Enhancing HIV testing among Disengaged Immigrants: Contextual and Opportunity Structures

New York University, New York NY

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Linked publications & trials

Abstract

? DESCRIPTION (provided by applicant): Immigrants comprise a growing population in the United States that is disproportionately impacted by HIV but has been historically disengaged from the HIV care continuum. Latinos constitute the largest foreign born population in the country with significant numbers residing in major metropolitan areas like New York City, which comprise HIV hotspots where HIV prevalence is high. Latinos are disproportionately impacted by HIV with infection rates more than three times that of Whites. Additionally, Latinos are more likely to get tested later in their disease. Curbing HIV among Latino immigrants is critical to reaching the goals of the National HIV/AIDS Strategy (NHAS), and a better understanding of factors that can influence HIV testing behaviors among this group and increase engagement in care is sorely needed. Recent contextual (social, political, and economic) shifts in the United States represent potentially impactful transitions in the broader healthcare context for immigrants. Specifically, shifts in access to social welfare and health care services may mark an unprecedented occasion where testing and linkage to care have never been more attainable for immigrants in the U.S. The proposed study seeks to understand Latino immigrants' contexts in relation to HIV testing and how they intersect with perceptions of recent macro contextual changes, synergistically expanding HIV testing opportunities and facilitating or preventing HIV testing behaviors. Phase 1 of this R36 involves in-depth interviews with Latino immigrants to obtain perspectives regarding HIV testing, perceptions of the healthcare environment and motivations for immigrants to get tested for HIV. The interviews seek to elicit perspectives on the feasibility and acceptability of targeted HIV prevention strategies for Latino immigrants to become engaged in HIV care. In Phase 2, a cross-sectional survey will be conducted with 300 Latino immigrants to examine associations between the social and resource contexts of Latino immigrants and engagement in HIV testing. Participants' receptivity to obtaining a rapid HIV test will also be assessed. The overall program of research addresses the National Institute of Health's AIDS research priorities to address the HIV pandemic through new strategies for disease prevention and improvement of disease outcomes by studying the continued disparities in HIV infection rates, access to testing and care, and treatment adherence to identify geographical, psychosocial and structural factors that could explain the disparities and suggest opportunities for novel and targeted interventions to reduce them. The primary goal of the study is to inform the future design of targeted interventions for Latino immigrants who reside in U.S. HIV hotspots across the country, by explicitly describing the role of broader contextual changes and specific HIV testing opportunities in engagement in the HIV care continuum.