In recent years, the global fight against HIV has witnessed significant advancements in treatment and care, yet disparities in engagement across diverse populations remain a pressing challenge. A groundbreaking study published in the International Journal for Equity in Health sheds crucial light on the social dynamics that influence how African American/Black and Latine emerging adults living with HIV navigate the continuum of care. This research provides a nuanced understanding of barriers and facilitators within these communities, revealing the complex interplay of social processes that impact health outcomes and adherence to treatment regimens.
The HIV care continuum, a conceptual framework encompassing diagnosis, linkage to care, retention, and viral suppression, is foundational to optimizing individual and public health. However, engagement along this continuum is not uniform. African American/Black and Latine populations often experience socio-structural challenges rooted in systemic racism, economic disenfranchisement, and cultural stigmas. This mixed-methods exploratory study uniquely integrates quantitative data with rich qualitative insights to delve deeply into the lived experiences of emerging adults aged 18 to 29, a demographic historically underrepresented in HIV research yet disproportionately affected by the epidemic.
Emerging adulthood marks a critical developmental stage characterized by identity exploration, shifting social networks, and increasing autonomy. For those living with HIV, this period is further complicated by the necessity of integrating chronic disease management into rapidly changing personal and social landscapes. The study captures how formative social interactions, such as peer influence, family support, and interactions with healthcare providers, shape individuals’ motivation and ability to persist in care. Findings reveal that social support is not merely beneficial but essential for maintaining engagement, influencing adherence to antiretroviral therapy, and survival outcomes.
One of the study’s core revelations is the bi-directional nature of stigma within these communities. Participants reported experiencing both enacted stigma—discriminatory behaviors from others—and internalized stigma, in which negative societal beliefs were absorbed and acted upon personally. Such stigma emerged as a formidable barrier, deterring individuals from accessing timely medical care or disclosing their status to supportive networks. The study elucidates how these stigma processes intersect with cultural values and norms, particularly machismo and familismo within Latine communities, complicating straightforward engagement with care systems.
Importantly, the research highlights health system interactions that can either reinforce or alleviate these barriers. Culturally competent care, delivered through providers trained to understand and respect the unique cultural backgrounds of African American/Black and Latine youth, was linked to increased trust and retention. Conversely, experiences of racial bias and systemic inefficiencies contributed to disengagement and treatment interruptions. This underscores the necessity of structural interventions alongside individual-level supports to enhance continuity in care.
Employing a rigorous mixed-methods design, the researchers administered standardized surveys assessing psychosocial factors, treatment adherence, and care retention metrics. Semi-structured interviews enriched the dataset, allowing participants to narrate their experiences in their own voices, revealing the emotional and social textures behind quantitative indicators. This methodological approach enabled the research team to triangulate findings, thereby strengthening the validity and applicability of conclusions drawn about social processes influencing care engagement.
The study’s timing is notable, coinciding with evolving public health landscapes marked by advancements in telehealth and community-based care models. Insights gleaned from participants revealed that digital interventions, while promising, present nuanced challenges related to privacy concerns, technology access, and digital literacy. For emerging adults striving to blend health management with broader life aspirations, these factors play a decisive role in whether new modalities of care delivery serve as facilitators or inhibitors.
Crucially, findings indicate that peer-driven interventions hold immense potential to disrupt cycles of disengagement. Participants emphasized the importance of relatable messengers—individuals who have lived experience navigating HIV within their cultural context—to foster openness and resilience. Peer support structures not only provide practical navigation of healthcare systems but also cultivate environments where stigma can be collectively challenged and diminished, enhancing psychological well-being alongside clinical outcomes.
In addressing retention in care, the research acknowledges economic determinants that disproportionately burden African American/Black and Latine emerging adults. Unstable housing, limited employment opportunities, and food insecurity intertwine with health vulnerabilities, exacerbating challenges to sustained engagement. The study advocates for integrated service models that encompass social determinants of health, emphasizing multi-sector collaboration as pivotal for both mitigating disparities and achieving equity in HIV care engagement.
The implications of this study extend far beyond the academic sphere into policy and clinical practice. The nuanced evidence base provided can guide targeted allocation of resources toward culturally tailored programs, influence training protocols for healthcare professionals, and stimulate innovative outreach strategies that resonate with the fears, aspirations, and realities of Black and Latine youth living with HIV. Through these avenues, the findings offer a roadmap for bridging gaps in care that have persisted despite widespread biomedical advances.
By foregrounding social processes in the continuum of HIV care, this research moves the field toward a more holistic understanding of treatment engagement. It challenges approaches that focus exclusively on individual behavior change or biomedical solutions absent of social context. Instead, it advocates for integrative frameworks that incorporate community narratives, structural inequities, and cultural identity as foundational components of effective intervention design and implementation.
Furthermore, the study emphasizes the importance of considering intersectionality, recognizing that participants’ identities encompass not only racial and ethnic lenses but also gender, sexual orientation, and socioeconomic status. This multidimensional perspective is essential for designing interventions that resonate authentically and effectively with the lived realities of diverse emerging adults. In doing so, it pushes the envelope on culturally sensitive research methodologies and intervention development.
The research contributes to an urgent discourse on health equity as a cornerstone of HIV prevention and care efforts in the United States and globally. By prioritizing voices historically marginalized in healthcare research and practice, it signals a paradigm shift toward inclusive, patient-centered models that honor complexity over simplistic narratives. This is especially critical at a public health inflection point marked by persistent disparities and the ever-present threat of new infections.
Conclusively, this landmark study represents an essential step forward in unraveling the social fabric that underpins successful HIV care engagement among African American/Black and Latine emerging adults. It calls on researchers, clinicians, policymakers, and community leaders to collaborate in creating systems and environments where every individual with HIV can navigate their journey toward health with dignity, support, and empowerment. The lessons drawn here will resonate as the global community strives to achieve the UNAIDS 95-95-95 targets and ultimately end the HIV epidemic.
As the scientific and public health communities digest these findings, the question turns to implementation. How can these insights be operationalized into scalable programs that retain fidelity to cultural nuances while reaching the breadth of those in need? The answer lies in continued partnership with affected communities, ongoing evaluation, and the political will to invest in equity-driven initiatives. This study illuminates a pathway toward that transformative future—one rooted in the very social processes that animate the human experience of health and healing.
Subject of Research: Social processes influencing engagement along the HIV care continuum among diverse African American/Black and Latine emerging adults living with HIV.
Article Title: Social processes and engagement along the HIV care continuum: a mixed methods exploratory study with diverse African American/Black and Latine emerging adults living with HIV.
Article References: Wilton, L., Gwadz, M., Cleland, C.M. et al. Social processes and engagement along the HIV care continuum: a mixed methods exploratory study with diverse African American/Black and Latine emerging adults living with HIV. Int J Equity Health 24, 295 (2025). https://doi.org/10.1186/s12939-025-02662-5
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