Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA.
Institute of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, USA.
Ethn Health. 2021 Oct;26(7):1098-1113. doi: 10.1080/13557858.2019.1620177. Epub 2019 May 20.
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.
目的:在美国,与男性发生性关系的拉丁裔男性(MSM)受到艾滋病毒的不成比例影响,而被诊断出感染艾滋病毒的拉丁裔人中只有一半人的病毒得到了抑制。关于拉丁裔人获得艾滋病毒护理和治疗结果的决定因素知之甚少。我们使用交叉性理论来评估在新移民目的地生活的感染艾滋病毒的同性恋拉丁裔男性的艾滋病毒检测、护理和治疗经历。
设计:我们对 14 名通过艾滋病毒护理提供者和案例管理人员的转介招募的、感染艾滋病毒的美国出生和外国出生的同性恋拉丁裔男性进行了定性深入访谈。我们使用 Maxwell 和 Miller 的定性分析理论来指导我们对数据的分析方法,整合叙述技术和主题编码。我们使用交叉性理论——包括交叉身份和结构——作为解释框架来理解参与者的结果和经验。
结果:所有参与者在接受采访时都在接受艾滋病毒护理。诊断和管理艾滋病毒生活的心理健康负担是所有访谈的一个突出主题。大多数参与者由于交叉的污名化身份(如同性恋、拉丁裔、无证)和交叉的结构(医疗保健、移民政策、制度化的恐同症)而中断了护理。无证参与者将自己的移民身份直接与获得工作的能力联系起来,这进而影响了他们在艾滋病毒护理和治疗依从性方面的保留率。
结论:检查身份和结构之间的相互作用提供了一个同性恋拉丁裔男性在艾滋病毒护理连续体中结果的背景化理解,超越了行为和文化解释。需要评估在流动、住房不稳定和移民政策等交叉结构下,长期管理艾滋病毒护理和治疗的经验。
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