Abstract
Critical consciousness, the awareness of social oppression, is important to investigate as a buffer against HIV disease progression in HIV-infected African American women in the context of experiences with discrimination. Critical consciousness comprises several dimensions, including social group identification, discontent with distribution of social power, rejection of social system legitimacy, and a collective action orientation. The current study investigated self-reported critical consciousness as a moderator of perceived gender and racial discrimination on HIV viral load and CD4+ cell count in 67 African American HIV-infected women. Higher critical consciousness was found to be related to higher likelihood of having CD4+ counts over 350 and lower likelihood of detectable viral load when perceived racial discrimination was high, as revealed by multiple logistic regressions that controlled for highly active antiretroviral therapy (HAART) adherence. Multiple linear regressions showed that at higher levels of perceived gender and racial discrimination, women endorsing high critical consciousness had a larger positive difference between nadir CD4+ (lowest pre-HAART) and current CD4+ count than women endorsing low critical consciousness. These findings suggest that raising awareness of social oppression to promote joining with others to enact social change may be an important intervention strategy to improve HIV outcomes in African American HIV-infected women who report experiencing high levels of gender and racial discrimination.
Similar content being viewed by others
References
Centers for Disease Control and Prevention. HIV Surveillance Report. 2011; 21.
Centers for Disease Control and Prevention. HIV Prevalence Estimates—United States, 2006. MMWR. 2008;57(39):1073–6.
Center for Disease Control and Prevention: National Center for Health Statistics (2011b). Deaths: final data for 2009. National Vital Statistics Report. 2011; 60(3).
Newman PA, Williams CC, Massaquoi N, Brown M, Logie C. HIV prevention for Black women: structural barriers and opportunities. J Health Care Poor Underserved. 2008;19(3):829–41.
Broman CL, Mavaddat R, Hsu S-Y. The experience and consequences of perceived racial discrimination: a study of African Americans. J Black Psychol. 2000;26(2):165–80.
Landrine H, Klonoff EA, Gibbs J, Manning V, Lund M. Physical and psychiatric correlates of gender discrimination: an application of the schedule of sexist events. Psychol Women Q. 1995;19(4):473–92.
Bennett GG, Wolin KY, Robinson EL, Fowler S, Edwards CL. Perceived racial/ethnic harassment and tobacco use among African American young adults. Am J Public Health. 2005;95(2):238–40.
Williams DR, Neighbors HW, Jackson JS. Racial/ethnic discrimination and health: findings from community studies. Am J Public Health. 2003;93(2):200–8.
Guthrie BJ, Young AM, Williams DR, Boyd CJ, Kintner EK. African American girls’ smoking habits and day-to-day experiences with racial discrimination. Nurs Res. 2002;51(3):183–90.
Broman CL. Perceived discrimination and alcohol use among Black and White college students. J Alcohol Drug Educ. 2007;51(1):8–16.
Penner LA, Dovidio JF, Edmondson D, et al. The experience of discrimination and Black-White health disparities in medical care. J Black Psychol. 2009;35(2):180–203.
Landrine H, Klonoff EA. The schedule of racist events: a measure of racial discrimination and a study of its negative physical and mental health consequences. J Black Psychol. 1996;22(2):144–68.
Krieger N. Racial and gender discrimination: risk factors for high blood pressure? Soc Sci Med. 1990;30(12):1273–81.
Williams DR, Neighbors HW. Racism, discrimination and hypertension: evidence and needed research. Ethn Dis. 2001;11(4):800–16.
Greer TM. Coping strategies as moderators of the relationship between race-and gender-based discrimination and psychological symptoms for African American women. J Black Psychol. 2010;37(1):42–54.
Landry LJ, Mercurio AE. Discrimination and women’s mental health: the mediating role of control. Sex Roles. 2009;61(3–4):192–203.
Szymanski DM, Stewart D. Racism and sexism as correlates of African American women’s psychological distress. Sex Roles. 2010;63(3–4):226–38.
Ro A, Choi K-H. Effects of gender discrimination and reported stress on drug use among racially/ethnically diverse women in Northern California. Womens Health Issues. 2010;20(3):211–8.
Dailey AB, Kasl SV, Jones BA. Does gender discrimination impact regular mammography screening? findings from the race differences in screening mammography study. J Womens Health. 2008;17(2):195–206.
Zucker AN, Landry LJ. Embodied discrimination: The relation of sexism and distress to women’s drinking and smoking behaviors. Sex Roles. 2007; 56(3–4): 193–203.
Boarts JM, Bogart LM, Tabak MA, Armelie AP, Delahanty DL. Relationship of race-, sexual orientation-, and HIV-related discrimination with adherence to HIV treatment: a pilot study. J Behav Med. 2008;31(5):445–51.
Bird ST, Bogart LM, Delahanty DL. Health-related correlates of perceived discrimination in HIV care. AIDS Patient Care STDS. 2004;18(1):19–26.
