College of Science and Health Theses and Dissertations

Date of Award

Spring 6-12-2015

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Psychology

First Advisor

Gary W. Harpher, PhD, MPH

Second Advisor

Bernadette Sanchez, PhD

Third Advisor

Leonard A. Jason, PhD

Abstract

INTRODUCTION: Among youth, marginalized groups, such as Latino YLWH (LYLWH), may face multiple social stigmas, including such concerns as limited English-language proficiency, sexual-minority status, and immigration status that impact engagement across the continuum of HIV care (van Servellen, Chang, & Lombardi, 2002). One necessary step toward increasing understanding of the facilitators and barriers to this group’s engagement in HIV care is to examine engagement in care through a socioecological framework to better understand each of the multiple factors impacting Latino youth’s engagement in HIV care (Bronfenbrenner, 1986; Hosek, Harper, Lemos et al., 2005; Mugavero, Norton & Saag, 2011). Through the use of key informants such as such as healthcare providers’ experiences and perceptions of barriers and facilitators we can yield important and insightful information on how to better address the needs of these youth.

APPROACH: This study used a psychological phenomenological approach, through inductive and deductive analysis, to explore the socioecological factors that specifically affect engagement in care for LYLWH from providers’ perspective. I conducted qualitative interviews with 26 healthcare providers who provide services to LYLWH.

RESULTS: The following themes emerged as important factors impacting engagement in care for LYLWH. Individual-level themes specific to LYLWH included mental health issues, substance use, adjustment to HIV diagnosis, and HIV education. Intrapersonal-level themes specific to LYLWH included the systematic impacts of family, providers, and one-on-one relationships with peers and romantic or sexual partners. Pertaining to community-level factors impacting engagement in care for LYLWH, providers discussed the role of compounded stigma surrounding HIV and LGBT issues, along with HIV-related stigma, poverty/unstable housing, and social-community norms. Sociocultural and policy-level factors include traditional Latino cultural beliefs, religious beliefs, acculturation, U.S. immigration policy, U.S. healthcare access and the healthcare system. In sum, study results reveal that individual (intrapersonal), interpersonal (microsystem), community (exosystem), and sociocultural/policy-level (macrosystem) factors are critical considerations for engagement in HIV care.

IMPLICATIONS: It is clear from the current study that LYLWH engage across the continuum of care in distinctive ways, resulting from community-level factors and the sociocultural and policy-level factors that directly and indirectly affect their ability to maintain optimal engagement in their HIV care. Additionally, these macrosystemic factors relate to other syndemic experiences such as mental health disorders and substance abuse, poverty, and HIV and LGBT stigma affecting Latino youth in general in our current society. By addressing these factors, society can positively affect the health of youth, inclusive of LYLWH.

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