A new study published in the Journal of Racial and Ethnic Health Disparities found that HIV-related discrimination and microaggressions are associated with poorer sleep, cognitive functioning, and daily functioning among Black women living with HIV (BWLWH). These microaggressions are rooted in systemic racism and inequality, affecting both the physical and mental health of Black women.
Black women living with HIV sit at the crossroads of sexism, racism, and the stigma of the disease, which increases their chance of poor health outcomes. In combination with adverse childhood experiences (ACEs), chronic stress, mental health issues, and systemic barriers to care, BWLWH are at high risk for poor cognitive functioning.
This study analyzed cross-sectional data from 183 Black women living with HIV. The women took part in a longitudinal cohort study from November 2023 to March 2024, which included a standard assessment administered every three months and a psychosocial assessment of brain health administered by an interviewer.
Eligibility criteria required participants to identify as a cisgender Black woman, capable of consent, 18 or older, fluent in English, living with HIV, and have access to a cell phone for a daily text. Participant ages ranged from 26 to 85, with an average age of 56.68.
The study defined microaggressions as “subtle, everyday interpersonal slights, indignities, or exclusions, whereas discrimination was defined as broader enacted unfair treatment across institutional and interpersonal contexts.”
Along with the Multiple Discrimination Scale, participants were given 13 additional questions catered specifically to gender-based discrimination. The subjects were also given the 26-question questionnaire, which asked about microaggressions in four areas:
The participants’ brain health was also evaluated, using the following screening tools:
The study indicated a relationship between higher levels of HIV-related microaggressions against Black women and poor sleep and cognitive functioning. One consistent factor associated with poor health outcomes was discrimination.
The racial and gendered microaggressions these women experienced were both indirect and direct. Specifically, women who reported race, gender, and HIV-based discrimination were found to have difficulties with sleep and cognitive functioning. The women who experienced high levels of HIV-based discrimination reported low cognitive performance and difficulty with day-to-day activities.
These findings suggest that HIV-related stigma may contribute to poorer health outcomes and cognitive well-being among BWLWH.
The study’s findings are particularly important given the disproportionate burden of HIV among Black women and the structural barriers many face throughout the care continuum.
HIV diagnoses among Black women have risen over the past decade, as they are 10 times more likely to be diagnosed with the virus. According to the CDC, Black women account for the most HIV diagnoses among all women, as well as the largest number of new HIV diagnoses. Even though Black women only made up 13 percent of the female population in the U.S. in 2021, they accounted for 50 percent of all HIV-diagnosed women. These disparities included Black transgender women, who make up 62 percent of HIV diagnoses in trans women in several U.S. metropolitan areas.
When it comes to prevention and care, Black individuals receive fewer resources than white individuals. In many instances, longstanding medical mistrust leads Black women to be less likely to contact HIV health services. In 2022, only 64 percent of Black people with HIV were linked to care, while 70 percent of white people were linked to care. Black women are also less likely to be represented in clinical research for HIV.
Psychosocial stressors such as microaggressions and discrimination can cause long-term stress, which in turn can cause distress and cognitive decline. These symptoms can also be exacerbated for people with ACES, of which Black women are disproportionately burdened by.
Additionally, Black women have lower rates of uptake of HIV-preventing pre-exposure prophylaxis, or PrEP.
Providers may consider incorporating routine screening for psychosocial stressors, experiences of discrimination, sleep disturbances, and cognitive concerns into HIV care visits, particularly for Black women who face multiple forms of stigma.
“There is a dearth of literature exploring the associations among neurocognitive factors and intersectional adversities of salience to the lived experiences of BWLWH, who represent the largest portion of women living with HIV in the U.S.,” wrote the study’s authors. “Our findings emphasize the potential cumulative toll of these psychosocial stressors, reinforcing the need for multifaceted interventions that address both individual and structural drivers of health inequity.”
Providers are also encouraged to facilitate community-based programs where BWLWH can feel supported and safe, ideally addressing various forms of stigma and reducing medical mistrust.
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