Systemic inequities, dignity, and trust in the context of HIV care: a qualitative analysis.
Adherence and retention in care are key targets to achieve favorable health outcomes for people with HIV. Challenges with adherence and retention are pronounced for marginalized communities facing intersectional structural oppression. Community health worker delivery of Managed Problem Solving (MAPS...
| Published in: | International Journal for Equity in Health Vol. 24; no. 1; pp. 1 - 18 |
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| Main Authors: | , , , , , , , |
| Format: | research tables/charts Journal Article |
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BioMed Central
5/6/2025
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| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=184977489&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 184977489 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 14759276 1CR4 jtl: International Journal for Equity in Health issn: 14759276 maglogo: N pubinfo: dt: 5/6/2025 vid: 24 iid: 1 pid: 24147 pub: BioMed Central artinfo: ui: 184977489 184977489 184977489 10.1186/s12939-025-02481-8 184977489 ppf: 1 ppct: 17 formats: tig: atl: Systemic inequities, dignity, and trust in the context of HIV care: a qualitative analysis. aug: au: Sanchez, Amanda L. Mills, Chynna Coley, DeAuj'Zhane Hoskins, Katelin Momplaisir, Florence Gross, Robert Brady, Kathleen A. Beidas, Rinad S. affil: https://ror.org/02jqj7156 Department of Psychology, George Mason University, Fairfax, VA, USA sug: subj: Healthcare Disparities Human Dignity Trust HIV Infections Therapy HIV Infections Psychosocial Factors Human Qualitative Studies Female Male Semi-Structured Interview Thematic Analysis Health Services Accessibility Medical Mistrust Stigma HIV-Positive Persons Psychosocial Factors Implementation Science Pennsylvania Funding Source Patient Compliance Respect Female Male ab: Adherence and retention in care are key targets to achieve favorable health outcomes for people with HIV. Challenges with adherence and retention are pronounced for marginalized communities facing intersectional structural oppression. Community health worker delivery of Managed Problem Solving (MAPS+), an evidence-based behavioral intervention, has the potential to improve adherence and retention, yet understanding structural inequities affecting people with HIV is necessary to increase the likelihood of equitable implementation. The current study explores systemic inequities influencing HIV care adherence and retention, and approaches to address these challenges. We conducted semi-structured interviews with 13 clinics and 4 constituent groups: prescribing clinicians, non-prescribing clinical team members (e.g., medical case managers), clinic administrators, and policymakers. Through reflexive thematic analysis within a constructionist paradigm, we identified two key themes. The first elucidated experiences of systemic inequities such as access to resources, healthcare system navigation difficulties, power differentials, medical mistrust, intersectional stigma and potential patient burden associated with MAPS+. The second theme highlighted the ways in which staff and clinicians shoulder the burden of addressing inequities by approaching people with HIV with dignity and developing trusting relationships and how MAPS + can bolster this approach by partnering with and centering patient needs. While these individual and organizational efforts are valuable, ending the HIV epidemic requires structural changes to address systemic inequities directly. This research underscores the complex interplay between structural oppression and HIV care, calling for comprehensive approaches to achieve health equity. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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