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Table 3 Recommendations that emerged from the present study

From: Understanding long-term HIV survivorship among African American/Black and Latinx persons living with HIV in the United States: a qualitative exploration through the lens of symbolic violence

Overall lesson learned Specific recommendations
Poverty is a fundamental cause of HIV-related health and other social inequities ▪ Provide universal basic income▪ Reduce barriers that prevent eligible individuals from accessing benefits [68]▪ Increase entitlement levels, as current sub-poverty benefit levels ensure continued hardship [68]▪ Entitlements and health benefits are generally subject to strict low-income guidelines, which precludes employment for many PLWH who need to retain benefits. Changing these policies could increase employment rates [69]▪ Provide job training programs in health care and social service settings, as employment can increase knowledge, money, power, prestige, and beneficial social connections and reduce the fundamental causes of disparities [70]
Stigma is a fundamental cause of HIV inequities ▪ Address community-level stigma within its broader structural context (e.g., CHHANGE study) [71]▪ Implement symbolic violence and stigma-reduction training and intervention efforts at the levels of health care systems, providers, and PLWH
Substance use is chronic and recurring ▪ Provide interventions to health care settings to reduce substance use-related stigma▪ Locate specialized retention clinics within HIV clinics to support persons who use substances [72]▪ Ground services in harm reduction, emphasizing support for individual autonomy and decisions▪ Locate evidence-based substance use treatment in HIV care settings
Housing is often precarious, coercive, and of poor quality ▪ Provide high-quality and stable housing to reduce dehumanization, social isolation, and exposure to others with substance use problems [73]
The physical and social characteristics of health care/social service settings can be experienced as dehumanizing ▪ Design health care settings to be open, transparent, and inclusive, consistent with the concepts of spatial and placial justice [74]
Aspects of health care/social service encounters can support HIV management but may be lacking in poorly-resourced settings ▪ Implement approaches in clinical settings that support PLWH’s autonomy to better foster engagement and decision making▪ Implement and train providers in stigma-reducing approaches that include a non-judgmental approach to possible ART non-persistence, substance use, and other aspects of PLWH’s lives that may be stigmatizing▪ Develop and implement practices that combat dehumanization and devaluation▪ Integrate motivational interviewing [75], strengths-based [76], and person-centered care approaches into services [77] because they have a strong evidence base, foster engagement, and support PLWH’s resilience and autonomy▪ PLWH miss HIV care appointments as one strategy to manage HIV over the long-term, but taking PLWH off patient rosters in response to missed visits creates barriers to their accessing HIV care
Negative emotions impede engagement, but are less commonly the focus of care/services than other aspects ▪ Implement interventions in clinical and social service settings that attend to emotional factors, along with those that focus on cognitions and behavioral skills [78, 79].▪ Acknowledge and address fear and distrust common among African American/Black and Latinx PLWH [78, 80,81,82]▪ Acknowledge and address other negative affective states and include programming to help participants manage negative emotions [78, 80,81,82]
Continuous traumatic stress is endemic and chronic ▪ Provide services to address the sequelae of a traumatic HIV diagnosis experience, and the often non-linear and challenging process of accepting and adapting to the diagnosis [24]▪ Train providers in trauma-informed care and integrate trauma-informed care in clinical and social service practice [83]
PLWH often prioritize individual “failings” despite myriad accomplishments ▪ Help staff and PLWH understand and acknowledge social and structural drivers of poor HIV management, called structural competence [84]▪ Highlight resilience and strengths in clinical encounters