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Endalamaw A, Gilks CF, Ambaw F, Shiferaw WS, Assefa Y. Explaining inequity in knowledge, attitude, and services related to HIV/AIDS: a systematic review. BMC Public Health 2024; 24:1815. [PMID: 38978024 PMCID: PMC11229290 DOI: 10.1186/s12889-024-19329-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 07/01/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND Equitable service provision and coverage are important responses to end the threat of the HIV/AIDS pandemic. Understanding inequity supports policies and programmes to deliver tailored interventions. There is continuous evidence generation on inequity in HIV/AIDS services. However, there was a lack of evidence on the global picture of inequity in behavioural and biomedical services related to HIV/AIDS. This systematic review assessed inequities in knowledge, attitude, HIV testing, and ART coverage across individual-level social groups and multiple (dis)advantage categories. METHODS This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline, with a PROSPERO registration number CRD42024521247. The risk of bias was assessed by using Hoy et al's and Joanna Brigg's quality appraisal checklists for cross-sectional quantitative and qualitative studies, respectively. The search date was from inception to the final database search date (May 29, 2023). The included articles were either quantitative or qualitative studies. We used mixed-methods approach to analyse the data from the review articles. Quantitative descriptive analysis was conducted to estimate frequency of articles published from different countries around the world. Qualitative content analysis of the findings from the original studies was conducted using the PROGRESS plus framework which stands for: place of residence, occupation or employment status, gender, religion, education status, socioeconomic status, and social capital. RESULTS Out of 6,029 articles that were accessed and screened, only 72 articles met the inclusion criteria. More articles on HIV-related equity in knowledge, attitude, testing, and ART were published in developed countries than in developing countries. Individuals from higher-income households had better knowledge about HIV/AIDS. Unfavourable attitudes towards people living with HIV and HIV/AIDS-associated stigma were common among women. HIV/AIDS service coverage (HIV testing or ART coverage) was higher among richer and urban residents. HIV/AIDS-associated stigma and lower levels of knowledge about HIV/AIDS were observed among multiple disadvantageous groups due to the intersection of two or more identities. CONCLUSIONS The current review revealed that there have been disparities in HIV/AIDS services between social classes. Ending service disparity towards the global threat of HIV/AIDS demands tailored interventions based on socially disadvantaged groups (e.g., poor, rural dwellers, and women) and intersectional determinants. There is a need to understand the deep-rooted causes of inequity and the challenges that an equity-oriented system faces over time. More studies on inequity are needed, including intersectional inequity, which has been rarely studied in developing countries.
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Affiliation(s)
- Aklilu Endalamaw
- School of Public Health, The University of Queensland, Brisbane, Australia.
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Charles F Gilks
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Fentie Ambaw
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Wondimeneh Shibabaw Shiferaw
- School of Public Health, The University of Queensland, Brisbane, Australia
- College of Medicine and Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia
| | - Yibeltal Assefa
- School of Public Health, The University of Queensland, Brisbane, Australia
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Garcia M. Intersectional Microaggressions and Implications for Health Inequities and HIV Among Latino/x Sexual Minority Males in Puerto Rico. J Racial Ethn Health Disparities 2024:10.1007/s40615-023-01900-2. [PMID: 38198018 DOI: 10.1007/s40615-023-01900-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 11/21/2023] [Accepted: 12/16/2023] [Indexed: 01/11/2024]
Abstract
Latino/x sexual minority males (SMM) continue to be disproportionately impacted by health inequities. This study aims to understand the lived experience of Puerto Rican (PR) SMM related to how intersectional microaggressions influence health-related risk and protective factors. Young adult (ages 21-30) PR SMM from San Juan, Puerto Rico, completed a bilingual in-depth individual interview (14 in Spanish and 1 in English). A thematic analysis based on the original language of the interviews was conducted using NVivo. Six prominent themes were identified through the data analysis: (1) religious microaggressions, being gay is bad because God doesn't like it; (2) gender microaggressions, gay is not good because it's not for men; (3) sexuality microaggressions, this one is a homosexual, coming out as a sexual minority; (4) trans microaggressions, drag queens create an illusion; (5) internalized microaggressions, battling with internalized homophobia; and (6) mitigating microaggressions, establishing a supportive community. Findings suggest that multiple forms of microaggressions based on the intersectionality of sexuality and gender manifest from straight as well as gay communities. PR SMM demonstrated their resiliency by assessing interactions with others to mitigate risks and enhance supportive networks.
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Affiliation(s)
- Moctezuma Garcia
- School of Social Work, San José State University, San Jose, CA, 95112, USA.
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA.
