ABSTRACT
Despite the disproportionate burden of HIV among Latinxs, there is a paucity of culturally appropriate interventions that have shown efficacy at increasing their engagement and retention in HIV care. We describe the development and implementation of Enlaces, a six-session, individual-level intervention, guided by the transnational framework, to improve HIV care outcomes for newly diagnosed and out-of-care Mexican men and transgender women (TW). Descriptive statistics summarizing baseline data and implementation outcomes are provided. 91 participants enrolled between October 2014 and August 2017. Intervention engagement and satisfaction was high; 81.3% completed all six sessions and 100% were very satisfied/satisfied with their experience. Successful implementation of the ENLACES intervention was the result of establishing client trust and maintaining a flexible, supportive approach to intervention delivery. Use of the transnational framework provided a contextualized approach to engaging with Mexican men and TW living with HIV that can be adapted to other Latino populations.
ABSTRACT
OBJECTIVE: Latino men who have sex with men (MSM) are disproportionately affected by HIV in the US and only half of Latinos diagnosed with HIV are virally suppressed. Little is known about the determinants of HIV care and treatment outcomes among Latinos. We used theories of intersectionality to assess the HIV testing, care and treatment experiences of gay Latino men living with HIV in a new immigrant destination. DESIGN: We conducted qualitative in-depth interviews with US and foreign-born gay Latino men living with HIV (n = 14) recruited through referrals from HIV care providers and case managers. We used Maxwell and Miller's theory of qualitative analysis to guide our approach to data analysis, integrating narrative techniques and thematic coding. We used theories of intersectionality - including both intersecting identities and structures - as an interpretive framework to understand participants' outcomes and experiences. RESULTS: All participants were engaged in HIV care at the time of the interviews. The mental health burden of diagnosis and managing life with HIV was a salient theme across all interviews. Most participants had experienced interruptions in their care due to both intersecting stigmatized identities (e.g. being gay, Latino, undocumented) and intersecting structures (healthcare, immigration policy, institutionalized homophobia). Undocumented participants directly connected their immigration status to their ability to get work, which then affected their retention in HIV care and treatment adherence. CONCLUSIONS: Examining the interplay between identities and structures provides a contextualized understanding of outcomes along the HIV care continuum among gay Latino men that goes beyond behavioral and cultural explanations. There is a need to assess long-term experiences of navigating HIV care and treatment given the intersecting structures of mobility, housing instability, and immigration policy.
Subject(s)
HIV Infections , Sexual and Gender Minorities , Continuity of Patient Care , Hispanic or Latino , Homosexuality, Male , Humans , Male , North CarolinaABSTRACT
The majority of HIV disease management happens outside of clinical encounters. As such, understanding how HIV fits into the lives of patients is key to improving HIV outcomes. The concept of control is a vital part of the social context within which health is managed. This qualitative study explores how a sample of Latino men who have sex with men living with HIV in North Carolina (n = 16) conceptualize and negotiate control in the context of living with HIV. We found that participants use a range of strategies to exert control over their lives including: understanding their infection, engaging with health care, and developing relationships with health professionals. By considering how individuals make sense of their HIV diagnosis and integrate it into their lives, HIV providers can direct efforts at strategic points of control decision-making and advanced clinicians can prioritize issues to address during clinical encounters.
Subject(s)
Attitude to Health , HIV Infections/psychology , Hispanic or Latino/psychology , Homosexuality, Male/psychology , Negotiating , Patient-Centered Care , Professional-Patient Relations , Adult , Decision Making , Disease Management , HIV Infections/diagnosis , HIV Infections/epidemiology , Hispanic or Latino/statistics & numerical data , Homosexuality, Male/statistics & numerical data , Humans , Interviews as Topic , Male , North Carolina , Qualitative ResearchABSTRACT
Only 80% of people living with HIV (PLWH) in the United States are linked to care, 40% are engaged in care, and 30% have achieved viral load suppression. We addressed linkage to care with a pilot program of a statewide referral call center to connect PLWH and their non-HIV specialty providers to HIV care. Callers received tailored referrals from nurses trained to work in an existing call center, using an electronic assessment tool and a comprehensive HIV provider list. Of 122 calls, 85% were from PLWH and 15% from providers calling about a patient. Overall, 88 of 104 (84.6%) PLWH and 16 of 18 (88.9%) providers accepted care referral, including 13% of PLWH callers without prior HIV care. Results indicated that the call center was an acceptable strategy for HIV care referral; the use of an existing call center facilitated feasibility of the program and improved linkage to HIV care.
