Systemic inequities, dignity, and trust in the context of HIV care: a qualitative analysis
Abstract 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 Solv...
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| Format: | Article |
| Language: | English |
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BMC
2025-05-01
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| Series: | International Journal for Equity in Health |
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| Online Access: | https://doi.org/10.1186/s12939-025-02481-8 |
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| author | Amanda L. Sanchez Chynna Mills DeAuj’Zhane Coley Katelin Hoskins Florence Momplaisir Robert Gross Kathleen A. Brady Rinad S. Beidas |
| author_facet | Amanda L. Sanchez Chynna Mills DeAuj’Zhane Coley Katelin Hoskins Florence Momplaisir Robert Gross Kathleen A. Brady Rinad S. Beidas |
| author_sort | Amanda L. Sanchez |
| collection | DOAJ |
| description | Abstract 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. |
| format | Article |
| id | doaj-art-fa3ec06972d4456caece9fd16d3fcfe4 |
| institution | Kabale University |
| issn | 1475-9276 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | BMC |
| record_format | Article |
| series | International Journal for Equity in Health |
| spelling | doaj-art-fa3ec06972d4456caece9fd16d3fcfe42025-08-20T03:53:11ZengBMCInternational Journal for Equity in Health1475-92762025-05-0124111710.1186/s12939-025-02481-8Systemic inequities, dignity, and trust in the context of HIV care: a qualitative analysisAmanda L. Sanchez0Chynna Mills1DeAuj’Zhane Coley2Katelin Hoskins3Florence Momplaisir4Robert Gross5Kathleen A. Brady6Rinad S. Beidas7Department of Psychology, George Mason UniversityDepartment of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern UniversityThe Brigham and Woman’s Hospital, Harvard Medical School and Massachusetts General HospitalDepartment of Biobehavioral Health Sciences, School of Nursing, University of PennsylvaniaDepartment of Medicine (Infectious Diseases), Perelman School of Medicine, University of PennsylvaniaDepartment of Medicine (Infectious Diseases), Perelman School of Medicine, University of PennsylvaniaDivision of HIV Health, Philadelphia Department of Public HealthDepartment of Medical Social Sciences, Feinberg School of Medicine, Northwestern UniversityAbstract 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.https://doi.org/10.1186/s12939-025-02481-8Implementation scienceHIV careRetention and adherenceHealth equity |
| spellingShingle | Amanda L. Sanchez Chynna Mills DeAuj’Zhane Coley Katelin Hoskins Florence Momplaisir Robert Gross Kathleen A. Brady Rinad S. Beidas Systemic inequities, dignity, and trust in the context of HIV care: a qualitative analysis International Journal for Equity in Health Implementation science HIV care Retention and adherence Health equity |
| title | Systemic inequities, dignity, and trust in the context of HIV care: a qualitative analysis |
| title_full | Systemic inequities, dignity, and trust in the context of HIV care: a qualitative analysis |
| title_fullStr | Systemic inequities, dignity, and trust in the context of HIV care: a qualitative analysis |
| title_full_unstemmed | Systemic inequities, dignity, and trust in the context of HIV care: a qualitative analysis |
| title_short | Systemic inequities, dignity, and trust in the context of HIV care: a qualitative analysis |
| title_sort | systemic inequities dignity and trust in the context of hiv care a qualitative analysis |
| topic | Implementation science HIV care Retention and adherence Health equity |
| url | https://doi.org/10.1186/s12939-025-02481-8 |
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