Testing for Measurement Invariance (MI): Do the Structures of Microaggression, Discrimination, and Resilience Among Black Women Living with HIV Remain the Same Across Time?

Journal of Racial and Ethnic Health Disparities https://doi.org/10.1007/s40615-024-02087-w Testing for Measurement Invariance (MI): Do the Structures of Microaggression, Discrimination, and Resilience Among Black Women Living with HIV Remain the Same Across Time? Jingxin Liu1 · Daniel J. Feaster1 · Naysha Shahid2 · Kimberly Lazarus2 · Devina J. Boga2 · Peyton Willie2 · Reyanna St. Juste2 · Maria Fernanda Silva2 · Layomi Adeojo2 · Mya Wright2 · Rachelle Reid2 · Stephanie Gonzalez2 · Aarti Madhu2 · Chelsie Warman2 · Roxana Bolden2 · Yue Pan1 · C. Mindy Nelson1 · WayWay Hlaing1 · Allan Rodriguez4 · Maria L. Alcaide4 · Gail Ironson2 · Steven Safren2 · Ian Wright3 · Sannisha K. Dale2 Received: 8 February 2024 / Revised: 2 July 2024 / Accepted: 2 July 2024 © The Author(s) 2024 Abstract Assessing measurement invariance and the interplay of discrimination, microaggressions, and resilience among Black women living with HIV (BWLWH) across time utilizing latent class and repeated measure analysis may provide novel insights. A total of 151 BWLWH in a southeastern U.S. city completed surveys focused on multiple forms of microaggressions and discrimination (race, gender, sexual orientation, or HIV-related) and resilience factors (social support, self-efficacy, posttraumatic growth) at baseline, 3 months, and 6 months. To capture the psychosocial domains of discrimination, microaggressions, and resilience, three latent factors were developed and measured across three time points. Latent class analysis was also conducted to identify and compare meaningful subgroups based on varying levels of discrimination, microaggressions, and resilience reported. Three latent classes were created. MI testing suggested that measurement invariance was partially met (established metric invariance and scalar invariance), and it is possible to compare factor means of discrimination, microaggressions, and resilience across time. Latent factor mean scores of microaggressions and discrimination decreased after 3 and 6 months and increased for resilience after 6 months and varied over time across the three latent classes identified. The subgroup with the lowest level of discrimination and microaggressions and the highest level of resilience reported at baseline, experienced increases in resilience after months 3 and 6. Clinical interventions, research, and policies aimed at promoting resilience and reducing structural and social barriers linked to racism, sexism, HIV stigma, and classism are needed to improve the health and well-being of BWLWH. Keywords Measurement invariance · Latent class analysis · Repeated measure analysis · Black women · HIV · Discrimination · Microaggression · Resilience Introduction * Sannisha K. Dale 1 Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA 2 Department of Psychology, University of Miami, Coral Gables, FL, USA 3 Department of Economics, University of Miami School of Business, Coral Gables, FL, USA 4 Department of Medicine (Infectious Diseases), University of Miami Miller School of Medicine, Miami, FL, USA HIV has been a consistent challenge to public health, especially among women, who account for more than half of people living with HIV (PLWH) worldwide [1]. In the United States (U.S.), Black women are particularly impacted by HIV, representing nearly 60% of newly diagnosed women living with HIV (WLWH) [2] and having the highest premature mortality rates among PLWH [3] despite making up approximately 14% of the U.S. population. Structural factors such as racism, sexism, and classism often give rise to disparities across the HIV care continuum and impact how Black women navigate day-to-day life on a systematic and interpersonal level. Intersectionality theory — rooted in Vol.:(0123456789) Journal of Racial and Ethnic Health Disparities Black feminist tradition and coined by Kimberlé Crenshaw [4] — highlights how interlocking systems of oppression (e.g., racism, sexism, classism, heterosexism) result in various means of privilege, marginalization, and discrimination [5, 6]. Experiencing mistreatment and prejudice due to the stigmatization of living with HIV is prevalent for BWLWH, and this is heightened by and co-occurs with discrimination and microaggressions as a result of racism and sexism and the intersection of the two (i.e., gendered racism). Due to holding overlapping identities that have been historically marginalized, it is important to understand how experiences of intersectional stigma and discrimination impact BWLWH over time. Furthermore, the role of resilience — the ability to bounce back from or in the face of adversity — in response to stressful life experiences rooted in intersectional stigma across time is relevant and necessary in identifying protective factors that may improve the health and wellbeing of BWLWH. Racial, gender, and HIV-related discrimination, as well as gendered racial microaggressions (GRM) — daily insults, passive-aggressive behaviors, and environmental slights that function at the intersection of racism and sexism [7] — have been identified as prominent stressors among BWLWH that have been linked to negative consequences at the institutional and interpersonal level [8]. For instance, higher levels of HIV-related discrimination, racial discrimination, and GRM have been linked to more barriers to care such as difficulty accessing medical facilities, lack of financial resources, and community stigma [8]. Furthermore, discrimination and microaggressions stemming from racism, sexism, and HIV stigma have also been shown to have an adverse impact on mental health among BWLWH [9–11]. Several studies have found that HIV-related discrimination and stigma, racial discrimination, and gendered-racial microaggressions have been significantly associated with depression and trauma symptoms among BWLWH [9–11]. In addition to mental health, experiences of discrimination have been connected to HIV-related outcomes among other groups disproportionately affected by HIV. Previous studies primarily conducted among Black men [12] or men who have sex with men [13] living with HIV, reported that discrimination related to race, HIV status, and sexual orientation negatively impacted medication adherence, engagement in care, and HIV viral suppression [12, 13]. Additionally, among Black women who have sex with women, discrimination rooted in heterosexism, and racism was related to lower engagement in care [14]. Such findings highlight the adverse impact intersectional stigma and discrimination have on the mental and physical health of PWLH and individuals who hold multiple marginalized identities. Despite being disproportionately exposed to stressful life experiences due to various isms, people navigating the world with intersectional stigmatized identities often build and rely on resilience, which represents the ability to cope and adapt when faced with adversities and inequities [15]. For PLWH, (...truncated)