The Impact of Intersectional Stigma on Shared Decision- Making and Antiretroviral Therapy Adherence for Young Latinos in the Deep South: Perspectives from HIV Clinicians

<p>Introduction. HIV treatment and prevention have seen significant advancements over the past four decades, with antiretroviral therapy (ART) enabling people living with HIV to achieve viral suppression and live long, healthy lives. However, disparities persist among Hispanic/Latino populations in the southern United States. In the Deep South region of the U.S., young Latino men face potential intersecting stigmas related to HIV status, sexual orientation, ethnicity, and immigration status. Stigma is an established barrier to healthcare access and optimal health outcomes. This study explored how HIV clinicians in the Deep South perceive the impact of intersectional stigma on shared decision-making (SDM) and antiretroviral therapy adherence for young Latino men living with HIV. Methods. This qualitative study employed semi-structured, virtual interviews with 11 HIV clinicians practicing in the Deep South. Data were analyzed using the Framework Method. Results. Clinicians identified cultural norms, religious beliefs, language barriers, and immigration-related fears as major contributors to intersectional stigma, which often led to non-disclosure of HIV status and reluctance to engage in care. They emphasized that building trust is essential but challenging, as patients’ guardedness is shaped by anticipated stigma. To foster stronger relationships, clinicians reported using neutral language and patient-centered approaches; however, shared decision-making was inconsistently practiced. Structural barriers, including bureaucratic processes and transportation challenges, further constrained consistent access to medication. Resources such as bilingual staff, on-site pharmacies, medication samples, and support from case managers or social workers were considered vital for improving ART adherence. Although clinicians demonstrated empathy and awareness of their patients’ intersectional challenges, they acknowledged gaps in consistently translating this understanding into practice. Conclusions. HIV clinicians in the Deep South recognize the influence of intersectional stigma on young Latino men living with HIV. While many clinicians employ patient- centered strategies to mitigate the impact of stigma on SDM and ART adherence, systemic barriers persist. Addressing these challenges requires both clinic-level interventions and broader policy-level reforms to reduce stigma. This study underscores the need for tailored interventions that bridge clinicians and systems to actionable practices to improve health outcomes for this population.</p>

Name thesis:degree_name

Doctor of Philosophy (PhD)

Level thesis:degree_level

Dissertation

Discipline thesis:degree_discipline

Nursing Science

Year dc:date.available

2025

Author dc:creator

• Cunningham, Jorden

Contributors dc:contributor

• J. Carolyn Graff

• Adherence
• Antiretroviral therapy
• HIV
• Intersectional stigma
• Latinos
• Southern U.S.
• Medicine and Health Sciences
• Nursing

Repository record dc:identifier

https://dc.uthsc.edu/dissertations/724

OAI identifier oai:identifier

oai:dc.uthsc.edu:dissertations-1724