Just about every day, black women living with HIV are subjected to subtle insults, comments, and jokes about their health status, race, gender, or sexual identity. Sannisha Dale, an assistant professor of psychology, knows this from her years of HIV research and outreach to marginalized communities where, despite effective drugs that keep the HIV virus in check, HIV cases continue to climb.
That's especially true in Miami, an HIV epicenter where Dale is launching a unique study called Project MMAGIC, for Monitoring Microaggressions and Adversities to Generate Interventions for Change, to gain a better understanding of how daily microaggressions affect the health of black women living with HIV.
It's an important question because across the nation but particularly in Miami, black women comprise the largest group of women living with HIV, and far too many of them--an estimated 42 percent--do not have an undetectable HIV viral load, which would not only keep them healthy, but prevent them from transmitting the virus to someone else. Becoming and staying undetectable requires taking HIV medications daily.
"Microaggressions are subtle but they are very hurtful. For example, it's hearing someone say, 'She doesn't look like she's positive,' as if HIV has a face. Or 'I'm HIV negative, I'm clean,' with the connotation being if you're HIV positive, you're dirty, you're tainted," Dale said. "When microaggressions come up they disrupt people's mood, they throw people off, and when they happen in a clinical setting with a health care provider, they may disrupt women's care in terms of their desire to return to visits or trust recommendations from that provider."
Project MMAGIC, which was developed with interdisciplinary collaborations across the University, is designed to engage and gather data from 150 women for one year to see how microaggressions and other related psychosocial experiences effect their viral suppression over time. The women will document their experiences by short, daily text messages, and through quarterly assessment visits.
"It's unique because it's the first study to look at microaggressions longitudinally, or over time, among black women living with HIV," said Dale, whose research explores the relationships between resilience, trauma, and health outcomes among individuals with HIV and the psychosocial and structural factors that relate to health disparities.
Previous smaller-scale studies that Dale led suggest that gendered racial microaggressions are related to depression, post-traumatic stress disorder, barriers to care, and medication adherence.
Dale hopes that Project MMAGIC will not only help tear down assumptions about black women living with HIV and highlight the role of social and structural issues impacting their lives, but inform policies, provider trainings, and interventions to empower women with HIV to navigate microaggressions when they occur.
Funded by a $670,000 grant from the National Institute of Mental Health, the Project MMAGIC team also will collect data related to violence and the reoccurrence of violence (such as physical and sexual assault) to analyze how violence impacts women's engagement in care, such as making their medical appointments, taking their medications properly, and, ultimately, how well they are doing in terms of HIV and wellness.
"We are also going to look at resilience factors, such as self-efficacy, spirituality, coping mechanisms, as well as environmental factors, like where black women with HIV live and the resources that are available in their communities, such as domestic violence shelters, health centers, and transportation access," Dale said.
Dale, who joined the University of Miami faculty two years ago and is committed to helping to improve HIV intervention and prevention strategies in Miami's local communities, has already made her mark. She is the director of the SHINE Research Program (Strengthening Health through Innovation and Engagement), the scientific director for community engagement for the new Center for HIV and Research in Mental Health (CHARM), and founding chair of the Diversity and Equity Committee in the Department of Psychology.
Prior to joining the College of Arts and Sciences, she was an assistant in psychology in behavioral medicine at Massachusetts General Hospital and an instructor in psychology at Harvard Medical School.
"The concept of Project MMAGIC comes from other preliminary work that I've done in my career," she said. "But here I'm thinking about the psychosocial stressors that black women who are living with HIV face, and gaining a wider understanding of how these daily microaggressions, over time, can affect their health."
In addition to Dale, Project MMAGIC includes an interdisciplinary team of experts from across the University of Miami: Ian Wright, an assistant professor at the University of Miami Patti and Allan Herbert Business School, professor Dan Feaster and associate professor Maria Alcaide at the Miller School of Medicine, and professors Steven Safren and Gail Ironson in the Department of Psychology at the College of Arts and Sciences.