PROJECT SUMMARY People with HIV (PWH) are two to five times more likely to have experienced interpersonal trauma in their lifetime than the general population1-3. Interpersonal trauma (childhood physical abuse, childhood sexual abuse [complex trauma], adult physical and sexual assault, and intimate partner violence [IPV/Adult Partner Abuse]) negatively impacts treatment adherence, retention in care, and viral suppression4-9 and HIV transmission4,39 African Americans (A.A.) bear a disproportionate burden of HIV and trauma2,10-12,39-40. HIV transmission rates and health outcomes differ for men and women with HIV, a difference that may be associated with their experience of trauma13-15. The impact of trauma for A.A. men and women on retention in HIV care, that is, keeping routine medical appointments and durable viral suppression, is not well understood. Long- term retention in HIV care is critical in preventing HIV disease progression, improving treatment adherence and viral load suppression, increasing positive clinical health outcomes and reducing HIV transmission and mortality4. Previous research showed that long-term retention in HIV care among A.A. living with HIV was only 46% at 36 months since the start of HIV care compared to 63% in the nonblack participants4. Results also showed racial disparities in durable viral suppression among A.A. men and women with HIV 4,16 begin at 12 months since the start of HIV care and beyond, increasing the potential risk of HIV transmission 24,33. A.A. account for 40% (479,300) of nearly 1.2 million PWH in the U.S., and 42% of nearly 36,801 new HIV diagnoses in the U.S., while only representing 13% of the U.S. population39-40. A.A. women have the poorest clinical health outcomes11,12 and greater experience of trauma than all races and ethnicities 10-12,17. HIV-positive men experience lower rates of trauma than women with HIV; however, they experience more trauma than HIV- negative men2. Thus far, most studies have used a cross-sectional design to examine relationships between retention in HIV care, viral suppression4, and trauma experiences providing only a snapshot of a single moment in time 12,18. Longitudinal studies are needed for a deeper understanding of the long-term clinical implications of trauma in retention in HIV care and durable viral suppression among the A.A. PWH. The purpose of this F31 fellowship, entitled MIRRORS (TRAUMA & HIV: RETENTION in HIV CARE and VIRAL LOAD SUPPRESSION SAVES LIVES), is to conduct a secondary analysis testing the relative contribution of each type of interpersonal trauma and life stages with experienced trauma (childhood, adulthood) on retention in HIV care and durable viral suppression among A.A. men and women with HIV over 24 months. The proposed study will utilize datasets from R01 MH092286 “Effects of Health Literacy on Health Disparities in HIV Clinical Outcomes” (P.I.: Waldrop), a completed longitudinal study among 700 men and women (n=424 Black/African American)...