Abstract
Gendered racial microaggressions (GRM; subtle daily insults due to racism and sexism) are salient psychosocial stressors that have been linked with mental health outcomes and barriers to care among Black women living with HIV (BWLWH). However, limited research has focused on potential links between GRM and coping mechanisms such as self-silencing and substance use which have been associated with both mental health and HIV-related outcomes. To better understand factors that contribute to disparities in HIV outcomes experienced by BWLWH, the present study examined the relationships among GRM, self-silencing, substance use, antiretroviral therapy (ART) medication adherence, and viral suppression using structural equation modeling and path analysis. Self-silencing and substance use were examined as potential mediators. Participants were 119 BWLWH residing in South Florida. Results of this study showed that GRM was directly and positively associated with self-silencing and indirectly and negatively associated with medication adherence via self-silencing. Self-silencing was directly and negatively associated with medication adherence. Medication adherence was directly and negatively related to viral suppression. The model fit the data well. Identifying the negative consequences of GRM in conjunction with self-silencing and substance use may help inform prevention and intervention strategies to improve mental health and HIV-related outcomes among BWLWH.