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Aurpibul L, Kaewpoowat Q, Detsakunathiwatchara C, Chairat S, Chaiwarith R, Tangmunkongvorakul A. Health Behaviors and Attitudes Toward HIV Clinic Among Young Men who Have Sex with Men Living with HIV in Chiang Mai, Thailand: A Mixed Methods Study. AIDS Behav 2024; 28:332-342. [PMID: 37542628 DOI: 10.1007/s10461-023-04132-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2023] [Indexed: 08/07/2023]
Abstract
Today, many young men who have sex with men (YMSM) with a new HIV infection were diagnosed and successfully linked to HIV services. Studies on their health behaviors while living with HIV and their attitude toward the HIV clinic are scarce. We characterized common health behaviors of YMSM and assessed their perspective towards the existing HIV services. We collected data from a self-administered questionnaire and in-depth interviews (IDI) using a mixed-method cross-sectional study design. A hundred YMSM, aged 18-24, who attended the HIV clinic were enrolled. Their median age was 23 years (interquartile range, IQR 21-24). Eighty-four (84%) were gay men. Their common health behaviors included 15 (15%) being current smokers and 30 (30%) using alcohol regularly. Sixty-four (64%) reported > 95% antiretroviral treatment adherence, while 32 (32%) self-reported adherence at 80-95%. Fifty-three (53%) reported 100% condom use, while 30 (30%) reported using a condom in > 80% of their sexual activities. From the questionnaire respondents, individual characteristics of providers were the most critical factor affecting participants' willingness to attend HIV services. From the IDI, social disclosure of HIV status was their primary concern, with the presence of self- and anticipating HIV-related stigma issues. In summary, YMSM living with HIV who regularly attended the HIV clinic had a low frequency of health risk behaviors. Most did not socially disclose their serostatus but could manage their health. They were generally satisfied with patient-friendly services while calling to protect their confidentiality and privacy.
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Affiliation(s)
- Linda Aurpibul
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Quanhathai Kaewpoowat
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Department of Internal Medicine, University of Iowa, Iowa, USA
| | | | - Suchada Chairat
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Romanee Chaiwarith
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Barreras JL, Bogart LM, MacCarthy S, Klein DJ, Pantalone DW. Discrimination and adherence in a cross-sectional study of Latino sexual minority men with HIV: Coping with discrimination as a mediator and coping self-efficacy as a moderator. J Behav Med 2023; 46:1057-1067. [PMID: 37392342 PMCID: PMC10577103 DOI: 10.1007/s10865-023-00426-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 05/25/2023] [Indexed: 07/03/2023]
Abstract
Discrimination is associated with antiretroviral therapy non-adherence and reduced well-being among people with HIV. We examined the potential for coping to mediate the associations between intersectional discrimination and non-adherence and coping self-efficacy (confidence in one's ability to cope with discrimination) as a moderator that may buffer the negative effects of discrimination on non-adherence in a cross-sectional convenience sample of 82 Latino sexual minority men with HIV. In bivariate linear regressions, discrimination targeting Latino ethnic origin, undocumented residency status, and sexual orientation were each significantly associated with lower self-reported antiretroviral therapy non-adherence (percentage of prescribed doses taken in the last month) and greater use of disengagement coping (denial, substance use, venting, self-blame, behavioral disengagement). Associations between discrimination targeting Latino ethnicity and non-adherence, and discrimination targeting undocumented residency status and non-adherence, were each mediated by disengagement coping responses. Moderation analyses highlighted significant discrimination by coping self-efficacy interaction effects-both coping self-efficacy for problem solving and stopping unpleasant emotions/thoughts each moderated the associations between Latino discrimination and adherence, between undocumented residency status discrimination and adherence, and between HIV discrimination and adherence. Coping self-efficacy for getting social support moderated the association between undocumented residency status discrimination and adherence. Further, the interaction coefficients across models indicated that the negative effects of discrimination on adherence were attenuated at higher levels of coping self-efficacy. Findings highlight the need for structural interventions that reduce-and ultimately eliminate-discrimination, and interventions that address the harmful effects of discrimination and adherence improvement interventions to enhance coping skills among people faced with intersectional discrimination.
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Affiliation(s)
- Joanna L Barreras
- School of Social Work, California State University Long Beach, 1250 Bellflower Boulevard, Long Beach, CA, 90840, USA.
- Bienestar Human Services, Inc, 5326 East Beverly Blvd, Los Angeles, CA, 90022, USA.
| | - Laura M Bogart
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA
| | - Sarah MacCarthy
- Department of Health Behavior, University of Alabama, 1665 University Boulevard, Birmingham, AL, 35294, USA
| | - David J Klein
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA
| | - David W Pantalone
- Department of Psychology, University of Massachusetts Boston, 100 Morrissey Boulevard, Boston, MA, 02125, USA
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA
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Mayo D, Lozano A, Williams RS, Safren SA, Harkness A. The Relationship Between Intersectional Oppression and Affirmation and Latino Sexual Minority Men's Mental Health. LGBT Health 2023; 10:629-638. [PMID: 37466482 PMCID: PMC10712364 DOI: 10.1089/lgbt.2022.0212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
Purpose: Latino sexual minority men (LSMM) may experience oppression based on their ethnicity, sexual orientation, and migratory status, yet scientific literature is only beginning to explore the intersection of these experiences. This study examined mental health (MH) in relation to LSMM's experiences of intersectional oppression and affirmation. Methods: We conducted a secondary analysis of baseline data from a cohort study examining LSMM's (n = 290) health care engagement in Miami, FL, from February to September 2020. Latent class analysis (LCA) identified classes based on self-reported multiple identity discrimination (e.g., race, ethnicity, and skin color), sexual orientation stigma/affirmation, and migration-related stress. Logistic and linear regressions examined associations between class membership and anxious, depressive, post-traumatic stress, somatic symptoms, and overall MH burden. Results: The LCA revealed a three-class solution: (1) affirmed LSMM (73.8%), (2) LSMM with intersectional oppression (21.7%), and (3) LSMM with immigration stress (4.5%). The three classes varied in terms of multiple identity discrimination, sexual orientation stigma/affirmation, and migration-related stress. Compared with Class 1, Class 2 had greater conditional probabilities of reporting clinically significant depressive (p = 0.033) and post-traumatic stress symptoms (p = 0.031), and at least one MH concern (p = 0.018). Greater depressive symptoms (p = 0.007), post-traumatic stress symptoms (p = 0.049), somatic symptoms (p = 0.024), and clinically significant MH concerns (p = 0.018) were found among Class 2 than among Class 1. Conclusion: Findings identified three groups of LSMM based on their experiences of intersectional oppression and affirmation. Discrimination at the intersection of multiple identities, sexual orientation stigma/affirmation, and migration-related stress were associated with LSMM's MH outcomes, particularly among immigrants.
