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.
We sought to determine linkage to and retention in HIV care after HIV diagnosis in foreign-born compared with US-born individuals. From a clinical data registry, we identified 619 patients aged ≥18 years with a new HIV diagnosis between 2000 and 2012. Timely linkage to care was the proportion of patients with an ICD-9 code for HIV infection (V08 or 042) associated with a primary care or infectious disease physician within 90 days of the index positive HIV test. Retention in HIV care was the presence of an HIV primary care visit in each 6-month period of the 24-month measurement period from the index HIV test. We used Cox regression analysis with adjustment for hypothesized confounders (age, gender, race/ethnicity, substance abuse, year and location of HIV diagnosis). Foreign-born comprised 36% (225/619) of the cohort. Index CD4 count was 225/μl (IQR 67–439/μl) in foreign-born compared with 328/μl (IQR 121–527/μl) in US-born (p<0.001). The proportion linked to care was 87% (196/225) in foreign-born compared with 77% (302/394) in US-born (p=0.002). The adjusted hazard ratio of linkage to HIV care in foreign-born compared with US-born was 1.28 (95% confidence interval [CI], 1.05–1.56). Once linked, there was no difference in retention in care or virologic suppression at 24 months. These results show that despite late presentation to HIV care, foreign-born persons can subsequently engage in HIV care as well as US-born. Interventions that promote HIV screening in foreign-born persons are a promising way to improve outcomes in these populations.
Women are less likely to be senior authors, invited to write in scientific journals, and to be cited in high impact journals. The aim of this study was to investigate trends in authorship and gender differences in peer-reviewed burn literature over 13 years. We performed a retrospective analysis of original research articles published from January 2009 to September 2021 in three burn journals. A gender determination application was used to categorize the gender of the first and senior author. Of the 3,908 articles analyzed, 42.5% had a woman first author and 27.6% had a woman senior author. We identified 2,029 unique senior authors, 29.0% of whom were women. Woman senior authorship was associated with increased odds of woman first authorship [OR=2.31 (95% CI 2.00, 2.67); p<0.001]. The percentage of papers with a woman senior author increased from 17.8% in 2009 to 35.7% in 2021. If this 1.0% (95% CI: 0.50 – 1.51%) linear trend increase per year in woman senior authorship continues, we will expect to see equal proportions of woman and man senior authors in the included journals starting in 2037. The field of burn care is far from reaching gender parity with respect to authorship of peer-reviewed publications. Supporting and encouraging gender concordant and discordant first:last authorship dyads in mentorship as well as redistributing obligations that may detract from authorship opportunities are potential ways to improve parity in authorship and academia.
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