New York University Silver School of Social Work, 1 Washington Place North, New York, NY, 10003, USA.
Division of Biostatistics, Department of Population Health, New York University School of Medicine, New York, NY, 10016, USA.
Int J Equity Health. 2023 Aug 30;22(1):168. doi: 10.1186/s12939-023-01992-6.
Racial/ethnic inequities along the HIV care continuum persist in the United States despite substantial federal investment. Numerous studies highlight individual and social-level impediments in HIV, but fewer foreground systemic barriers. The present qualitative study sought to uncover and describe systemic barriers to the HIV care continuum from the perspectives of African American/Black and Latino persons living with HIV (PLWH) with unsuppressed HIV viral load, including how barriers operated and their effects.
Participants were African American/Black and Latino PLWH with unsuppressed HIV viral load (N = 41). They were purposively sampled for maximum variability on key indices from a larger study. They engaged in semi-structured in-depth interviews that were audio-recorded and professionally transcribed. Data were analyzed using directed content analysis.
Participants were 49 years old, on average (SD = 9), 76% were assigned male sex at birth, 83% were African American/Black and 17% Latino, 34% were sexual minorities (i.e., non-heterosexual), and 22% were transgender/gender-nonbinary. All had indications of chronic poverty. Participants had been diagnosed with HIV 19 years prior to the study, on average (SD = 9). The majority (76%) had taken HIV medication in the six weeks before enrollment, but at levels insufficient to reach HIV viral suppression. Findings underscored a primary theme describing chronic poverty as a fundamental cause of poor engagement. Related subthemes were: negative aspects of congregate versus private housing settings (e.g., triggering substance use and social isolation); generally positive experiences with health care providers, although structural and cultural competency appeared insufficient and managing health care systems was difficult; pharmacies illegally purchased HIV medication from PLWH; and COVID-19 exacerbated barriers. Participants described mitigation strategies and evidenced resilience.
To reduce racial/ethnic inequities and end the HIV epidemic, it is necessary to understand African American/Black and Latino PLWH's perspectives on the systemic impediments they experience throughout the HIV care continuum. This study uncovers and describes a number of salient barriers and how they operate, including unexpected findings regarding drug diversion and negative aspects of congregate housing. There is growing awareness that systemic racism is a core determinant of systemic barriers to HIV care continuum engagement. Findings are interpreted in this context.
尽管美国联邦政府投入了大量资金，但在艾滋病毒护理连续体方面仍存在着种族/民族不平等现象。许多研究强调了艾滋病毒方面的个人和社会障碍，但很少有研究突出系统障碍。本定性研究旨在从感染艾滋病毒的非裔美国/黑人和拉丁裔人（PLWH）的角度揭示和描述艾滋病毒护理连续体的系统性障碍，包括障碍的运作方式及其影响。
参与者是非裔美国/黑人和感染艾滋病毒的拉丁裔人（PLWH），他们的 HIV 病毒载量未得到抑制（N=41）。他们是从一项更大的研究中对关键指标进行最大变异性的目的抽样。他们参与了半结构化的深入访谈，访谈内容被录制下来并进行了专业转录。使用定向内容分析对数据进行分析。
参与者的平均年龄为 49 岁（标准差=9），76%的人出生时被指定为男性，83%是非裔美国/黑人，17%是拉丁裔，34%是性少数群体（即非异性恋者），22%是跨性别/非二元性别者。所有人都有长期贫困的迹象。参与者在研究前平均（标准差=9）19 年前被诊断出患有 HIV。大多数（76%）在入组前六周内服用了 HIV 药物，但水平不足以达到 HIV 病毒抑制。研究结果强调了一个主要主题，即慢性贫困是贫困参与的根本原因。相关的子主题包括：集中式与私人住房环境的负面方面（例如，引发药物使用和社会孤立）；与医疗保健提供者的一般积极体验，尽管结构和文化能力似乎不足，管理医疗保健系统也很困难；药店非法从 PLWH 购买 HIV 药物；以及 COVID-19 加剧了障碍。参与者描述了缓解策略，并表现出了韧性。
为了减少种族/民族不平等，结束艾滋病毒流行，有必要了解感染艾滋病毒的非裔美国/黑人及拉丁裔人的观点，了解他们在艾滋病毒护理连续体中所经历的系统性障碍。这项研究揭示并描述了一些明显的障碍及其运作方式，包括关于药物转移和集中式住房负面方面的意外发现。人们越来越认识到，系统性种族主义是艾滋病毒护理连续体参与的系统性障碍的核心决定因素。研究结果是在这一背景下解释的。