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Affiliation(s)
- Daniel Mayo
- College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Alyssa Lozano
- Department of Public Health Sciences and University of Miami, Miami, Florida, USA
| | | | - Steven A. Safren
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Audrey Harkness
- School of Nursing and Health Studies, University of Miami, Coral Gables, Florida, USA
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Lee YG, Alessi EJ, Lynn M, Starks TJ, Robles G. Everyday Discrimination and HIV Testing Among Partnered Latino/x Sexual Minority Men in the United States: A Stratified Analysis by Birth Location. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2023; 35:376-389. [PMID: 37843904 DOI: 10.1521/aeap.2023.35.5.376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
We examined the association between everyday discrimination and HIV testing patterns-current (≤ 6 months), recent (7-12 months), and delayed (> 12 months or never tested)-among partnered Latino/x sexual minority men (SMM). Multinomial regression analyses revealed that in the full sample (N = 484) experiencing discrimination based on sexual orientation and race/ethnicity attributions concurrently (vs. no discrimination) was associated with higher odds of delayed (vs. current) HIV testing (AOR = 2.6, 95% CI [1.0, 6.7]). Similarly, in the subset of Latino/x SMM born outside the mainland U.S. (n = 209), experiencing concurrent sexual orientation- and race/ethnicity-based discrimination (vs. no discrimination) was associated with higher odds of recent (AOR = 12.4, 95% CI [1.3, 115.7]) and delayed HIV testing (AOR = 7.3, 95% CI [1.6, 33.0]), compared with current testing. Findings suggest that addressing discrimination may improve HIV testing uptake among partnered Latino/x SMM, particularly those born outside the U.S.
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Affiliation(s)
- Yong Gun Lee
- School of Social Work, Rutgers University, New Brunswick, New Jersey
| | - Edward J Alessi
- School of Social Work, Rutgers University, New Brunswick, New Jersey
| | - Matthew Lynn
- School of Social Work, Rutgers University, New Brunswick, New Jersey
| | - Tyrel J Starks
- Department of Psychology, Hunter College of the City University of New York, New York, New York
| | - Gabriel Robles
- School of Social Work, Rutgers University, New Brunswick, New Jersey
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Maiorana A, Zamudio-Haas S, Santiago-Rodríguez EI, Sauceda JA, Rodríguez-Díaz CE, Brooks RA, Myers JJ. HIV Disclosure Practices to Family Among Mexican and Puerto Rican Sexual Minority Men with HIV in the Continental USA: Intersections of Sexual Orientation and HIV Stigma. JOURNAL OF HOMOSEXUALITY 2023; 70:1911-1935. [PMID: 35225747 DOI: 10.1080/00918369.2022.2043731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Disclosing a seropositive HIV status still is a complex process of assessing the risks, benefits, and potential personal and interpersonal outcomes associated with disclosure, such as stigma, rejection, or emotional support. We examined HIV disclosure practices to family and intersectional stigma related to HIV and sexual orientation among Latino sexual minority men (LSMM) of Mexican and Puerto Rican origin with HIV in the continental USA. Guided by Framework Analysis, we present data from 54 interviews with 33 LSMM participants in HIV care engagement interventions, and 21 project staff implementing the interventions. LSMM disclosed their HIV status to family seeking support. They applied stigma management techniques to manage the information communicated to family about their HIV status, including selective disclosure to some family members, conveying strategic information about the significance of having HIV, non-disclosure, or partial disclosure, silence and deceptions. LSMM HIV disclosure practices to family encompassed appraisals of intersectional stigma related to their sexual orientation and HIV, assessing the potential outcomes of disclosure, and the preservation of family ties.
