title: Barriers and facilitators to engagement of vulnerable populations in HIV primary care in New York City.
abstract: BACKGROUND
  Engagement in HIV care helps to maximize viral suppression, which in turn, reduces morbidity and mortality and prevents further HIV transmission. With more HIV cases than any other US city, New York City reported in 2012 that only 41% of all persons estimated to be living with HIV (PLWH) had a suppressed viral load, whereas nearly three-quarters of those in clinical care achieved viral suppression. Thus, retaining PLWH in HIV care addresses this central goal of both the US National HIV/AIDS Strategy and Governor Cuomo's plan to end the AIDS epidemic in New York State.
  
  
  METHODS
  We conducted 80 in-depth qualitative interviews with PLWH in 4 New York City populations that were identified as being inconsistently engaged in HIV medical care: African immigrants, previously incarcerated adults, transgender women, and young men who have sex with men.
  
  
  RESULTS
  Barriers to and facilitators of HIV care engagement fell into 3 domains: (1) system factors (eg, patient-provider relationship, social service agencies, transitions between penal system and community), (2) social factors (eg, family and other social support; stigma related to HIV, substance use, sexual orientation, gender identity, and incarceration), and (3) individual factors (eg, mental illness, substance use, resilience). Similarities and differences in these themes across the 4 populations as well as research and public health implications were identified.
  
  
  CONCLUSIONS
  Engagement in care is maximized when the social challenges confronted by vulnerable groups are addressed, patient-provider communication is strong, and coordinated services are available, including housing, mental health and substance use treatment, and peer navigation.
authors: *HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Columbia University, New York, NY; †Einstein-Montefiore Center for AIDS Research, Albert Einstein College of Medicine, New York, NY; ‡New York City Department of Health and Mental Hygiene, New York, NY; and §Public Health Foundation Enterprises, La Puente, CA.
authors: Robert H
authors: RH
authors: Remien
authors: Laurie J
authors: LJ
authors: Bauman
authors: Joanne E
authors: JE
authors: Mantell
authors: Benjamin
authors: B
authors: Tsoi
authors: Javier
authors: J
authors: Lopez-Rios
authors: Rosy
authors: R
authors: Chhabra
authors: Abby
authors: A
authors: DiCarlo
authors: Dana
authors: D
authors: Watnick
authors: Angelic
authors: A
authors: Rivera
authors: Nehama
authors: N
authors: Teitelman
authors: Blayne
authors: B
authors: Cutler
authors: Patricia
authors: P
authors: Warne
mesh_terms: D000293:Adolescent; D000328:Adult; D003142:Communication; D003266:Continuity of Patient Care; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D010342:Patient Acceptance of Health Care; D011320:Primary Health Care; D012725:Sexual Behavior; D057545:Social Stigma; D012944:Social Support; D063106:Transgender Persons; D035862:Vulnerable Populations; D055815:Young Adult