Sociocultural and Structural Barriers to Care Among Undocumented Latino Immigrants with HIV Infection

Timely entry into HIV care is critical for early initiation of therapy, immunologic recovery and improved survival. However,
undocumented Latinos are more likely to enter HIV care late in the disease course and with concurrent AIDS. We conducted a
qualitative study to examine the circumstantial, situational and social factors that uniquely affect entry and retention in
care for this population. Between June and August 2006, we conducted semi-structured, in-depth, individual interviews with
22 undocumented Latino immigrants living with HIV infection. The interviews were audiotaped, transcribed and reviewed for
accuracy. Data was analyzed using a grounded theory approach. Word content was coded and sorted by themes using AnSWR software.
Emergent themes related to health care barriers include (1) the challenges of dealing with HIV stigma and rejection from family
and community; and (2) the experienced and perceived structural barriers of accessing care as an undocumented individual.
Societal intolerance of HIV and stigma-related experiences result in feelings of secrecy and shame. In addition, the undocumented
state complicates the situation even further. These unique barriers include fear of deportation, work restrictions, inadequate
translation services and difficulties meeting paperwork requirements. This study offers insight into the unique sociocultural
and structural barriers faced by undocumented Latinos with HIV infection. Understanding and addressing these barriers will
prove vital in the development and implementation of strategies to promote early entry into HIV care.