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Affiliation(s)
- Andres Maiorana
- Department of Prevention Science, University of California at San Francisco, Center for Aids Prevention Studies, San Francisco, California, USA
| | - Sophia Zamudio-Haas
- Department of Prevention Science, University of California at San Francisco, Center for Aids Prevention Studies, San Francisco, California, USA
| | - Edda I Santiago-Rodríguez
- Department of Prevention Science, University of California at San Francisco, Center for Aids Prevention Studies, San Francisco, California, USA
| | - John A Sauceda
- Department of Prevention Science, University of California at San Francisco, Center for Aids Prevention Studies, San Francisco, California, USA
| | - Carlos E Rodríguez-Díaz
- Department of Prevention and Community Health, The George Washington University, Milken Institute School of Public Health, Washington, DC, USA
| | - Ronald A Brooks
- Department of Family Medicine, University of California at Los Angeles, David Geffen School of Medicine, Los Angeles, California, USA
| | - Janet J Myers
- Department of Prevention Science, University of California at San Francisco, Center for Aids Prevention Studies, San Francisco, California, USA
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Mitchell BD, Utterback L, Hibbeler P, Logsdon AR, Smith PF, Harris LM, Castle B, Kerr J, Crawford TN. Patient-Identified Markers of Quality Care: Improving HIV Service Delivery for Older African Americans. J Racial Ethn Health Disparities 2023; 10:475-486. [PMID: 35064521 PMCID: PMC8781691 DOI: 10.1007/s40615-022-01237-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 01/11/2022] [Accepted: 01/12/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Over 50% of new AIDS/HIV diagnoses are older adults and disproportionately African American people. Longstanding health inequities, driven by the enduring nature of systemic racism, pose challenges to obtaining optimal HIV services. Patient experiences and identities shape the health care experience, yet patient voices are often minimized, including their assessment of quality HIV care. Understanding these markers of care, including facilitators of and barriers to care and engagement, may help enhance the patient voice, potentially improving service delivery and eradicating HIV healthcare disparities. METHOD Using a convergent mixed method design, our study identifies patient-identified markers of quality care among older African Americans (N = 35). Measurements of global stress, HIV stigma, and engagement in care were collected, and in-depth qualitative interviews explored the symbols of quality care as well as facilitators of and barriers to care. RESULTS We identified widespread participant awareness and recognition of quality care, the detection of facilitators and barriers across individual, clinic, and community levels. Facilitators of care include diet, health, relationships, community support, and compassionate HIV care. Barriers to care include health comorbidities, economic, food, and housing insecurity, lack of transportation, and structural racism. CONCLUSION Our findings illuminate how the prominence of barriers to care often uproot facilitators of care, creating impediments to HIV service delivery as patients transition through the HIV care continuum. We offer implications for practice and policy, as well as recommendations for reducing structural barriers to care by enhancing the patient voice and for aligning services toward compassionate and inclusive care.
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Affiliation(s)
- Brandon D. Mitchell
- grid.266623.50000 0001 2113 1622Kent School of Social Work, University of Louisville, Louisville, KY USA
| | - Liz Utterback
- grid.266623.50000 0001 2113 1622Kent School of Social Work, University of Louisville, Louisville, KY USA
| | - Paul Hibbeler
- grid.266623.50000 0001 2113 1622Kent School of Social Work, University of Louisville, Louisville, KY USA
| | - Ashley R. Logsdon
- grid.266623.50000 0001 2113 1622Kent School of Social Work, University of Louisville, Louisville, KY USA
| | - Patricia F. Smith
- grid.266623.50000 0001 2113 1622Kent School of Social Work, University of Louisville, Louisville, KY USA
| | - Lesley M. Harris
- grid.266623.50000 0001 2113 1622Kent School of Social Work, University of Louisville, Louisville, KY USA
| | - Billie Castle
- grid.266623.50000 0001 2113 1622School of Public Health and Information Sciences, University of Louisville, Louisville, KY USA
| | - Jelani Kerr
- grid.266623.50000 0001 2113 1622School of Public Health and Information Sciences, University of Louisville, Louisville, KY USA
| | - Timothy N. Crawford
- grid.268333.f0000 0004 1936 7937Family Medicine and Population and Public Health Sciences, Wright State University, Dayton, OH USA
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Nkulu-Kalengayi FK, Ouma AA, Hurtig AK. 'HIV ended up in second place' - prioritizing social integration in the shadow of social exclusion: an interview study with migrants living with HIV in Sweden. Int J Equity Health 2022; 21:175. [PMID: 36471317 PMCID: PMC9724319 DOI: 10.1186/s12939-022-01783-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 10/31/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Migrants are overrepresented among people living with HIV in Sweden as they often face conditions that increased their risk and vulnerability for HIV/STI infections prior, during or after migration. Yet, there is limited research on their experiences and perceptions of living with HIV in the Swedish context. This study aims to explore migrants' experiences of living with HIV in Sweden. METHODS This is a qualitative study based on in-depth interviews with 13 migrants from 11 countries living with HIV in Sweden. Interviews were analysed with thematic analysis using an intersectional perspective to explore the interactions of multiple social identities such as ethnicity, socio-economic status, gender, age, and sexual orientation that shape an individual's or group's experiences. RESULTS The analysis resulted in a main theme: 'Prioritizing social integration-HIV ends up in second place', which is based on four subthemes: 'Better opportunities in the new country than what the home country could offer', 'Better conditions for LGBTQI people than in the home country', 'Navigating a new system: linguistic and bureaucratic challenges' and 'Feeling like a second-class resident: racism, xenophobia and multiple discrimination'. The results suggest that migrants living with HIV in Sweden experience social integration as a greater challenge than HIV infection. Although the new country offers opportunities for better living conditions, many participants described being challenged in their daily life by linguistic and structural barriers in their encounters with public services. They are facing multiple discrimination simultaneously as migrants due to their multiple and intersecting identities (e.g. being non-white, foreigners/foreign-born and non-Swedish speakers), which is compounded by HIV status and thus limit their opportunities in the new country and too often result in an existence of exclusion. CONCLUSION The study shows that most of the challenges that migrants living with HIV face are related to their status as migrants rather than HIV status, which is often not known by the public or authorities. These challenges are similar, but still differ depending on social position, previous experiences, time since arrival and since diagnosis. This emphasizes the importance of both intersectional, intersectoral and multisectoral approaches to address reported issues.
