title: Barriers and facilitators to testing, treatment entry, and engagement in care by HIV-positive women of color.
abstract: Women of color (WOC) are at increased risk of dying from HIV/AIDS, a disparity that may be partially explained by the care barriers they face. Based in a health care disparity model and the socio-ecological framework, the objective of this study was to identify the barriers and facilitators to HIV care at three points along the HIV continuum: HIV testing, entry/early care, and engagement. Two focus groups (n=11 women) and 19 semi-structured interviews were conducted with HIV-positive WOC in an academic medical setting in North Carolina. Content was analyzed and interpreted. We found barriers and facilitators to be present at multiple levels of the ecological framework, including personal-, provider-, clinic-, and community-levels. The barriers reported by women were aligned with the racial health care disparity model constructs and varied by stage of HIV. Identifying the salient barriers and facilitators at multiple ecological levels along the HIV care continuum may inform intervention development.
authors.affiliation: School of Community Health, Portland State University, Portland, OR 97207, USA. lynne.messer@pdx.edu
authors.forename: Lynne C
authors.initials: LC
authors.lastname: Messer
authors.forename: E Byrd
authors.initials: EB
authors.lastname: Quinlivan
authors.forename: Heather
authors.initials: H
authors.lastname: Parnell
authors.forename: Katya
authors.initials: K
authors.lastname: Roytburd
authors.forename: Adaora A
authors.initials: AA
authors.lastname: Adimora
authors.forename: Natasha
authors.initials: N
authors.lastname: Bowditch
authors.forename: Nancy
authors.initials: N
authors.lastname: DeSousa
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data; D001291:Attitude of Health Personnel; D003266:Continuity of Patient Care; D005006:Ethnicity / Q000523:psychology / Q000706:statistics & numerical data; D005260:Female; D017144:Focus Groups; D015658:HIV Infections / Q000175:diagnosis / Q000208:ethnology* / Q000523:psychology / Q000628:therapy; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000208:ethnology; D006801:Humans; D007407:Interviews as Topic; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D010342:Patient Acceptance of Health Care / Q000208:ethnology* / Q000706:statistics & numerical data; D011369:Professional-Patient Relations; D036301:Qualitative Research; D012944:Social Support; D012959:Socioeconomic Factors