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"Where It Falls Apart": Barriers to Retention in HIV Care in Latino Immigrants and Migrants.
- Source :
-
AIDS patient care and STDs [AIDS Patient Care STDS] 2017 Sep; Vol. 31 (9), pp. 394-405. - Publication Year :
- 2017
-
Abstract
- Latino immigrants in the United States are disproportionately affected by HIV. Barriers to consistent attendance (retention) in HIV primary care constrain opportunities for HIV treatment success, but have not been specifically assessed in this population. We conducted semistructured interviews with 37 HIV-infected Latinos (aged ≥18 years and born in Puerto Rico or a Latin American Spanish-speaking country) and 14 HIV providers in metropolitan Boston (total n = 51). The Andersen Model of Healthcare Utilization informed a semistructured interview guide, which bilingual research staff used to explore barriers to HIV care. We used thematic analysis to explore the processes of retention in care. Six ubiquitous themes were perceived to influence HIV clinic attendance: (1) stigma as a barrier to HIV serostatus disclosure; (2) social support as a safety net during negative life circumstances; (3) unaddressed trauma and substance use leading to interruption in care; (4) a trusting relationship between patient and provider motivating HIV clinic attendance; (5) basic unmet needs competing with the perceived value of HIV care; and (6) religion providing a source of hope and optimism. Cultural subthemes were the centrality of family (familismo), masculinity (machismo), and trusting relationships (confianza). The timing of barriers was acute (e.g., eviction) and chronic (e.g., family conflict). These co-occurring and dynamic constellation of factors affected HIV primary care attendance over time. HIV-infected Latino immigrants and migrants experienced significant challenges that led to interruptions in HIV care. Anticipatory guidance to prepare for these setbacks may improve retention in HIV care in this population.
- Subjects :
- Acculturation
Adult
Communication Barriers
Counseling
Female
HIV Infections epidemiology
HIV Infections psychology
Humans
Interviews as Topic
Male
Patient Acceptance of Health Care psychology
Patient Dropouts psychology
Physician-Patient Relations
Puerto Rico
Qualitative Research
Social Support
Transients and Migrants statistics & numerical data
United States ethnology
Emigrants and Immigrants
HIV Infections drug therapy
Hispanic or Latino psychology
Patient Acceptance of Health Care ethnology
Patient Dropouts ethnology
Social Stigma
Transients and Migrants psychology
Subjects
Details
- Language :
- English
- ISSN :
- 1557-7449
- Volume :
- 31
- Issue :
- 9
- Database :
- MEDLINE
- Journal :
- AIDS patient care and STDs
- Publication Type :
- Academic Journal
- Accession number :
- 28891715
- Full Text :
- https://doi.org/10.1089/apc.2017.0084