Abstract
This study investigates the evolving nature of sexuality among Black women living with HIV (BWLWH) and explores how Black queer women in this population experience and cope with microaggressions. Black queer women living with HIV (BQWLWH) experience numerous oppressive systems in their day-to-day life, including but not limited to racism, sexism, HIV-related stigma, homophobia, classism, and ableism. However, there is little literature on the impact of intersectional marginalization on the mental and HIV-related health outcomes of BQWLWH. Qualitative interviews were administered to further discuss the role of structural oppression, coping mechanisms, and resilience strategies that BQWLWH have utilized to navigate systems of oppression. Additionally, a quantitative analysis was utilized to understand how sexuality changes over time for BWLWH and how various factors (e.g., education, income, microaggression) impact and influence identity synthesis and acceptance. For the qualitative component, a thematic analysis was utilzed to interpret data and identify recurring patterns and themes (n = 20). For the quantitative component, it was analyzed using Generalized Estimating Equations (GEE; n = 260). This study’s findings reveal the complex, intersecting challenges faced by BQWLWH, including frequent experiences of racism, sexism, homophobia, and HIV-related stigma. These forms of discrimination - anticipated, enacted, and internalized - were linked to psychological distress but also prompted adaptive coping, particularly through faith and spirituality. While quantitative data showed stability in sexual identity over time, qualitative accounts highlighted fluidity and evolution in participants’ self-identification. Participants shared experiences of exclusion from families, healthcare, and both Black and LGBTQ+ communities, yet also described resilience through reflection, spirituality, and advocacy. These results underscore the need for trauma-informed, culturally responsive interventions that support the well-being and agency of BQWLWH.