Health outcomes and healthcare utilization of Native Hawaiians and other Pacific Islanders living with HIV in Hawai‘i: A mixed-methods study

ABSTRACT

Objectives:

Past research shows mixed outcomes in terms of HIV-related disparities among Native Hawaiians and Pacific Islanders (NHOPI). This study investigates HIV-related disparities among NHOPI living with HIV in Hawai‘i.

Design:

An explanatory sequential design was utilized. The quantitative portion analyzed survey data from a statewide Ryan White Needs Assessment (N = 398) to examine the differences in viral suppression and satisfaction with care between NHOPI and other ethnic groups. Utilizing the behavioral model for vulnerable populations (BMVP), semi-structured interviews (N = 16) were conducted next to explain what factors play a role in satisfaction with care and viral suppression when it comes to NHOPI living with HIV in Hawai‘i.

Results:

Among the 398 participants 13% were NHOPI. NHOPI were more likely to have a viral load of ≥10,000 copies/mL compared to those who didn’t identify as NHOPI. However, there were no significant differences for other viral load levels (20–199 or 200–9999), and only 20 participants (5.2%) had a viral load of 10,000 copies/mL or more. No significant ethnic differences were found in satisfaction with medical care. In the qualitative phase, factors from all domains of the BMVP were represented within the four themes identified: (1) Care coordination is essential- with AIDs service organizations taking the lead; (2) HIV care, as well as overall health, is defined by the effectiveness of medication; (3) Initial diagnosis is a critical moment for intervention; and (4) Aspects of culture are intangible.

Conclusion:

Among NHOPI in Hawai‘i who are engaged in case management, there appears to be no substantial disparities in either viral load or satisfaction with care compared to other ethnic groups. Despite this, qualitative findings provide insights on how ethnicity and culture may still be playing a role. Addressing all domains of the BMVP is crucial to addressing this.

KEYWORDS:

• Native Hawaiian
• Pacific Islander
• HIV
• AIDS
• healthcare utilization
• HIV care continuum
• viral suppression
• culturally-relevant care
• culture and healthcare

Acknowledgements

The authors would like to acknowledge the time, effort, and openness of all of the participants involved in both the quantitative and qualitative portions of this study, and the ASOs that were essential in recruiting participants, and administering the survey portion. We would also like to extend our sincere appreciation to all ASOs throughout Hawaii for providing essential services to PLWH in Hawai‘i.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The qualitative data in this study are not available due to their personally identifying nature. Quantitative data may be available with permission from the Hawai‘i Department of Health. To seek permission for use, please contact Dr. Barile at barilehawaii.edu.

Additional information

Funding

Research reported in this publication was supported by the National Institute Of Mental Health of the National Institutes of Health under Award Number R25MH084565. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.