Gwadz Marya, Wilton Leo, Cleland Charles M, Serrano Samantha, Sherpa Dawa, Zaldivar Maria Fernanda, Freeman Robin, Campos Stephanie, Beharie Nisha, Rosmarin-DeStefano Corey, Filippone Prema, Munson Michelle R
Silver School of Social Work, New York University, 1 Washington Square North, New York, NY, 10003, USA.
Department of Human Development, State University of New York at Binghamton, 4400 Vestal Parkway East, Binghamton, NY, 13902, USA.
BMC Public Health. 2025 Feb 14;25(1):620. doi: 10.1186/s12889-025-21869-3.
American/Black and Latine (AABL) young/emerging adults living with HIV in the United States (US) have consistently failed to meet targets for HIV care/medication engagement. Among this population, those with non-suppressed HIV viral load are understudied, along with immigrants and those with serious socioeconomic deprivation. Guided by social action theory, we took a mixed methods approach (sequential explanatory design) to describe sociodemographic, background, and contextual factors, and their relationships to HIV management, among a diverse cohort.
Participants (N = 271) received structured baseline assessments and HIV viral load testing. Primary outcomes were being well-engaged in HIV care and HIV viral suppression. A subset (N = 41) was purposively sampled for maximum variability for in-depth interviews. Quantitative data were analyzed with descriptive statistics and logistic regression, and used to develop a research question about life contexts. Qualitative data were analyzed with directed content analysis, and the joint display method was used to integrate results.
Participants were 25 years old, on average (SD = 2). The majority (59%) were Latine/Hispanic and the reminder African American/Black. Almost all were assigned male sex at birth (96%) and sexual minorities (93%). Half (49%) were born outside the US and 33% spoke primarily Spanish. They were diagnosed with HIV four years prior on average (SD = 3). Most were well-engaged in HIV care (72%) and evidenced viral suppression (81%). Speaking Spanish was associated with a higher odds of care engagement, and adverse childhood experiences and income from federal benefits were associated with a lower odds. None of the factors predicted viral suppression. Qualitative results highlighted both developmentally typical (insufficient financial resources, unstable housing) and atypical challenges (struggles with large bureaucracies, HIV disclosure, daily medication use). Federal benefits and the local HIV social services administration were critical to survival. Immigrant participants came to the US to escape persecution and receive HIV care, but HIV management was often disrupted. Overall qualitative results highlighted both risk and protective factors, and resilience. Qualitative results added detail, nuance, and richness to the quantitative findings.
The present study advances what is known about the backgrounds and contexts of diverse and understudied AABL young/emerging adults living with HIV.
在美国，感染艾滋病毒的美国黑人/拉丁裔青年/新兴成年人一直未能达到艾滋病毒护理/药物治疗参与率目标。在这一人群中，艾滋病毒病毒载量未得到抑制的人群、移民以及社会经济严重贫困的人群研究较少。在社会行动理论的指导下，我们采用了混合方法（序列解释性设计）来描述一个多样化队列中的社会人口学、背景和环境因素，以及它们与艾滋病毒管理的关系。
参与者（N = 271）接受了结构化的基线评估和艾滋病毒病毒载量检测。主要结果是积极参与艾滋病毒护理和艾滋病毒病毒抑制。有目的地抽取了一个子集（N = 41）以实现最大程度的变异性，用于深入访谈。定量数据采用描述性统计和逻辑回归进行分析，并用于提出一个关于生活环境的研究问题。定性数据采用定向内容分析法进行分析，并使用联合展示法整合结果。
参与者平均年龄为25岁（标准差 = 2）。大多数（59%）是拉丁裔/西班牙裔，其余为非裔美国人/黑人。几乎所有人出生时被指定为男性（96%）且为性少数群体（93%）。一半（49%）在美国境外出生，33%主要讲西班牙语。他们平均在四年前被诊断出感染艾滋病毒（标准差 = 3）。大多数人积极参与艾滋病毒护理（72%）且实现了病毒抑制（81%）。讲西班牙语与更高的护理参与几率相关，童年不良经历和联邦福利收入与更低的几率相关。这些因素均未预测到病毒抑制情况。定性结果突出了典型的发展性挑战（财政资源不足、住房不稳定）和非典型挑战（与大型官僚机构的斗争、艾滋病毒披露、每日用药）。联邦福利和当地艾滋病毒社会服务管理对生存至关重要。移民参与者来到美国是为了逃避迫害并接受艾滋病毒护理，但艾滋病毒管理常常受到干扰。总体定性结果突出了风险和保护因素以及复原力。定性结果为定量研究结果增添了细节、细微差别和丰富性。
本研究推进了对感染艾滋病毒的多样化且研究较少的美国黑人/拉丁裔青年/新兴成年人的背景和环境的认识。
