When University of Miami researchers set out in the fall of 2019 to assess how everyday stressors affect the health of Black women living with HIV, they had no idea the women would soon be contending with two unprecedented social upheavals that rocked the world.
But the convergence of the COVID-19 pandemic and the Black Lives Matter protests that followed George Floyd’s murder provided new insights into how subtle but hurtful insults, more blatant discrimination, and recurring violence affect the health of Black women living with HIV. It also provided the opportunity to connect the women to vital resources during unexpectedly chaotic times.
“Some of the women were genuinely scared for their lives,” said Nadine Gardner, a research associate with the University’s Strengthening Health with Innovation and Engagement (SHINE) Research Program. “Everywhere they turned, it was COVID, COVID, COVID, and how high-risk Black people are. So, they were scared to leave their houses. They couldn’t see their children. They began to think of their homes as jail. Then comes George Floyd’s death to cause even more distress.”
Gardner and a handful of fellow research associates and graduate students were able to offer many of the women a caring ear, soothing voice, and up-to-date information about food distribution sites, rental assistance, online support groups, and other lifeline resources through a unique study known as MMAGIC, for Monitoring Microaggressions and Adversities to Generate Interventions for Change.
Through daily text messages and regular visits, the MMAGIC team stayed in touch with 151 Black women living with HIV (BWLWH) to determine how subtle but demeaning insults about their race, sexual orientation, health status, or other psychosocial experiences affected their mental or physical health. In particular, the researchers wanted to know whether such stressors changed the women’s resolve to take the daily medications that can suppress their virus to undetectable levels—not only keeping them healthier but preventing them from transmitting HIV to someone else.
It’s an important question because, as SHINE founder and lead investigator Sannisha Dale said, Black women across the nation comprise more than half the women living with HIV, and an estimated 42 percent of them do not have undetectable viral loads. And, she said, daily barrages of microaggressions can throw oppressed and marginalized people off, disrupting their moods, and routines.
“Microaggressions are subtle but very hurtful,” said Dale, an associate professor in the Department of Psychology, who was just awarded a $2.6 million grant from the National Institute of Mental Health to expand MMAGIC to 300 women and follow them for four years. “They can be someone saying, ‘She doesn’t look like she’s positive,’ as if HIV has a face,” Dale continued. “Or ‘I’m HIV negative, I’m clean,’ as if someone else is dirty. They can happen anywhere—from people you socialize with, from strangers. But if they happen in a medical setting, they can impact care, because if you don’t feel validated and cared for, you aren’t going to keep going back.”
Published in the journal AIDSs and Behavior, the preliminary data from the inaugural MMAGIC participants indeed suggested an inverse relationship between daily microaggressions and viral loads. “The higher the microaggression, the lower the viral suppression, and the lower the microaggressions the higher the viral suppression,” Dale said.
In all, the inaugural MMAGIC participants who answered a daily text survey reported a total of 17,097 daily microaggressions during a nine-month period. In their responses, the women also rated their level of distress, which researchers found may have been intensified by the broader social context—particularly the upheavals associated with the pandemic and George Floyd’s May 25, 2020, death under the knee of a Minneapolis police officer who was convicted of murder.
The researchers specifically found that the probability of microaggression-related distress increased from 52 percent at the onset of the study to 70 percent during the 2019 Thanksgiving and Christmas holidays. Then, in March 2020, when COVID-19-imposed restrictions confined many people in their homes, distress declined to 55 percent. But as pandemic-related job losses and deaths, particularly in Black communities, mounted in April and May, the probability of microaggression-related distress began escalating, peaking at 83 percent in the two months after Floyd’s death, when Black Lives Matter protests swept the nation.
“Although COVID and George Floyd’s death weren’t part of the equation when we started this study, they were unfortunate fits into the overall question of how systems of marginalization affect the health of Black women living with HIV,” Dale said. “To make a conclusive statement that microaggressions, acts of discrimination, or repeated violence are impacting women’s viral suppression, we need to see this over time.”
But just as important as the insights gained from the initial MMAGIC participants, Dale said, was the support they received when they shared their distress in their daily texts, or during the clinical assessments that took place every three months. Because a hallmark of the SHINE program’s research and community outreach is its partnerships with community organizations, team members were informed almost instantly about newly available resources, like a food distribution site, and could quickly connect study participants to them.
“It naturally happened, but I think it naturally happened because it’s never just about the research study,” Dale said. “It’s about the human beings, about learning from them, viewing them as an asset and resource, and ensuring their well-being. So, in doing the research, we were also a source of support for all these women who were saying, ‘This situation is really scary.’ ‘I haven't been able to get food, or my family member just died.’ ”
Prior familiarity with SHINE may be one reason, Dale said, that the overwhelming majority of the 143 women—nearly 87 percent—were virally suppressed at the onset of the study, a statistic that belies the national norm. But many participants had previously consented to be contacted by the research program, or found out about it at community clinics, health centers, or community-based organizations—suggesting they were already engaged in care.
Now, as Dale and her fellow researchers expand their study to 300 BWLWH, she said there will be a concerted effort to recruit those who aren’t virally suppressed—and to continue to connect them to needed resources as well.
For Gardner, that will be mean even more opportunity to develop a relationship with the women and hold space for the stories that she knows will leave her in awe. “I’ve heard so many that just make me want to applaud,” she said. “Because if it were me, I don’t know how I would do it. These are women who have experienced violence, traumas, and numerous losses, who live in neighborhoods without a grocery store, and who have to take two buses to get anywhere. These are women who don’t usually open up and talk about things. So, it’s important we give them the space to be heard.”
