“They make me feel I am worth it”: Interactions with healthcare providers and retention in HIV care for HIV+ MSM in Puerto Rico

Expressions of HIV stigma such as prejudice and discrimination among healthcare providers (HCP) have been associated with challenges in patient’s adherence and continuity in care. This is particularly true for HIV+ men who have sex with men (MSM) who are otherwise disenfranchised in health services. Research has shown that HCP’s professional competency and knowledge about HIV and sexual diversity positively influences provider-patient relationships. However, very limited research has been conducted on how stigma impacts the healthcare provider-patient relationship and retention in HIV care, particularly among HIV+MSM in Puerto Rico (PR). A qualitative study following a life history approach was conducted using semi-structured interviews with 18 HIV+MSM. Interviews included questions about experiences with HIV testing and treatment, engagement in care, and healthcare providers. Interviews were transcribed and content and discourse analyses informed by grounded theory were completed. Participants reported that HCP’s HIV knowledge, a positive and non-judgemental approach to sexuality, and a familial interaction were essential to build trust and deciding about continuing healthcare. Issues of confidentiality, limited time dedicated to clinical encounters, and discrimination based on sexual orientation and HIV status were commonly reported as barriers to continue HIV care. Proper engagement in care is essential to the wellbeing and quality of life of people living with HIV. Nonetheless, stigma experiences in provider-patient relationships negatively affect the retention in the continuum of HIV care of HIV+MSM in PR. Future interventions should invest in culturally-appropriate training for HCPs on HIV care, sexual health, and how to provide appropriate services to gay men and other MSM