"Where It Falls Apart'': Barriers to Retention in HIV Care in Latino Immigrants and Migrants
"Where It Falls Apart'': Barriers to Retention in HIV Care in Latino Immigrants and Migrants
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DOI：
10.1089/apc.2017.0084
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发表时间：
2017-09-01
影响因子：
4.9
通讯作者：
Safren, Steven
中科院分区：
文献类型：
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作者：
Levison, Julie H.;Bogart, Laura M.;Safren, Steven
美国的拉丁裔移民感染艾滋病毒的比例过高。在艾滋病毒初级保健中持续出席（保留）的障碍限制了艾滋病毒治疗成功的机会，但尚未在这一人群中进行专门评估。我们对37名感染艾滋病毒的拉丁裔（年龄0 = 18岁，出生在波多黎各或拉丁美洲西班牙语国家）和14名波士顿大都会的艾滋病毒提供者（总n = 51）进行了半结构化访谈。医疗保健利用的安德森模型提供了半结构化访谈指南，双语研究人员使用该指南来探索艾滋病毒护理的障碍。我们使用专题分析来探讨护理中的保留过程。六个普遍存在的主题被认为影响艾滋病毒门诊就诊：(1)耻辱是艾滋病毒血清状态披露的障碍；(2)在消极生活环境中作为安全网的社会支持；(3)未解决的创伤和物质使用导致护理中断；(4)患者与提供者之间的信任关系促进了HIV门诊就诊；(5)基本需求未被满足与HIV护理的感知价值相竞争；(6)宗教提供了希望和乐观的源泉。文化副主题是家庭（familismo）、男子气概（machismo）和信任关系（confianza）的中心地位。障碍出现的时间是急性的（如驱逐）和慢性的（如家庭冲突）。随着时间的推移，这些共同发生和动态的因素影响了艾滋病毒初级保健的出勤率。感染艾滋病毒的拉丁裔移民和移徙者面临重大挑战，导致艾滋病毒护理中断。为这些挫折做好准备的前瞻性指导可能会提高这一人群对艾滋病毒护理的保留率。
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 cooccurring 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.