People with severe mental illness (e.g., schizophrenia, bipolar disorder; SMI) are a socially marginalized population with up to ten times increased likelihood of being diagnosed with HIV compared to the general US population. The parent grant (R01-MH112420) aims to investigate the increased HIV transmission risk, low testing rate, and potential HIV treatment gaps for people with SMI using a large, geographically diverse national retrospective longitudinal Medicaid cohort. The outcomes assessed by the parent grant, however, may be modified by membership in intersecting categories of social marginalization. Leveraging ten years of Medicaid data (2001 through 2012), the major goal of this research is to assess the existence and magnitude of outcome inequalities along the HIV continuum of care, with respect to intersecting categories of social marginalization (schizophrenia diagnosis, race/ethnicity, sex, age, and intravenous drug use).
This RAP proposal seeks to provide mentored theoretical and methodological training for the candidate in the area of quantitative intersectionality research and the SMI population. The research aims are to: (1) complete a systematic review of the cutting-edge quantitative intersectionality approaches; (2) examine differential rates of HIV testing by intersecting categories of social marginalization in the R01 parent grant retrospective cohort; and (3) examine differential rates of HIV treatment by intersecting categories of social marginalization in the R01 parent grant retrospective cohort. The evidence generated from this work could identify the riskiest intersectional positions to inform targeted, cost-effective, interventions to improve HIV testing and care outcomes among those most vulnerable. Additionally, the foundational knowledge of intersectionality as a theoretical framework, paired with the application of quantitative intersectionality methods to a large administrative data set, will position this early stage investigator to have an impactful career as an independent investigator generating rigorous quantitative evidence demonstrating health inequities among socially marginalized populations.