In the United States (U.S.), African Americans/Blacks (AAs) are the racial/ethnic group most adversely impacted by the HIV epidemic. As such, one of the goals of the White House National HIV/AIDS Strategy is to permanently reduce long-standing health disparities in HIV disease. Lower HIV clinic attendance and suboptimal antiretroviral therapy (ART) use (i.e., initiation, modification, and adherence) by AAs are likely the main mediators of continually worse HIV virologic responses among AAs compared to Caucasians. However, despite the development and implementation of interventions targeting many known individual-level risk and protective factors for clinic attendance and ART use, substantial racial disparities remain. Persistent disparities may be due, in part, to the adverse conditions that characterize the high risk neighborhood environments (e.g., socioeconomic deprivation and violence) in which HIV+ AAs disproportionately reside. However, despite such adversities some AAs demonstrate resilience (i.e., displaying positive behaviors/outcomes despite adversity) which may be critical to reducing persistent racial disparities. Compared to the risk environment, individual, interpersonal, and neighborhood resilience represent novel and more malleable intervention targets for reducing persistent disparities. Unfortunately, resilience remains understudied in the HIV literature, perhaps due to the absence of a reliable and valid resilience measure for HIV+ adults that captures all resilience components. The objective of the proposed research is to develop a reliable and valid measure of individual, interpersonal, and neighborhood resilience; to document its psychometric properties; and to assess longitudinally whether higher resilience facilitates positive HIV outcomes among HIV+ AAs by the level of the risk environment. Data on HIV+ AAs enrolled in the UNC CFAR HIV Clinical Cohort and the UAB 1917 Clinic Cohort will be used for the proposed study. Specifically, this study aims to (1) use advanced concept mapping, which is a mixed methods approach, to generate items that capture all components of resilience; (2) perform psychometric testing of concept mapping items to create a reliable and valid resilience measure that includes all components of resilience; (3a) examine whether resilience and non-resilience individual-level factors (e.g., alcohol/drug use, mental illness, and health insurance) are prospectively associated with HIV outcomes (e.g., clinic attendance, ART adherence, and virologic suppression) by the level of the neighborhood risk environment; and (3b) assess for interactions between resilience and non-resilience individual-level factors by the level of the risk environment. This study responds to the critical need to develop a multi-component resilience measure for HIV+ adults and to establish whether resilience facilitates positive HIV outcomes among HIV+ AAs. Our important findings may lead to the development and implementation of novel multilevel resilience-related interventions to reduce persistent racial disparities in HIV disease.
This innovative project will determine whether resilience facilitates positive HIV outcomes among HIV+ African American/Black (AA) adults in the United States (U.S.) by the level of the neighborhood risk environment. Completing this work will provide critical evidence about the relationship between resilience and HIV outcomes among HIV+ AAs from two longitudinal HIV clinic cohort studies. Such critical evidence is necessary to justify the investment of limited resources into developing interventions targeted at enhancing resilience among AAs to (a) reduce persistent HIV racial disparities in the U.S. and (b) help achieve the goals of the White House National HIV/AIDS Strategy.