“Where It Falls Apart”: Barriers to Retention in HIV Care in Latino Immigrants and Migrants

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.

Documenting best practices for maintaining access to HIV prevention, care and treatment in an era of shifting immigration policy and discourse

“…Clinics that openly acknowledged this complexity and tailored their services by hiring people from within the communities they served were successful at welcoming and retaining clients. Establishing trust by providing culturally competent and bilingual care has been associated with retention in care [27][28]. In addition, having co-located counseling available that was designed to be open to sexual and gender minorities allowed patients to feel cared for in these settings and to have multiple needs met in one site.…”

Anal Cancer Prevention Perspectives Among Foreign-Born Latino HIV-Infected Gay and Bisexual Men

“…No additional negative side effects from the vaccine (which does not consist of the live virus) have been reported among HIV-infected populations when compared to the general population. 41 Human immunodeficiency virus-infected adults often test negative for oncogenic strains of HPV. Over time, however, they increase their risk of acquiring cancerous HPV strains if they increase their number of sexual partners.…”

“…Past research has also described the intersectionality of stigma related to HIV status, sexual orientation, and race as barriers to retention in HIV care among African American and Latino MSM. 40 , 41 Together, these various forms of stigma lead to social isolation, depression, and lack of retention in HIV primary care, 42 and they are correlated with increased sexual risk behaviors. 43 Culturally tailored community-engaged interventions aimed at reducing homophobia and these various forms of stigma may increase Latino HIV-infected GBM’s retention in HIV primary care and, in turn, increase cancer-screening behaviors.…”

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.…”