Reed E, Santana MC, Bowleg L, Welles SL, Horsburgh C, Raj A. Experiences of racial discrimination and relation to sexual risk for HIV among a sample of urban African American men. J Urban Health. 2012. http://link.springer.com/article/10.1007%2Fs11524-012-9690-x. Accessed December 5, 2012.
Applebaum AJ, Richardson MA, Brady SM, Brief DJ, Keane TM. Gender and other psychosocial factors as predictors of adherence to highly active antiretroviral therapy (HAART) in adults with comorbid HIV/AIDS, psychiatric and substance-related disorder. AIDS Behav. 2009;13(1):60–5.
Boarts JM, Sledjeski EM, Bogart LM, Delahanty DL. The differential impact of PTSD and depression on HIV disease markers and adherence to HAART in people living with HIV. AIDS Behav. 2006; 10(3): 253–261.
Chander G, Himelhoch S, Moore RD. Substance abuse and psychiatric disorders in HIV-positive patients: epidemiology and impact on antiretroviral therapy. Drugs. 2006;66(6):769–89.
Cohen MH, French AL, Benning L, et al. Causes of death among women with human immunodeficiency virus infection in the era of combination antiretroviral therapy. Am J Med. 2002;113(2):91–8.
Cohen MH, Cook JA, Grey D, et al. Medically eligible women not on highly active antiretroviral therapy: the importance of abuse, drug use and race. Am J Public Health. 2004;94(7):1147–51.
Cook JA, Grey DD, Burke-Miller JD, et al. Illicit drug use, depression and their association with highly active antiretroviral therapy in HIV-positive women. Drug Alcohol Depend. 2007;89(1):74–81.
Cook JA, Grey DD, Burke-Miller JK, et al. Effects of treated and untreated depressive symptoms on highly active antiretroviral therapy use in a US multi-site cohort of HIV-positive women. AIDS Care. 2006;18(2):93–100.
Cook RL, Zhu F, Belnap BH, et al. Longitudinal trends in hazardous alcohol consumption among women with human immunodeficiency virus infection, 1995–2006. Am J Epidemiol. 2009;169(8):1025–32.
Turner BJ, Laine C, Cosler L, Hauck WW. Relationship of gender, depression, and health care delivery with antiretroviral adherence in HIV-infected drug users. J Gen Intern Med. 2003;18(4):248–57.
Freire P. Pedagogy of the oppressed. New York: Seabury Press; 1970.
Watts RJ, Griffith DM, Abdul-Adil J. Sociopolitical development as an antidote for oppression—theory and action. Am J Community Psychol. 1999;27(2):255–71.
Gurin P, Miller AH, Gurin G. Stratum identification and consciousness. Soc Psychol Q. 1980;43(1):30–47.
Neville HA, Coleman MN, Falconer JW, Holmes D. Color-blind racial ideology and psychological false consciousness among African Americans. J Black Psychol. 2005;31(1):27–45.
Brown LM, Johnson SD. Ethnic consciousness and its relationship to conservatism and blame among African Americans. J Applied Soc Psychol. 1999;29(12):2465–80.
Tucker A, de Swardt G, Struthers H, McIntyre J. Understanding the needs of township men who have sex with men (MSM) health outreach workers: Exploring the interplay between volunteer training, social capital and critical consciousness. AIDS Behav. 2012. http://link.springer.com/article/10.1007%2Fs10461-012-0287-x. Accessed December 5, 2012.
Hatcher A, de Wet J, Bonell CP. Promoting critical consciousness and social mobilization in HIV/AIDS programmes: lessons and curricular tools from a South African intervention. Health Educ Res. 2011;26(3):542–55.
Zucker AN, Stewart AJ, Pomerleau CS, Boyd CJ. Resisting gendered smoking pressures: critical consciousness as a correlate of women’s smoking status. Sex Roles. 2005;53(3/4):261–72.
Sellers SL, Neighbors HW, Bonham VL. Goal-striving stress and the mental health of college-educated Black American men: the protective effects of system-blame. Am J Orthopsychiatry. 2011;81(4):507–18.
LaVeist TA, Sellers R, Neighbors HW. Perceived racism and self and system blame attribution: consequences for longevity. Ethn Dis. 2001;11(4):711–21.
World Health Organization. Antiretroviral therapy for HIV infection in adults and adolescents: recommendations for a public health approach. 2010 revision. http://whqlibdoc.who.int/publications/2010/9789241599764_eng.pdf. Accessed 20 December 2012.
Bacon MC, von Wyl V, Alden C, et al. The women’s interagency HIV study: an observational cohort brings clinical sciences to the bench. Clin Diagn Lab Immunol. 2005;12(9):1013–9.
Barkan SE, Melnick SL, Preston-Martin S, et al. The women’s interagency HIV study: the WIHS collaborative study group. Epidemiology. 1998;9(2):117–25.
