From the Department of Psychology, University of South Carolina, Columbia.
ViiV Healthcare, Durham, North Carolina.
South Med J. 2024 Oct;117(10):617-622. doi: 10.14423/SMJ.0000000000001742.
Addressing structural barriers to care for people living with human immunodeficiency virus (HIV) in the southern United States is critical to increase rates of viral suppression and to reduce existing HIV disparities. This qualitative study aimed to describe transportation-related barriers experienced by people living with HIV in South Carolina, understand perceived effects of transportation vulnerability on HIV care, and explore strategies used by individuals to overcome transportation-related challenges.
We conducted semistructured interviews with 20 people living with HIV from South Carolina who were either reengaging in HIV care after a prolonged absence (>9 months) or in care but with a detectable viral load (ie, >200 copies/mL). All people living with HIV reported transportation vulnerability. A deductive/inductive approach was used to identify transportation-related barriers perceived to negatively affect HIV care. We also identified strategies and resources described by people living with HIV as helpful in addressing transportation challenges.
Participants described a range of transportation-related barriers to HIV care, including lack of access to reliable, safe, and affordable transportation, as well as stigma due to HIV and socioeconomic statuses. These barriers were reported to negatively affect engagement in care and worsen both physical and mental health. Participants indicated flexible clinic policies and instrumental support from family and friends were useful in overcoming barriers.
This study offers insight for the development of transportation interventions to improve equitable access to HIV care for people living with HIV in South Carolina. It also calls attention to the ways in which transportation vulnerability, HIV-related stigma, and disability status intersect to create unique challenges for some people living with HIV.
解决美国南部艾滋病毒（HIV）感染者护理方面的结构性障碍，对于提高病毒抑制率和减少现有 HIV 差距至关重要。这项定性研究旨在描述南卡罗来纳州 HIV 感染者在交通方面遇到的障碍，了解交通脆弱性对 HIV 护理的影响，并探讨个人克服与交通相关挑战所采用的策略。
我们对南卡罗来纳州的 20 名 HIV 感染者进行了半结构化访谈，这些人要么是在长期（>9 个月）未接受 HIV 护理后重新开始护理，要么是在接受护理但病毒载量可检测（即>200 拷贝/ml）。所有 HIV 感染者都报告了交通脆弱性。我们采用了演绎/归纳方法，确定了被认为对 HIV 护理产生负面影响的交通相关障碍。我们还确定了 HIV 感染者描述的有助于解决交通挑战的策略和资源。
参与者描述了一系列与 HIV 护理相关的交通障碍，包括缺乏可靠、安全和负担得起的交通方式，以及由于 HIV 和社会经济地位而产生的耻辱感。这些障碍被报告对参与护理产生负面影响，并恶化身体和心理健康。参与者表示，灵活的诊所政策和家人及朋友的实际支持有助于克服障碍。
这项研究为改善南卡罗来纳州 HIV 感染者获得公平的 HIV 护理机会的交通干预措施的制定提供了深入了解。它还提请注意交通脆弱性、与 HIV 相关的耻辱感和残疾状况相互交织，给一些 HIV 感染者带来独特挑战的方式。
