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.
