AIDS Patient Care and STDs
Volume 31, Issue 9, 2017, Pages 394-405

"where It Falls Apart": Barriers to Retention in HIV Care in Latino Immigrants and Migrants (Article)

Levison J.H.* , Bogart L.M. , Khan I.F. , Mejia D. , Amaro H. , Alegría M. , Safren S.
  • a Division of General Internal Medicine, Massachusetts General Hospital, 50 Staniford St, Boston, MA 02114, United States, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States, Department of Medicine, Harvard Medical School, Boston, MA, United States
  • b Health Unit, RAND Corporation, Santa Monica, CA, United States
  • c Division of General Internal Medicine, Massachusetts General Hospital, 50 Staniford St, Boston, MA 02114, United States
  • d Division of General Internal Medicine, Massachusetts General Hospital, 50 Staniford St, Boston, MA 02114, United States
  • e Suzanne Dworak-Peck School of Social Work and Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
  • f Department of Medicine, Massachusetts General Hospital, Boston, MA, United States, Department of Medicine, Harvard Medical School, Boston, MA, United States, Department of Psychiatry, Harvard Medical School, Boston, MA, United States
  • g Department of Psychology, University of Miami, Miami, FL, United States

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. © Copyright 2017, Mary Ann Liebert, Inc. 2017.

Author Keywords

qualitative research foreign-born/immigrant Latino/Hispanic retention in care HIV/AIDS

Index Keywords

doctor patient relation cultural anthropology communication barrier Physician-Patient Relations Puerto Rico Communication Barriers immigrant Guatemala HIV Infections primary medical care Human immunodeficiency virus infection mental health human middle aged statistics and numerical data cd4 antigen Colombia social support ethnology Mexico Hispanic Americans qualitative research masculinity Dominican Republic heterosexuality interview United States Young Adult Humans migrant psychology Hispanic Interviews as Topic counseling male Acculturation female Emigrants and Immigrants Honduras substance use semi structured interview CD4 lymphocyte count telephone interview Social Stigma stigma cultural factor Article health care utilization thematic analysis adult major clinical study migration infection risk patient attitude Patient Acceptance of Health Care Transients and Migrants anticipatory guidance Patient Dropouts El Salvador patient dropout
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85029211615&doi=10.1089%2fapc.2017.0084&partnerID=40&md5=5c039e6600bb2ba39e549e05e37580e9
DOI: 10.1089/apc.2017.0084
ISSN: 10872914
Cited by: 6
Original Language: English