David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.
Research Volunteer, University of California, Los Angeles, Los Angeles, CA, United States.
Front Public Health. 2024 May 30;12:1336184. doi: 10.3389/fpubh.2024.1336184. eCollection 2024.
Black and Latinx communities experience inequities in the social determinants of health (SDOH) and high rates of chronic illnesses [e.g., cardiovascular disease (CVD), HIV]. The COVID-19 pandemic amplified these long-standing SDOH disparities. However, scant attention has been paid to the pandemic-related experiences of populations exposed to structural inequities.
Using a semi-structured interview guide, 60 in-depth telephone interviews were conducted with Black and Latinx people living with HIV (PLWH) and CVD risks to assess: (1) perceived personal and community risk for COVID-19; (2) knowledge of and access to COVID-19 public health information; (3) barriers to COVID-19 public health recommendations and vaccine uptake; and (4) perceptions of HIV, CVD, and COVID-19. Interviews were professionally transcribed into either English or Spanish. Spanish transcripts were translated into English. Rapid qualitative analysis was used to summarize each transcript into a structured templaicte corresponding to interview guide domains. Summaries were combined into matrices for identification and comparison of themes across domains.
Participants reported risks for COVID-19 due to being immunocompromised and SDOH, including transportation, exposure to risks conferred by others, living in under-resourced neighborhoods, and housing insecurity. Participants engaged in protective countermeasures by adhering to public health mandates. Relationships with providers, participating in community support groups, and digital inclusion and literacy were salient with respect to dissemination of COVID-19 information and vaccine uptake. Experiences with managing a chronic illness facilitated vaccine acceptance. Participants described language barriers, experiences of discrimination, and a historical lack of trust in medical systems and vaccines.
This study provides a real-time narrative from PLWH and CVD risks who were vulnerable during the height of the COVID-19 pandemic. Implications include the need for continuity with providers and established community networks, increasing internet access and digital health literacy, and addressing historical trauma incurred in medical settings. It is critical to understand the impact of traditional SDOH on those living with chronic illness as well as other social determinants that shed light on access to public health information, adherence to public health recommendations, and vaccine uptake among populations exposed to structural inequities.
黑人和拉丁裔群体在健康的社会决定因素（SDOH）方面存在不平等现象，并且患有多种慢性疾病[例如，心血管疾病（CVD），HIV]。COVID-19 大流行放大了这些长期存在的 SDOH 差距。然而，人们很少关注暴露于结构性不平等人群的大流行相关经历。
使用半结构化访谈指南，对 60 名患有 HIV（PLWH）和 CVD 风险的黑人和拉丁裔人进行了深入的电话访谈，以评估：（1）个人和社区对 COVID-19 的感知风险；（2）对 COVID-19 公共卫生信息的了解和获取；（3）对 COVID-19 公共卫生建议和疫苗接种的障碍；（4）对 HIV，CVD 和 COVID-19 的看法。访谈由专业人员转录为英语或西班牙语。西班牙语抄本被翻译成英语。快速定性分析用于将每个抄本总结为与访谈指南领域相对应的结构化模板。总结被组合到矩阵中，以识别和比较主题领域。
参与者报告说，由于免疫功能低下和 SDOH（包括交通，暴露于他人带来的风险，居住在资源不足的社区以及住房不安全）而面临 COVID-19 的风险。参与者通过遵守公共卫生命令采取了保护措施。与提供者的关系，参与社区支持小组以及数字包容性和文化素养对于传播 COVID-19 信息和疫苗接种都很重要。管理慢性疾病的经验促进了疫苗的接受。参与者描述了语言障碍，歧视经历以及对医疗系统和疫苗的历史缺乏信任。
这项研究从易受 COVID-19 大流行影响的 HIV 和 CVD 高危人群中提供了实时叙述。其意义包括与提供者和既定社区网络保持联系的必要性，增加互联网访问和数字健康素养的必要性，以及解决在医疗环境中产生的历史创伤。了解生活在慢性疾病中的人群以及其他社会决定因素对公共卫生信息的获取，对公共卫生建议的遵守以及结构性不平等人群的疫苗接种的影响至关重要。
