A Critical Review and Commentary on the Challenges in Engaging HIV-Infected Latinos in the Continuum of HIV Care

Abstract

Antiretroviral therapy for treatment of HIV infection has become increasingly effective. Persistent poor HIV outcomes in racial and ethnic minority populations in the US call for a closer examination into why Latinos are at significant risk for acquiring and dying from HIV. To improve clinical outcomes and achieve an AIDS-free generation, HIV research must address disparities in HIV outcomes in Latinos, the largest ethnic/racial minority population in the US. Immigrant status as well as cultural factors influence HIV care utilization and are essential to highlight for effective intervention development in Latinos. A better understanding of these individual and contextual factors is critical to developing tailored approaches to engaging Latinos in HIV care. Based on a comprehensive literature review, we offer a framework for understanding what is needed from clinical practice and research to improve engagement in HIV care for US-based Latinos. These findings may have implications for other minority populations.

Beyond Interpretation: The Unmet Need for Linguistically and Culturally Competent Care for Latinx People Living with HIV in a Southern Region with a Low Density of Spanish Speakers

“…1). Many of these challenges to care have previously been seen in studies of Latinx PLWH, 10,[13][14][15][23][24][25] although the pervasive sense of isolation and lack of community may be more pronounced in our nonurban population with a low density of LEP patients. The current system of care for Spanish-speaking Latinx PLWH is not meeting this population's needs.…”

“…28,29 However, bilingual providers may not be readily available for low-density minority language populations. Increasing the bilingual provider workforce is a worthy goal, 25 but this change cannot be enacted immediately. Additionally, language impacts all stages of care, not only the patient/provider interaction.…”

“…30 Literature on HIV prevention among Latinxs describes how cultural norms related to sexuality, gender roles, and social reluctance may limit discussion related to sexual identity and sexual activity. 25 Diversifying care teams to include members of minority language populations may provide a broader range of perspectives. It is also important for providers to recognize the diversity within minority language populations, given the heterogeneity of cultures among Spanish-speaking individuals.…”

“…The sense of isolation felt by many Latinx PLWH may be particularly pronounced given the cultural importance of familismo. 25 Social support and disclosure of status to members of one's social network improves retention in care. 43 ''Confianza,'' or trusting relationships, is a cultural theme in care, as supported by our participants who sought a sense of warmth with providers.…”

“…Stigma, a high concern among Spanish-speaking Latinx PLWH, 48 results in worse outcomes for PLWH. 49 Before 2010, HIV infection could be a reason to bar entry into the United States, 25 a fact known by at least two participants. Under the public charge rule, immigrants who utilize some public programs, or those with certain illnesses commonly impacting PLWH, may be deemed ineligible for entry into the United States or adjustment to legal permanent resident status.…”