Williams DR, Yu Y, Jackson J, Anderson N. Racial differences in physical and mental health: socioeconomic status, stress, and discrimination. J Health Psychol. 1997;2(3):335–51.
Paterson DL, Swindells S, Mohr J, et al. Adherence to protease inhibitor therapy and outcomes in patients with HIV infection. Ann Intern Med. 2000;133(1):21–30.
Banks KH, Kohn-Wood LP, Spencer M. An examination of the African American experience of everyday discrimination and symptoms of psychological distress. Comm Mental Health J. 2006;42:555–70.
Taylor TR, Kamarck TW, Shiffman S. Validation of the Detroit area study discrimination scale in a community sample of older African American adults: the Pittsburgh healthy heart project. Int J Beh Med. 2004;11:88–94.
Keith VM, Lincoln KD, Taylor RJ, Jackson JS. Discriminatory experiences and depressive symptoms among African-American women: do skin tone and mastery matter? Sex Roles. 2010;62:48–59.
Lewis TT, Everson-Rose SA, Powell LH, et al. Chronic exposure to everyday discrimination and coronary artery calcification in African-American women: the SWAN heart study. Psychosom Med. 2006;68:362–8.
Holmbeck GN. Post-hoc probing of significant moderational and mediational effects in studies of pediatric populations. J Pediatr Psychol. 2002;27(1):87–96.
Lazarus RS, Folkman S. Stress, appraisal, and coping. New York: Springer; 1984.
Leserman J, Petitto JM, Golden RN, et al. The effects of depression, stressful life events, social support, and coping on the progression of HIV infection. Curr Psychiatry Rep. 2000;2(6):495–502.
Antoni MH, Schneiderman N, Esterling B, Ironson G. Stress management and adjustment to HIV-1 infection. Homeost Health Dis. 1994;35(3):149–60.
Ironson G, O’Cleirigh C, Fletcher MA, et al. Psychosocial factors predict CD4 and viral load change in men and women with human immunodeficiency virus in the era of highly active antiretroviral treatment. Psychosom Med. 2005;67(6):1013–21.
Mulder CL, Antoni MH, Duivenvoorden HJ, Kauffmann RH, Goodkin K. Active confrontational coping predicts decreased clinical progression over a 1 year period in HIV-infected homosexual men. J Psychosom Res. 1995;39(8):957–65.
Crocker J, Major B. Social stigma and self-esteem: the self-protective properties of stigma. Psychol Review. 1989;96(4):608–30.
Cole S. Psychosocial influences on HIV-1 disease progression: neural, endocrine, and virologic mechanisms. Psychosom Med. 2008;70(5):562–8.
Carrico AW, Antoni MH. Effects of psychological interventions on neuroendocrine hormone regulation and immune status in HIV-positive persons: a review of randomized controlled trials. Psychosom Med. 2008;70(5):575–84.
Krieger N, Sidney S. Racial discrimination and blood pressure: the CARDIA study of young Black and White women and men. Am J Public Health. 1996;86(10):1370–8.
Brown C, Matthews KA, Bromberger JT, Chang Y. The relation between perceived unfair treatment and blood pressure in a racially/ethnically diverse sample of women. Am J Epidemiol. 2006;164(3):257–62.
Matthews KA, Salomon K, Kenyon K, Zhou F. Unfair treatment, discrimination, and ambulatory blood pressure in Black and White adolescents. Health Psychol. 2005;24(3):258–65.
Sue DW, Capodilupo CM, Torino GC, et al. Racial microaggressions in everyday life: implications for clinical practice. Am Psychol. 2007;62(4):271–86.
Champeau DA, Shaw SM. Power, empowerment and critical consciousness in community collaboration: lessons from an advisory panel for an HIV awareness media campaign for women. Women Health. 2002;36(3):31–50.
Acknowledgments
The Chicago site of the Women’s Interagency HIV study (WIHS) collected data for this study. WIHS is funded by National Institute of Allergy and Infectious Diseases (NIAID) Grant 5U01A1034993 (PI: Mardge Cohen, M.D.) and co-funded by National Cancer Institute and National Institute of Drug Abuse. Kathleen Weber is also funded in part by P30- AI 082151. Sannisha Dale is funded by the National Institute of Mental Health, National Research Service Award Grant F31MH095510. These funding sources had no role in study design, data collection and analysis, decision to publish, or preparation of manuscript. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the views of the National Institutes of Health. We acknowledge the valuable contributions of Cheryl Watson, Crystal Winston, and Darlene Jointer for their commitment and compassion in their work with WIHS participants, Sally Urwin, Maria Pyra, and Jane Burke-Miller for their tireless help with the data, and of the women of WIHS for their generous dedication to the research.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kelso, G.A., Cohen, M.H., Weber, K.M. et al. Critical Consciousness, Racial and Gender Discrimination, and HIV Disease Markers in African American Women with HIV. AIDS Behav 18, 1237–1246 (2014). https://doi.org/10.1007/s10461-013-0621-y
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10461-013-0621-y