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Critical Consciousness, Racial and Gender Discrimination, and HIV Disease Markers in African American Women with HIV

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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.

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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.

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Correspondence to Leslie R. Brody.

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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

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