Perceived discrimination, critical consciousness, and health in African-American women with HIV

Thesis (Ph.D.)--Boston UniversityPerceived racial discrimination (PRD), perceived gender discrimination (PGD), and discrimination-related stress (DS) have been shown to predict poor health and substance abuse in African-American women. They may contribute to racial disparities in both HIV infection and incarceration, which disproportionately affect African-American women. Critical consciousness (CC), the awareness of sociopolitical inequality, may provide a buffer against the effects of discrimination on health outcomes. This study examined (1) the effects of PGD, PRD, and DS on health and substance use and of CC as a moderator of these relationships in HIV-infected African-American women; and (2) the relationships of PRD, PGD, DS, and CC to HIV status and incarceration in HIV-infected and uninfected women. Seventy-three HIV-infected and 25 HIV-uninfected African-American women (ages 26 to 72 years) from the Chicago site of the Women's Interagency HIV Study completed self-report measures of PGD, PRD, DS, CC, depressive symptoms, quality oflife, cigarette smoking, anti-retroviral medication adherence and substance use. Blood pressure, body mass index, cholesterol, CD4+ cell count, and HIV viral load were also measured. Multiple linear and logistic regressions revealed that in HIV-infected women, PRD significantly related to higher and PGD related to lower blood pressure, likelihood of cigarette smoking, and likelihood of crack/cocaine/heroin and marijuana use. PRD significantly related to lower viral load when controlling for DS. Path analyses showed a significant direct relation of PRD to lower depressive symptoms, but a significant indirect relation to higher depressive symptoms as mediated by DS. Critical consciousness was found to relate to better HIV health markers in the context of high discrimination. At higher PGD, PRD, and DS, women with higher CC had higher CD4+ counts and lower viral load than women with lower CC. Partial correlations showed that in HIV-infected and uninfected women, there were significant positive relations of incarceration to PGD, PRD, DS, and CC. These results suggest that relationships of PGD, PRD and DS with health and substance use are complex, being protective for some outcomes but conferring risk for others. CC related to better health outcomes and provided a buffer against poor HIV health at high levels of discrimination

Gender Roles and Mental Health in Women With and at Risk for HIV

Predominantly low-income and African American women from the same community, HIV-infected (n = 100; HIV+) and uninfected (n = 42; HIV−), were assessed on reported gender roles in sexual and other close relationships—including levels of self-silencing, unmitigated communion, and sexual relationship power—at a single recent study visit during 2008–2012. Recent gender roles were investigated in relation to depressive symptoms and health-related quality of life assessed both at a single visit during 2008–2012 and averaged over semiannual visits (for depressive symptoms) and annual visits (for quality of life) occurring between 1994 and 2012. Compared to HIV− women, HIV+ women reported significantly higher levels of several aspects of self-silencing, unmitigated communion, and multi-year averaged depressive symptoms as well as lower levels of sexual relationship power and recent and multi-year averaged quality of life. For both HIV+ and HIV− women, higher self-silencing and unmitigated communion significantly related to recent or multi-year averaged higher depressive symptoms and lower quality of life. Intervention strategies designed to increase self-care and self-advocacy in the context of relationships could potentially minimize depressive symptoms and enhance quality of life in women with and at risk for HIV

Resilience Moderates the Association Between Childhood Sexual Abuse and Depressive Symptoms Among Women with and At-Risk for HIV

Childhood sexual abuse (CSA) places women at risk for HIV infection and once infected, for poor mental health outcomes, including lower quality of life and depressive symptoms. Among HIV-positive and demographically matched HIV-negative women, we investigated whether resilience and HIV status moderated the relationships between CSA and health indices as well as the relationships among CSA, depressive symptoms, and health-related quality of life (HRQOL). Participants included 202 women (138 HIV+, 64 HIV−, 87% African American) from the Women’s Interagency HIV Study (WIHS) Chicago CORE Center site. Results indicated that in both HIV-positive and HIV-negative women, higher resilience significantly related to lower depressive symptoms and higher HRQOL. CSA related to higher depressive symptoms only for women scoring low in resilience. Interventions to promote resilience, especially in women with a CSA history, might minimize depressive symptoms and poor HRQOL among HIV-positive and HIV-negative women

Resilience Among Women with HIV: Impact of Silencing the Self and Socioeconomic Factors

In the U.S., women account for over a quarter of the approximately 50,000 annual new HIV diagnoses and face intersecting and ubiquitous adversities including gender inequities, sexism, poverty, violence, and limited access to quality education and employment. Women are also subjected to prescribed gender roles such as silencing their needs in interpersonal relationships, which may lessen their ability to be resilient and function adaptively following adversity. Previous studies have often highlighted the struggles encountered by women with HIV without focusing on their strengths. The present cross-sectional study investigated the relationships of silencing the self and socioeconomic factors (education, employment, and income) with resilience in a sample of women with HIV. The sample consisted of 85 women with HIV, diverse ethnic/racial groups, aged 24 – 65 enrolled at the Chicago site of the Women’s Interagency HIV Study in the midwestern region of the United States. Measures included the Connor-Davidson Resilience Scale -10 item and the Silencing the Self Scale (STSS). Participants showed high levels of resilience. Women with lower scores on the STSS (lower self-silencing) reported significantly higher resilience compared to women with higher STSS scores. Although employment significantly related to higher resilience, silencing the self tended to predict resilience over and above the contributions of employment, income, and education. Results suggest that intervention and prevention efforts aimed at decreasing silencing the self and increasing employment opportunities may improve resilience