Enhancing Routine HIV Testing Among Latino Immigrants: Gatekeepers to Health Access and Social Services

Background and Purpose:

HIV testing is the first step in linking infected persons to care; however immigrants are often disengaged from preventive services and get tested further along in their disease.  Latinos, who comprise the largest immigrant group in the U.S., are at significantly greater risk of late diagnoses.  As Latinos are disproportionately impacted by HIV/AIDS, increasing HIV testing among this population is critical to curbing the epidemic. Yet, a better understanding of factors that influence HIV testing behaviors specific to the microenvironments in which Latino immigrants reside is sorely needed. Recent macro-level shifts in the U.S. represent potentially impactful transitions in the broader healthcare context for immigrants. Specifically, shifts in access to health care services mark an unprecedented occasion where HIV testing has never been more attainable. These contextual changes give reason to examine access to HIV testing among Latino immigrants.

The present paper engages this timely occasion and examines gatekeeper perspectives to identify gaps and opportunities for HIV testing among Latino immigrants. Gatekeepers from diverse community sectors offer expert knowledge and observations regarding Latino immigrants’ microenvironment and demonstrate strategies for engagement.

Methods: Thirteen in-depth, semi-structured interviews were conducted with gatekeepers in the Corona, Queens community of New York City. Corona represents a unique microenvironment characterized by a large Latino foreign born population and high rates of sexually transmitted infections. Purposive sampling identified participants based on the following criteria: (1) Authority figure in Corona; (2) Involvement and commitment to the health of Corona residents; and (3) Knowledge of the needs and behaviors of Corona residents. Diversity of participants in sectors of social services, health, policy/advocacy, labor employment, and religious/faith community was sought. Interviews elicited perspectives from experts and leaders within these sectors on the challenges and opportunities to HIV testing for Latino immigrants in Corona. Interviews were transcribed verbatim and analyzed in a two-step process which involved writing analytic summaries of key findings in each interview and systematic coding of transcripts informed by grounded theory and a well-defined thematic codebook.

Findings: Gatekeepers highlighted disparities in perceptions of access to HIV testing services between documented and undocumented Latino immigrants in Queens. Despite availability of resources and services regardless of migration status, community leaders indicated that fear and lack of trust with regard to health care systems are persistent barriers to HIV testing. Moreover, participants acknowledged a sense of neglect and abandonment attributed to the highly immigrant population of the community. Gatekeepers suggested that community-centered approaches to education and services that have buy-in from community members can facilitate HIV testing and service utilization.

Conclusion and Implications: Efforts to increase routine HIV testing among the Latino immigrant community require continuous education and outreach. Normalization of HIV testing as part of preventative health services is critical to stigma and fear reduction for this population. By focusing HIV testing efforts on targeted microenvironments with attention to their unique cultural and social context, Latino immigrants may perceive greater access to services and find HIV testing to be more feasible and acceptable as routine behavior.