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Affiliation(s)
| | - Anne Adhiambo Ouma
- grid.12650.300000 0001 1034 3451Department of Epidemiology and Global Health, Umeå University, SE-901 87 Umeå, Sweden
| | - Anna-Karin Hurtig
- grid.12650.300000 0001 1034 3451Department of Epidemiology and Global Health, Umeå University, SE-901 87 Umeå, Sweden
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Fauk NK, Gesesew HA, Seran AL, Raymond C, Tahir R, Ward PR. Barriers to Accessing HIV Care Services in Host Low and Middle Income Countries: Views and Experiences of Indonesian Male Ex-Migrant Workers Living with HIV. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14377. [PMID: 36361253 PMCID: PMC9654942 DOI: 10.3390/ijerph192114377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 06/16/2023]
Abstract
Migrant populations are one of the vulnerable groups to HIV transmission and its consequences. They are also reported to experience delayed entry or linkage into HIV services and have poorer HIV-related health outcomes. This study aimed to understand barriers to accessing HIV care services in host countries among Indonesian, male, former (returned) migrant workers living with HIV. The study was carried out from December 2020 to February 2021. It utilised a qualitative design employing in-depth interviews to collect data from twenty-two returned migrant workers from Eastern Indonesia, recruited using the snowball sampling technique. A qualitative data analysis framework was used to guide a step-by-step analysis of the findings. Findings demonstrated that limited host-country language proficiency, lack of knowledge regarding healthcare systems in host countries and having 'undocumented' worker status were barriers to accessing HIV care services. Data also revealed the unavailability of HIV care services nearby migrants' work locations, long-distance travel to healthcare facilities, and challenges in accessing public transportation as barriers that impeded their access to the services. Other factors limiting the participants' access to HIV services were identified as the transient and mobile nature of migrant work requiring frequent relocation and disrupting work-life stability. Additionally, in lieu of formal HIV services, many participants self-medicated by using over-the-counter herbal or 'traditional' medicines, often because of peer or social group influence regarding the selection of informal treatment options. Recommendations arising from this study demonstrate the need to improve pre-departure information for migrant workers regarding the healthcare system and access procedures in potential host countries. Data from this study also indicate that social services should be available to assist potential migrants to access legal channels for migrant work overseas, to ensure that Indonesian migrants can safely access healthcare services in the countries for which they are providing migrant labour. Future studies to understand barriers to accessing HIV care services among various migrant groups living with HIV are warranted to build evidence for potential social policy change.
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Affiliation(s)
- Nelsensius Klau Fauk
- Research Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide 5000, Australia
- Institute of Resource Governance and Social Change, Kupang 85227, Indonesia
| | - Hailay Abrha Gesesew
- Research Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide 5000, Australia
- College of Health Sciences, Mekelle University, Mekelle 1871, Ethiopia
| | - Alfonsa Liquory Seran
- Atapupu Public Health Centre, Health Department of Belu District, Atambua 85752, Indonesia
| | - Christopher Raymond
- Research Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide 5000, Australia
| | - Roheena Tahir
- College of Medicine and Public Health, Flinders University, Adelaide 5042, Australia
| | - Paul Russell Ward
- Research Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide 5000, Australia
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Ramírez-Ortiz D, Seitchick J, Polpitiya M, Algarin AB, Sheehan DM, Fennie K, Cyrus E, Trepka MJ. Post-immigration factors affecting retention in HIV care and viral suppression in Latin American and Caribbean immigrant populations in the United States: a systematic review. ETHNICITY & HEALTH 2022; 27:1859-1899. [PMID: 34647837 PMCID: PMC9008069 DOI: 10.1080/13557858.2021.1990217] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 10/01/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To reduce disparities in HIV care outcomes among Latin American and Caribbean (LAC) immigrants living with HIV in the U.S., it is necessary to identify factors influencing HIV care in this population. A systematic review that provides a comprehensive understanding of factors influencing retention in HIV care and viral suppression among LAC immigrants living with HIV in the U.S. is lacking. This systematic review used the Immigrant Health Services Utilization theoretical framework to provide an understanding of these factors. DESIGN We searched for peer-reviewed publications in MEDLINE, EMBASE, CINAHL, PsycINFO, and ASSIA, from January 1996 to June 2020. RESULTS A total of 17 qualitative (n = 10) and quantitative (n = 7) studies were included in the review. The most commonly reported general and immigrant-specific factors appearing in studies were undocumented immigration status, HIV stigma, homophobia, cultural norms, values and beliefs, family and social support, language barriers, structure, complexity and quality of the U.S. healthcare delivery system, and patient-provider relationship. CONCLUSION These findings highlight the importance of considering immigrant-specific factors along with general factors to improve the provision of HIV care services and HIV care outcomes among LAC immigrant populations.
