Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Apr;28(4):1276-1290.
doi: 10.1007/s10461-023-04157-2. Epub 2023 Aug 29.

Gendered Racial Microaggressions, Self-silencing, Substance Use, and HIV Outcomes Among Black Women Living with HIV: A Structural Equation Modeling Approach

Naysha N Shahid  1 , Sannisha K Dale  2
Affiliations

Gendered Racial Microaggressions, Self-silencing, Substance Use, and HIV Outcomes Among Black Women Living with HIV: A Structural Equation Modeling Approach

Naysha N Shahid et al. AIDS Behav. 2024 Apr.

Abstract
in English, Spanish

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.

Para comprender mejor los factores que pueden contribuir a los resultados del VIH experimentados por las mujeres negras que viven con el VIH (BWLWH), el presente estudio examinó las relaciones entre las microagresiones raciales de género (GRM; sutiles insultos diarios debido al racismo y el sexismo), el auto silenciamiento, el uso de sustancias, la adherencia a la medicación de la terapia antirretroviral (ART) y la supresión viral utilizando modelos de ecuaciones estructurales y análisis de ruta. El autosilenciamiento y el consumo de sustancias se examinaron como mediadores potenciales. Los participantes fueron 119 BWLWH que residían en el sur de Florida. Los resultados de este estudio mostraron que GRM se asoció directa y positivamente con el autosilenciamiento e indirecta y negativamente se asoció con la adherencia a la medicación a través del autosilenciamiento. GRM se relacionó directamente con una mayor gravedad del trastorno por consumo de alcohol. El autosilenciamiento se asoció directa y negativamente con la adherencia a la medicación. La adherencia a la medicación se relacionó directa y negativamente con la supresión viral. El modelo se ajusta bien a los datos. Identificar las consecuencias negativas de GRM junto con el auto silenciamiento y el uso de sustancias puede ayudar a informar estrategias de prevención e intervención para mejorar la salud mental y los resultados relacionados con el VIH entre BWLWH.

Keywords: Black women; HIV; Medication adherence; Microaggressions; Self-silencing; Substance use.

PubMed Disclaimer

Figures

Figure 1:
Figure 1:
Theoretical Structural Equation Modeling Diagram for Gendered Racial Microaggressions Frequency Model
Figure 2:
Figure 2:. CFA Model with Gendered Racial Microaggression Appraisal Latent
KEY: BSOA=Beauty and Sexual Objectification Stress Appraisal, SMA=Silenced and Marginalized Stress Appraisal, SBWA= Strong Black Woman Stress Appraisal, ABWA=Angry Black Woman Stress Appraisal, ES=Externalized Self-Perception, CS=Care as Self-sacrifice, STS=Silencing the Self, DS=The Divided Self, SR MEDAD= Self-reported Medication Adherence
Figure 3:
Figure 3:. CFA Model with Gendered Racial Microaggression Frequency Latent
KEY: BSOF=Beauty and Sexual Objectification Frequency, SMF=Silenced and Marginalized Frequency, SBWF= Strong Black Woman Frequency, ABWF=Angry Black Woman Frequency, ES=Externalized Self-Perception, CS=Care as Self-sacrifice, STS=Silencing the Self, DS=The Divided Self, SR MEDAD= Self-reported Medication Adherence
Figure 4:
Figure 4:
Hybrid Model with Gendered Racial Microaggression Appraisal Latent
Figure 5:
Figure 5:
Hybrid Model with Gendered Racial Microaggression Frequency Latent
See this image and copyright information in PMC

References

    1. CDC. HIV Surveillance Report 2018 (updated). Centers for Disease Control and Prevention [Internet]. 2020. [cited 2022 Dec 20];31. Available from: https://www.cdc.gov/hiv/library/reports/hiv-surveillance.html
    1. Bradley ELP, Williams AM, Green S, Lima AC, Geter A, Chesson HW, et al. Disparities in Incidence of Human Immunodeficiency Virus Infection Among Black and White Women — United States, 2010–2016. MMWR Morb Mortal Wkly Rep. 2019;68:416–8. - PMC - PubMed
    1. Velis E, Shaw G. The AIDS epidemic in South Florida: Black non-Hispanics in our communities remain increasingly vulnerable. 3rd Mediterranean Interdisciplinary Forum on Social Sciences and Humanities, MIFS 2015. 2015;17–19.
    1. AIDSVu. Miami (Miami-Dade County) [Internet]. 2020. Available from: https://aidsvu.org/local-data/united-states/south/florida/miami/
    1. Bruck-Segal D, Schwartz RM, Cohen MH, Weber KM, Burke-Miller JK, Kassaye S, et al. The Costs of Silencing the Self and Divided Self in the Context of Physical Abuse, Racial/Ethnic Identity, and Medication Adherence in Women Living with HIV. Sex Roles. 2020;82:716–30. - PMC - PubMed