TY - JOUR
T1 - Discrimination, resilience, and HIV testing frequency among black women seeking services from STD clinics
AU - Stockman, Jamila K.
AU - Lucea, Marguerite B.
AU - Cimino, Andrea N.
AU - Wood, Brittany A.
AU - Tsuyuki, Kiyomi
AU - Granger, Douglas A.
AU - Campbell, Jacquelyn C.
N1 - Funding Information:
We thank the study participants who generously provided the data for this research. We also thank the Baltimore City Health Department for their support on this project. We acknowledge manuscript assistance received from Cassandra Cyr and statistical support received from Bruna Hentges, Doctoral Candidate in Epidemiology at the Federal University of Rio Grande do Sul and Visiting Research Scholar at the University of California, San Diego. This research was supported by the Eunice Kennedy Shriver National Institute on Child Health and Human Development ( NICHD Grant # R01HD077891 ). J. K. Stockman and K. Tsuyuki acknowledge support by the San Diego Center for AIDS Research (Grant # P30AI036214 ) and California HIV/AIDS Research Program ( CHRP Grant # HD15-SD-059 ). A.N. Cimino and J.C. Campbell acknowledge support by the Johns Hopkins Center for AIDS Research (Grant # P30AI094189 ). The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies. The authors have no conflicts of interest to disclose.
Funding Information:
We thank the study participants who generously provided the data for this research. We also thank the Baltimore City Health Department for their support on this project. We acknowledge manuscript assistance received from Cassandra Cyr and statistical support received from Bruna Hentges, Doctoral Candidate in Epidemiology at the Federal University of Rio Grande do Sul and Visiting Research Scholar at the University of California, San Diego. This research was supported by the Eunice Kennedy Shriver National Institute on Child Health and Human Development (NICHD Grant #R01HD077891). J. K. Stockman and K. Tsuyuki acknowledge support by the San Diego Center for AIDS Research (Grant #P30AI036214) and California HIV/AIDS Research Program (CHRP Grant #HD15-SD-059). A.N. Cimino and J.C. Campbell acknowledge support by the Johns Hopkins Center for AIDS Research (Grant #P30AI094189). The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies. The authors have no conflicts of interest to disclose.
Publisher Copyright:
© 2022
PY - 2023/1
Y1 - 2023/1
N2 - Rationale: In the United States, Black women are disproportionately affected by HIV, accounting for most new HIV infections diagnosed among women. Socio-structural barriers to HIV testing include stigma and discrimination but may be mitigated by resilience. Objective: We aimed to examine the effect of discrimination and resilience on HIV testing behaviors among Black women. Methods: Between 2016 and 2018, we conducted The ESSENCE Project, a retrospective cohort study on the role of physiological and environmental factors on the association between sexual assault and HIV risk among Black women in Baltimore, Maryland, USA. Black women aged 18-44 were recruited from public health STD clinics and completed an audio-computer-assisted self-interview survey. Hierarchical multiple negative binomial regression models were used to examine the associations of everyday discrimination (subtle and overt) and resilience on HIV testing frequency; resilience and its subscales (relational maintenance, personal fortitude, positive coping, independence and insight) were also examined as moderators. Results: Among 236 Black women reporting HIV testing history, the median number of lifetime HIV tests was 4 (IQR = 2, 6). Mean everyday discrimination was 2.3 (SD = 1.2). Mean resilience was 5.3 (SD = 0.8). Everyday discrimination and its subscales (overt and subtle) were negatively associated with lifetime HIV testing frequency, while overall resilience was not associated with lifetime HIV testing frequency. Accounting for demographics, overall resilience moderated the association of subtle discrimination and lifetime HIV testing frequency. For the resilience subscales, more specifically: (1) associations of subtle discrimination and HIV testing frequency were significant at the lowest relational maintenance and lowest positive coping resilience; and (2) the association of subtle discrimination and HIV testing frequency was significant at the highest resilience for all four subscales. Conclusions: These findings highlight the need for provider- and community-level interventions addressing the deleterious effects of everyday discrimination and more specifically subtle everyday discrimination to encourage HIV testing.
AB - Rationale: In the United States, Black women are disproportionately affected by HIV, accounting for most new HIV infections diagnosed among women. Socio-structural barriers to HIV testing include stigma and discrimination but may be mitigated by resilience. Objective: We aimed to examine the effect of discrimination and resilience on HIV testing behaviors among Black women. Methods: Between 2016 and 2018, we conducted The ESSENCE Project, a retrospective cohort study on the role of physiological and environmental factors on the association between sexual assault and HIV risk among Black women in Baltimore, Maryland, USA. Black women aged 18-44 were recruited from public health STD clinics and completed an audio-computer-assisted self-interview survey. Hierarchical multiple negative binomial regression models were used to examine the associations of everyday discrimination (subtle and overt) and resilience on HIV testing frequency; resilience and its subscales (relational maintenance, personal fortitude, positive coping, independence and insight) were also examined as moderators. Results: Among 236 Black women reporting HIV testing history, the median number of lifetime HIV tests was 4 (IQR = 2, 6). Mean everyday discrimination was 2.3 (SD = 1.2). Mean resilience was 5.3 (SD = 0.8). Everyday discrimination and its subscales (overt and subtle) were negatively associated with lifetime HIV testing frequency, while overall resilience was not associated with lifetime HIV testing frequency. Accounting for demographics, overall resilience moderated the association of subtle discrimination and lifetime HIV testing frequency. For the resilience subscales, more specifically: (1) associations of subtle discrimination and HIV testing frequency were significant at the lowest relational maintenance and lowest positive coping resilience; and (2) the association of subtle discrimination and HIV testing frequency was significant at the highest resilience for all four subscales. Conclusions: These findings highlight the need for provider- and community-level interventions addressing the deleterious effects of everyday discrimination and more specifically subtle everyday discrimination to encourage HIV testing.
KW - Discrimination
KW - HIV testing
KW - Resilience
KW - United States
KW - Women
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U2 - 10.1016/j.socscimed.2022.115344
DO - 10.1016/j.socscimed.2022.115344
M3 - Article
C2 - 36115729
AN - SCOPUS:85138074906
SN - 0277-9536
VL - 316
JO - Social Science and Medicine
JF - Social Science and Medicine
M1 - 115344
ER -