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Affiliation(s)
- Daisy Ramírez-Ortiz
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL
- Florida International University Research Center in Minority Institutions (FIU–RCMI), Miami, FL
| | - Jessica Seitchick
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL
| | - Medhani Polpitiya
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL
| | - Angel B. Algarin
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA
| | - Diana M. Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL
- Florida International University Research Center in Minority Institutions (FIU–RCMI), Miami, FL
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), Florida International University, Miami, FL
| | | | - Elena Cyrus
- Department of Population Health Sciences, College of Medicine, University of Central Florida, Orlando, FL
| | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL
- Florida International University Research Center in Minority Institutions (FIU–RCMI), Miami, FL
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12
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Ali S, Stanton M, Keo BS, Stanley M, McCormick K. HIV and Mental Health Services in the US South: A Meso Analysis. Community Ment Health J 2022; 58:1146-1156. [PMID: 35048220 DOI: 10.1007/s10597-021-00925-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 12/01/2021] [Indexed: 01/21/2023]
Abstract
The US South is disproportionately impacted by HIV. Social, cultural, economic, and political characteristics of the South shape access to mental health services leaving adverse impacts on health and wellness outcomes among People Living with HIV. The aim of this paper was to: (a) identify meso factors (at individual, organizational and community-level manifestations) which impact mental health services among People living with HIV in the South of those factors and (b) pose community-articulated recommendation and strategies. Through qualitative interviews with People Living with HIV and service providers, this study found that the meso factors of restricted funding and compounding stigma shaped mental health services in the South. Given the disproportionate rate of HIV, lack of mental health care, and landscape of socio-political factors unique to the region, attention to intervenable meso factors and community-based strategies are needed to enhance mental health services and respond to the HIV epidemic in the US South.
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Affiliation(s)
- Samira Ali
- University of Houston Graduate College of Social Work, 3511 Cullen Blvd., Room 402, Houston, TX, 77204-4013, USA.
| | - Megan Stanton
- Eastern Connecticut State University, Social Work, Willimantic, CT, USA
| | - Bec Sokha Keo
- University of Houston Graduate College of Social Work, Houston, TX, USA
| | - Marcus Stanley
- University of Houston Graduate College of Social Work, Houston, TX, USA
| | - Katie McCormick
- University of Houston Graduate College of Social Work, Houston, TX, USA
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13
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Felizzola J, Pinho V, Funk D, Del Río-González AM, Zea MC, Sol C, Barker S. Transforming Latinx HIV Care: Mixed-Methods Evaluation of a Patient-Centered HIV Practice Transformation. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2022; 34:131-141. [PMID: 35438539 DOI: 10.1521/aeap.2022.34.2.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
We conducted a mixed-method longitudinal evaluation of an HIV primary care practice transformation project in Washington, D.C. The project aimed to enhance organizational capacity to deliver culturally appropriate and patient-centered care for Latinxs living with HIV. Quantitative and qualitative data were simultaneously collected to capture the complex interactions among care providers, staff, and patients as well as to monitor practice changes that occurred as a result of the project implementation. The practice transformation intervention consisted of core competency workforce training, workflow redesign, and data-driven quality improvement strategies utilized to guide the intervention and to gather data from providers and patients. The mixed-methods approach facilitated meaningful change within the clinic that resulted in improved patient outcomes, patient experiences of care, and increases in staff's perceived level of knowledge of patient-centered care and improved efficiencies in HIV health care service delivery.
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Affiliation(s)
| | | | - Danielle Funk
- The Fenway Institute, Fenway Health, Boston, Massachusetts
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14
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Stigma, HIV Risk, and Access to HIV Prevention and Treatment Services Among Men Who have Sex with Men (MSM) in the United States: A Scoping Review. AIDS Behav 2021; 25:3574-3604. [PMID: 33866444 PMCID: PMC8053369 DOI: 10.1007/s10461-021-03262-4] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2021] [Indexed: 12/11/2022]
Abstract
In light of recent advances in HIV prevention and treatment, we reviewed the literature to understand how different types of stigma impact HIV risk; access to HIV prevention, care, and treatment services; and related health outcomes among men who have sex with men (MSM) in the US. We conducted a scoping literature review of observational and qualitative studies that examined stigma and HIV-related outcomes among MSM. Our search identified 5794 studies, of which 47 met the eligibility criteria and were included in the final analysis. The review suggests that stigma remains a formidable barrier to engaging in HIV prevention and treatment among both HIV-negative and HIV-positive MSM. Among the studies of HIV-positive MSM, internalized stigma was related to lower levels of treatment engagement. HIV-positive MSM in the Southern part of the US were also more likely to engage in risky sexual behavior. Perceived health care discrimination was negatively associated with PrEP awareness, particularly among HIV-negative Black MSM. Among young MSM of color, intersectional stigma compounded the social structural barriers to PrEP adherence. Findings indicate that stigma reduction interventions should be implemented in diverse MSM communities to address the disproportionate burden of HIV along with critical gap in the care continuum. Further research should examine how individual types of stigma, including intersectional stigma, affect viral suppression and PrEP uptake and adherence, especially among MSM of color.
