How do clinic experiences affect HIV related attitudes and risk: A study of seropositive Latino patients in Los Angeles

BACKGROUND: Latinos are disproportionately affected by HIV. Increasing numbers are presenting for HIV care at community health clinics. While researchers have focused on cross-ethnic HIV differences in access to care and perceptions of risk, few have examined intra-ethnic differences. This study examined how Latino seropositive patients' experiences utilizing services at Los Angeles community HIV clinics affect HIV care and risk-related attitudes and behavior.

METHODS: A sample of 161 Latinos was interviewed. Factor analysis was used to create constructs related to clinic experiences and patient attitudes about HIV, care and risk behavior. Demographic and health-related variables represented covariates in linear regression to determine relationships to clinic- and HIV-related attitudes. Analysis further examined the interaction of covariates and attitudinal variables with key HIV risk outcomes.

RESULTS: Age, insurance status, and sexual orientation were associated with clinic satisfaction. Gender, less than high school education, and sexual orientation were associated with feeling shame about HIV status. Concern about having infected someone in the previous six months was associated with sexual orientation, education level, age, and being unemployed. Patients less satisfied with the clinic were more likely to report having unprotected sex. Length of time since HIV diagnosis and a gay/bisexual identity were associated with having multiple partners and partners of unsure HIV status.

CONCLUSION: As secondary HIV prevention is increasingly occurring in primary care, it is important to develop clinic-based prevention service models targeting Latino seropositive patients that are designed to appreciate the potential influence of clinic experiences on risk or perception of risk.