Understanding the COVID-19, Racism, and Violence Syndemic and Its Effects on COVID-19 Testing Disparities

Black communities in the US are experiencing three converging public health crises: COVID-19, systemic racism, and community and police violence. Black
Americans are significantly less likely to receive a needed COVID-19 test and have higher rates of COVID-19 infection and death than white Americans.
Additionally, Black communities have experienced a surge in gun violence in 2020 and continue to be victims of police harassment and violence, resulting in
large-scale social justice demonstrations. The convergence of these epidemics has created a syndemic, wherein racism, violence, and COVID-19 cluster in
predominantly Black and low-income communities. The proposed study aims to characterize this syndemic to understand how personal and systemic racism
and violence in Black communities may influence COVID-19 testing decisions. This mixed-method study with Black residents of Chicago, IL will result in
community-driven recommendations to enhance COVID-19 testing and prevention strategies and address this emerging syndemic. We will examine the
potential mediating pathways of medical mistrust, psychological trauma and stress, and economic injustice. Additionally, we will take a strengths-based
approach to understand potential protective factors including neighborhood cohesion, social support, and access to health care. The specific aims of the
study are to: 1) Qualitatively examine how experiences of racial discrimination, community violence, and police violence influence trust in and engagement
with healthcare systems and contribute to decisions around COVID-19 testing and mitigation strategies (e.g. social distancing) among Black individuals in
Chicago (N=S0); 2) Quantitatively assess the prevalence and correlates of COVID-19 testing among Black residents in Chicago (N = 500) and characterize
the COVID-19, racism, and violence syndemic; and 3) In partnership with a Community Advisory Council, use an integrative translational workshop approach
and intervention mapping techniques to develop community and data-driven recommendations and an intervention blueprint for local health departments,
researchers, and public health organizations to improve COVID-19 testing among Black Americans. This study will result in policy and research
recommendations, community resources, and a 'shovel-ready' intervention blueprint to enhance COVID-19 testing and address this emerging syndemic