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15
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Phillips G, McCuskey D, Ruprecht MM, Curry CW, Felt D. Structural Interventions for HIV Prevention and Care Among US Men Who Have Sex with Men: A Systematic Review of Evidence, Gaps, and Future Priorities. AIDS Behav 2021; 25:2907-2919. [PMID: 33534056 PMCID: PMC7856612 DOI: 10.1007/s10461-021-03167-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2021] [Indexed: 12/01/2022]
Abstract
The preponderance of HIV interventions have been behavioral, targeting individual, dyadic, or group dynamics. However, structural-level interventions are required to decrease HIV transmission and increase engagement in care, especially for men who have sex with men (MSM), particularly Black and Latinx MSM. A systematic literature review was conducted to assess the current state of structural interventions; only two studies detailing structural interventions related to HIV for Black and Latinx MSM in the US were identified. An additional 91 studies which discussed structural-level barriers to optimal HIV outcomes among MSM, yet which did not directly evaluate a structural intervention, were also identified. While this paucity of findings was discouraging, it was not unexpected. Results of the systematic review were used to inform guidelines for the implementation and evaluation of structural interventions to address HIV among MSM in the U.S. These include deploying specific interventions for multiply marginalized individuals, prioritizing the deconstruction of structural stigma, and expanding the capacity of researchers to evaluate “natural” policy-level structural interventions through a standardization of methods for rapid evaluative response, and through universal application of sex, sexual orientation, and gender identity demographic measures.
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Affiliation(s)
- Gregory Phillips
- Evaluation, Data Integration, and Technical Assistance (EDIT) Program, Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N Michigan Ave #14-043, Chicago, IL, 60611, USA.
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - David McCuskey
- Evaluation, Data Integration, and Technical Assistance (EDIT) Program, Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N Michigan Ave #14-043, Chicago, IL, 60611, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Megan M Ruprecht
- Evaluation, Data Integration, and Technical Assistance (EDIT) Program, Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N Michigan Ave #14-043, Chicago, IL, 60611, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Caleb W Curry
- Evaluation, Data Integration, and Technical Assistance (EDIT) Program, Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N Michigan Ave #14-043, Chicago, IL, 60611, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Case Western Reserve University Undergraduate Studies, Cleveland, OH, USA
| | - Dylan Felt
- Evaluation, Data Integration, and Technical Assistance (EDIT) Program, Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N Michigan Ave #14-043, Chicago, IL, 60611, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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16
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Arora AK, Ortiz-Paredes D, Engler K, Lessard D, Mate KK, Rodriguez-Cruz A, Kronfli N, Vedel I, Cox J, Quesnel-Vallée A, Lebouché B. Barriers and Facilitators Affecting the HIV Care Cascade for Migrant People Living with HIV in Organization for Economic Co-Operation and Development Countries: A Systematic Mixed Studies Review. AIDS Patient Care STDS 2021; 35:288-307. [PMID: 34375137 PMCID: PMC8380795 DOI: 10.1089/apc.2021.0079] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Migrants in countries affiliated with the Organization for Economic Co-operation and Development (OECD) have a higher risk of acquiring HIV, experience delayed HIV diagnosis, and have variable levels of engagement with HIV care and treatment when compared to native-born populations. A systematic mixed studies review was conducted to generate a multilevel understanding of the barriers and facilitators affecting HIV Care Cascade steps for migrant people living with HIV (MLWH) in OECD countries. Medline, Embase, Scopus, CINAHL, and the Cochrane Library were searched on March 25, 2020. Screening, critical appraisal, and analysis were conducted independently by two authors. We used qualitative content analysis and the five-level Socio-Ecological Model (i.e., individual, interpersonal, organizational, community, and policy) to categorize barriers and facilitators. Fifty-nine studies from 17 OECD countries were included. MLWH faced similar barriers and facilitators regardless of their host country, ethnic and geographic origins, or legal status. Most barriers and facilitators were associated with the individual and organizational levels and centered around retention in HIV care and treatment. Adapting clinical environments to better address MLWH's competing needs via multidisciplinary models would address retention issues across OECD countries.
