Social Determinants of Health and Linkage to HIV Care Among Groups at High Risk for Not Linking to HIV Care

Background 1 in 5 people with new HIV diagnoses are not linked to medical care after diagnosis. Persons who are Black/African American, Hispanic/Latinx, young, and previously or currently use drugs via injection have low rates of linking to HIV care. We explored perceptions of patients living with HIV about how social determinants of health (SDoH) affect linkage to care. Methods We recruited patients from a large safety-net hospital in Boston belonging to one of the groups with high risk for low linkage to HIV care. We conducted semi-structured interviews in-person or via Zoom/telephone about how the five domains of SDoH (i.e., health care access and quality, education access and quality, economic stability, neighborhood and built environment, and social and community context) impacted their HIV care experience. We conducted rapid thematic analysis of data by creating: 1) transcript summaries organized by each SDoH and 2) a matrix comprising the transcript summary data. Results Participants were 50% female, 72% Black/African American, 22% Hispanic or Latina/o/x, and 56% with current or past use of drugs via injection. 89% had experienced at least one gap in HIV care since diagnosis. Themes related to how healthcare access and quality impacted linking individuals to HIV care included enrollment in HIV drug assistance programs and rapport with (or stigma from) healthcare providers including mental healthcare providers. Themes related to education access included explicit education on HIV treatment from providers and adapting HIV education to patient’s needs (e.g., tailoring to patient’s self-efficacy for independently finding credible health information). Economic stability themes included access to affordable food, and reliable transportation. Themes on social and community context included emotional support (or stigma) from family, friends, and/or partners. Conclusions Participants perceived multiple social needs as impacting HIV care linkage. Their most salient perceptions related to positive and negative roles of family/friend support, self-perception as a person with HIV, and HIV stigma. Addressing SDoH may improve linkage to HIV care in disproportionately affected populations.