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Table 5 Joint display comparing quantitative and qualitative findings

From: Stopping, starting, and sustaining HIV antiretroviral therapy: a mixed-methods exploration among African American/Black and Latino long-term survivors of HIV in an urban context

Domains of main quantitative findings

Summary of quantitative findings

Summary of qualitative findings

Sociodemographic characteristics

– More starts (the worse outcome) associated with younger age, being male, and transgender gender identity

– Longer maximum duration on ART (the better outcome) associated with Latino ethnic background

– Shorter maximum duration (the worse outcome) associated with Black racial background

– Participants reported inadequate or even discriminatory health care experiences they attributed to race/ethnicity, social class, sexual orientation, and substance use patterns

– These experiences contributed to medical distrust, which was a major barrier to HIV care and ART

Qualitative results did not reveal major differences between African American/Black and Latino PLWH

Years since diagnosis

– More starts associated with fewer years since diagnosis

– Emotional fatigue associated with long-term HIV survivorship was common

– Giving up on HIV management for periods was common, followed by periods of recommitment to HIV care and ART

Possible discrepancy between qualitative and quantitative findings

Motivation for ART and HIV care

– More starts associated with lower motivation for HIV care

– Longer maximum duration on ART associated with higher motivation for ART and HIV care

– Motivation was a foundational aspect of HIV management and necessary but not sufficient for HIV management

– Motivation was either fostered or eroded/overwhelmed by participants’ larger life contexts and life events

– Autonomy was associated with motivation and was an important value for PLWH but not always supported by service settings

Substance use including IDU

– More starts associated with higher-risk cannabis use

– Fewer starts associated with lifetime (but not recent) IDU

– Shorter maximum duration on ART associated with higher-risk alcohol use

– Longer maximum duration on ART associated IDU in the past 3 months

– Substance use (SU) was a primary obstacle to HIV management

– The understanding that one can take ART while using substances was critical to sustaining ART, but many PLWH do not know or fully understand they can take ART while using substances

– In the context of poverty, PLWH commonly sell or “divert” ART to support SU, and corrupt pharmacies initiate these transactions

– SU was disruptive to stability and contributes to social isolation

– SU was one component of “taking a break from ART,” a strategy PLWH used to manage fear of ART toxicity

– Those with past and recent trauma reported substance use as a coping strategy

– Reductions in or cessation of SU promoted re-establishment of social ties, emotional and material stability, and a more consistent schedule, which supported HIV management

– Harm reduction was found helpful and consistent with the desire for autonomy and support

Qualitative findings did not address IDU

Social support

– Longer maximum duration on ART associated with less social support

– Lack of social support was associated with poor HIV management

– Loss of a close other commonly precipitated stopping ART

– Peer support and peer modeling were critical to restarting ART and effective ART management

– Insufficient social support contributed to “self-destructive” behavior, including social isolation, loss of the will to live, and “not caring” about oneself, which eroded motivation and ability to take ART

Possible discrepancy between qualitative and quantitative findings

Stigma re: ART, HIV care

– More starts associated with higher medication stigma and HIV care stigma

– Stigma reduced successful HIV management and frequently resulted in social isolation

– Stigma impeded disclosure of HIV status to others, which impeded HIV management

Major themes from qualitative results not found or not examined in quantitative results

 Homelessness and housing

– Unstable or substandard housing and other forms of material precarity were major contributors to a sense of instability

– Unstable or substandard housing contributed to social isolation

– Housing that is unstable or substandard is often a hub of drug selling and other illegal activities, which served as a trigger for PLWH wishing to avoid or reduce substance use

– In times of hardship and/or when substance use escalates, PLWH commonly sell or “divert” ART to pay bills

– Housing status was one aspect of material precarity, but housing was vital for stability, wellbeing, and to support ART use

 Adverse childhood experiences

– Those with past trauma reported substance use as a coping strategy

– Sustained self-reflection helped participants deal with trauma

 Aspects of health care settings

– Health care settings were experienced as a means of making money off patients, and this discourages engagement in care

– High quality clinical care, medical care, and social services can foster resilience and engagement in HIV care and ART