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Affiliation(s)
- Anish K. Arora
- Department of Family Medicine, Faculty of Medicine & Health Sciences, McGill University, Montréal, Canada
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montréal, Canada
- Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV Care, Canadian Institutes of Health Research, Montréal, Canada
| | - David Ortiz-Paredes
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montréal, Canada
| | - Kim Engler
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montréal, Canada
- Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV Care, Canadian Institutes of Health Research, Montréal, Canada
| | - David Lessard
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montréal, Canada
- Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV Care, Canadian Institutes of Health Research, Montréal, Canada
| | - Kedar K.V. Mate
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montréal, Canada
- Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV Care, Canadian Institutes of Health Research, Montréal, Canada
| | - Adriana Rodriguez-Cruz
- Department of Family Medicine, Faculty of Medicine & Health Sciences, McGill University, Montréal, Canada
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montréal, Canada
- Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV Care, Canadian Institutes of Health Research, Montréal, Canada
| | - Nadine Kronfli
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Canada
- Chronic Viral Illness Service, Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montréal, Canada
| | - Isabelle Vedel
- Department of Family Medicine, Faculty of Medicine & Health Sciences, McGill University, Montréal, Canada
| | - Joseph Cox
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Canada
- Chronic Viral Illness Service, Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montréal, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine & Health Sciences, McGill University, Montréal, Canada
| | - Amélie Quesnel-Vallée
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine & Health Sciences, McGill University, Montréal, Canada
- Department of Sociology, Faculty of Arts, McGill University, Montréal, Canada
| | - Bertrand Lebouché
- Department of Family Medicine, Faculty of Medicine & Health Sciences, McGill University, Montréal, Canada
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montréal, Canada
- Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV Care, Canadian Institutes of Health Research, Montréal, Canada
- Chronic Viral Illness Service, Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montréal, Canada
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17
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Pierce LJ, Rebeiro P, Brantley M, Fields EL, Jenkins CA, Griffith DM, Conserve D, Shepherd B, Wester C, Ahonkhai AA. Who Is Not Linking to HIV Care in Tennessee - the Benefits of an Intersectional Approach. J Racial Ethn Health Disparities 2021; 9:849-855. [PMID: 33876409 PMCID: PMC8523577 DOI: 10.1007/s40615-021-01023-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 02/17/2021] [Accepted: 03/14/2021] [Indexed: 11/21/2022]
Abstract
Introduction Guided by an intersectional approach, we assessed the association between social categories (individual and combined) on time to linkage to HIV care in Tennessee. Methods Tennessee residents diagnosed with HIV from 2012-2016 were included in the analysis (n=3750). Linkage was defined by the first CD4 or HIV RNA test date after HIV diagnosis. We used Cox proportional hazards models to assess the association of time to linkage with individual-level variables. We modeled interactions between race, age, gender, and HIV acquisition risk factor (RF), to understand how these variables jointly influence linkage to care. Results Age, race, and gender/RF weAima A. Ahonkhaire strong individual (p < 0.001 for each) and joint predictors of time to linkage to HIV care (p < 0.001 for interaction). Older individuals were more likely to link to care (aHR comparing 40 vs. 30 years, 1.20, 95%CI 1.11-1.29). Blacks were less likely to link to care than Whites (aHR= 0.73, 95% CI: 0.67-0.79). Men who have sex with men (MSM) (aHR = 1.18, 95%CI: 1.03-1.34) and heterosexually active females (females) (aHR = 1.32, 95%CI: 1.14-1.53) were more likely to link to care than heterosexually active males. The three-way interaction between age, race, and gender/RF showed that Black males overall and young, heterosexually active Black males in particular were least likely to establish care. Conclusions Racial disparities persist in establishing HIV care in Tennessee, but data highlighting the combined influence of age, race, gender, and sexual orientation suggest that heterosexually active Black males should be an important focus of targeted interventions for linkage to HIV care. Supplementary Information The online version contains supplementary material available at 10.1007/s40615-021-01023-6.
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Affiliation(s)
- Leslie J Pierce
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, 2525 West End Ave, Suite 750, Nashville, TN, 37203, USA
| | - Peter Rebeiro
- Department of Medicine, Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA.,Department of Medicine, Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | | | - Errol L Fields
- Division of Adolescent/Young Adult Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Cathy A Jenkins
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Derek M Griffith
- Center for Research on Men's Health, Vanderbilt University, Nashville, TN, USA
| | - Donaldson Conserve
- Department of Health Promotion, Education and Behavior, University of South Carolina, Columbia, SC, USA
| | - Bryan Shepherd
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | | | - Aima A Ahonkhai
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, 2525 West End Ave, Suite 750, Nashville, TN, 37203, USA. .,Department of Medicine, Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA.
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18
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Hightow-Weidman L, Carcano J, Choi SK, Sampson L, Barrington C. Enlaces Por La Salud: A Personal Health Navigator Intervention Grounded in the Transnational Framework. J Immigr Minor Health 2021:10.1007/s10903-021-01192-w. [PMID: 33835380 PMCID: PMC8033285 DOI: 10.1007/s10903-021-01192-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2021] [Indexed: 10/31/2022]
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.
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Affiliation(s)
- Lisa Hightow-Weidman
- Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, USA.
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA.
| | | | - Seul Ki Choi
- School of Nursing, University of Pennsylvania, Philadelphia, USA
| | - Lynne Sampson
- Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, USA
| | - Clare Barrington
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA
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19
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Syndemic statuses: Intersectionality and mobilizing for LGBTQ+ Latinx health equity after the Pulse shooting. Soc Sci Med 2020; 295:113260. [DOI: 10.1016/j.socscimed.2020.113260] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 06/08/2020] [Accepted: 07/25/2020] [Indexed: 11/21/2022]
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