Intersectionalities and the HIV continuum of care among gay Latino men living with HIV in North Carolina

ABSTRACT

Objective

Latino men who have sex with men (MSM) are disproportionately affected by HIV in the US and only half of Latinos diagnosed with HIV are virally suppressed. Little is known about the determinants of HIV care and treatment outcomes among Latinos. We used theories of intersectionality to assess the HIV testing, care and treatment experiences of gay Latino men living with HIV in a new immigrant destination.

Design

We conducted qualitative in-depth interviews with US and foreign-born gay Latino men living with HIV (n = 14) recruited through referrals from HIV care providers and case managers. We used Maxwell and Miller’s theory of qualitative analysis to guide our approach to data analysis, integrating narrative techniques and thematic coding. We used theories of intersectionality – including both intersecting identities and structures – as an interpretive framework to understand participants’ outcomes and experiences.

Results

All participants were engaged in HIV care at the time of the interviews. The mental health burden of diagnosis and managing life with HIV was a salient theme across all interviews. Most participants had experienced interruptions in their care due to both intersecting stigmatized identities (e.g. being gay, Latino, undocumented) and intersecting structures (healthcare, immigration policy, institutionalized homophobia). Undocumented participants directly connected their immigration status to their ability to get work, which then affected their retention in HIV care and treatment adherence.

Conclusions

Examining the interplay between identities and structures provides a contextualized understanding of outcomes along the HIV care continuum among gay Latino men that goes beyond behavioral and cultural explanations. There is a need to assess long-term experiences of navigating HIV care and treatment given the intersecting structures of mobility, housing instability, and immigration policy.

KEYWORDS:

• HIV
• intersectionality
• Latino
• men who have sex with men

Acknowledgement

We are grateful to the participants for sharing their stories and experiences. We are also grateful to Jennifer Ailshire and faculty at the Center for Health, Risk and Society at the American University for providing feedback on an earlier draft of this paper.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by Health Resources and Services Administration [grant number 5H97-HA26505-04].