title: Barriers to HIV care for women of color living in the Southeastern US are associated with physical symptoms, social environment, and self-determination.
abstract: HIV-infected women of color (WOC) face particular barriers to accessing HIV medical care. To understand the impact of physical symptoms, social support, and self-determination on barriers to care, we interviewed HIV-infected women of color. HIV-infected WOC (N=141), attending an academic infectious disease clinic for HIV care in North Carolina, completed the Barriers to Care scale and were categorized as reporting a history of low (less than four of eleven barriers) or high (five or more) barriers to care. Binomial regression was used to estimate prevalence ratios and risk differences of reported barriers to care and its correlates such as depression, anxiety, illness-severity, psychological abuse, social support, treatment-specific social support, and self-determination (autonomy, relatedness, competency). A lower risk of reporting five or more barriers to care was associated with higher levels of autonomy (PR=0.93, 95% CI: 0.89, 0.96), relatedness (PR=0.92, 95% CI: 0.89, 0.94), competency (PR=0.93, 95% CI: 0.87, 0.98), and social support (PR=0.24, 95% CI: 0.81, 0.81). Depression, illness severity, and psychological abuse were associated with a greater risk of having five or more barriers to care. There are multiple social and psychological factors that contribute to perceived barriers to HIV care among WOC in the southeastern USA. Interventions that promote social support and increase individual self-determination have the potential to improve access to HIV care for WOC.
authors.affiliation: 1 Gillings School of Global Public Health, University of North Carolina-Chapel Hill , North Carolina.
authors.forename: Matthew
authors.initials: M
authors.lastname: Toth
authors.forename: Lynne C
authors.initials: LC
authors.lastname: Messer
authors.forename: E Byrd
authors.initials: EB
authors.lastname: Quinlivan
mesh_terms: D000328:Adult; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; 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; D001523:Mental Disorders / Q000453:epidemiology; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D010342:Patient Acceptance of Health Care / Q000208:ethnology* / Q000706:statistics & numerical data; D010465:Perception; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D012044:Regression Analysis; D012720:Severity of Illness Index; D012931:Social Environment; D012944:Social Support; D012959:Socioeconomic Factors; D055815:Young Adult