才能专门了解其关系 病毒抑制。此外，我们开始理解弹性，COVID-19和诸如弹性的作用 当前的美国种族气候。概念模型：项目MMAGIC的概念模型（监视 微侵略和逆境，以产生变化的干预措施）专注于微攻击和其他 逆境是由心理健康症状介导的HIV病毒抑制（主要结果）的负面预测因素 健康行为（艺术依从性和护理中的参与）。我们将纵向检查两个潜在的直接影响 以及由个人（例如自我效能感），人际关系（例如社会支持）和 社区层面（例如社区卫生中心）。通过阐明这些途径在BWLWH中抑制病毒 并且与社区合作伙伴进行持续的互动，我们的发现将直接为干预提供信息。该提议是 与NIH HIV/AIDS（高）研究优先级相一致，以支持研究以减少健康差异 患有艾滋病毒的人的治疗结果。研究计划：300 BWLWH将在迈阿密注册（151名招募[4丢失] 通过R56 Grant），并遵循4年的时间。每3个月的评估访问时将收集数据 微侵略，歧视/大攻击，创伤和暴力，心理健康症状，药物治疗 依从性，参与护理，病毒抑制和弹性因素。鉴于微侵略的每日性质， 我们将使用一种创新的文本生态瞬时评估方法，显示为可行（99％ 响应率）在我们的R56中。每年，我们将从公共数据源中收集信息（使用邮政编码） 邻里水平的弹性资源，例如与社区卫生中心和国内的距离和距离 暴力庇护所。含义：本研究发生在Covid-19的背景下，并提高了对 美国的种族主义带来了一个不幸但无与伦比的重要机会，可以在艾滋病毒中心学习BWLWH。