Journal of Acquired Immune Deficiency Syndromes
Volume 69, 2015, Pages S16-S24

Barriers and facilitators to engagement of vulnerable populations in HIV Primary Care in New York City (Article)

Remien R.H.* , Bauman L.J. , Mantell J.E. , Tsoi B. , Lopez-Rios J. , Chhabra R. , Di Carlo A. , Watnick D. , Rivera A. , Teitelman N. , Cutler B. , Warne P.
  • a HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Columbia University, Unit 15, 1051 Riverside Drive, New York, NY 10032, United States
  • b Einstein-Montefiore Center for AIDS Research, Albert Einstein College of Medicine, New York, NY, United States
  • c HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Columbia University, Unit 15, 1051 Riverside Drive, New York, NY 10032, United States
  • d New York City Department of Health and Mental Hygiene, New York, NY, United States
  • e HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Columbia University, Unit 15, 1051 Riverside Drive, New York, NY 10032, United States
  • f Einstein-Montefiore Center for AIDS Research, Albert Einstein College of Medicine, New York, NY, United States
  • g HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Columbia University, Unit 15, 1051 Riverside Drive, New York, NY 10032, United States
  • h Einstein-Montefiore Center for AIDS Research, Albert Einstein College of Medicine, New York, NY, United States
  • i Einstein-Montefiore Center for AIDS Research, Albert Einstein College of Medicine, New York, NY, United States
  • j Einstein-Montefiore Center for AIDS Research, Albert Einstein College of Medicine, New York, NY, United States
  • k Public Health Foundation Enterprises, La Puente, CA, United States
  • l HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Columbia University, Unit 15, 1051 Riverside Drive, New York, NY 10032, United States

Abstract

Background: Engagement in HIV care helps to maximize viral suppression, which in turn, reduces morbidity and mortality and prevents further HIV transmission. With more HIV cases than any other US city, New York City reported in 2012 that only 41% of all persons estimated to be living with HIV (PLWH) had a suppressed viral load, whereas nearly three-quarters of those in clinical care achieved viral suppression. Thus, retaining PLWH in HIV care addresses this central goal of both the US National HIV/AIDS Strategy and Governor Cuomo's plan to end the AIDS epidemic in New York State. Methods: We conducted 80 in-depth qualitative interviews with PLWH in 4 New York City populations that were identified as being inconsistently engaged in HIV medical care: African immigrants, previously incarcerated adults, transgender women, and young men who have sex with men. Results: Barriers to and facilitators of HIV care engagement fell into 3 domains: (1) system factors (eg, patient-provider relationship, social service agencies, transitions between penal system and community), (2) social factors (eg, family and other social support; stigma related to HIV, substance use, sexual orientation, gender identity, and incarceration), and (3) individual factors (eg, mental illness, substance use, resilience). Similarities and differences in these themes across the 4 populations as well as research and public health implications were identified. Conclusions: Engagement in care is maximized when the social challenges confronted by vulnerable groups are addressed, patient-provider communication is strong, and coordinated services are available, including housing, mental health and substance use treatment, and peer navigation. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.

Author Keywords

HIV care engagement Previously incarcerated adults Transgender women Young men who have sex with men African immigrants

Index Keywords

Vulnerable Populations vulnerable population Transgender Persons doctor patient relation patient care immigrant HIV Infections primary medical care sexual behavior Human immunodeficiency virus infection Communication interpersonal communication human middle aged social aspect priority journal social support African gender identity Social Work men who have sex with men qualitative research interview mental disease Young Adult Humans geography Adolescent New York sexual orientation male transgender female substance use Social Stigma Continuity of Patient Care Article major clinical study adult New York City patient attitude Patient Acceptance of Health Care primary health care
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-84988878382&doi=10.1097%2fQAI.0000000000000577&partnerID=40&md5=634a2ab4114cfd578eecdfda49627a6e
DOI: 10.1097/QAI.0000000000000577
ISSN: 15254135
Cited by: 54
Original Language: English