Is racism a barrier to HIV care continuum engagement among Black People in the United States? A scoping review to assess the state of the science and inform a research agenda.

Abstract

People living with HIV can achieve viral suppression through timely HIV care continuum (HCC) engagement (ie, diagnosis, linkage to HIV care, retention in care, and adherence to prescribed treatment regimens). Black populations have poorer viral suppression, suboptimal HCC engagement, and higher levels of racism-related mistrust. The state of the evidence linking suboptimal HCC engagement to racism among US Black populations is assessed in this article. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 6 English language databases were searched using 3 sets of key terms related to HCC engagement (eg, HIV diagnosis), racism (eg, discrimination), and the population (eg, Black people). To exclude articles, 3 rounds of reviews were conducted and results assessed for interrater reliability (κ = 99.00%; P < 0.00). From 2027 articles initially retrieved, the final set of analyses (n = 32) included clinical and nonclinical samples of people living with or at risk for HIV. Overall, the evidence was conceptually robust but methodologically simple. Studies primarily targeted intrapersonal and interpersonal racism and the late stage of HCC engagement: adherence. Sample-specific prevalence of racism ranged considerably; for example, 20% to 90% of sample members in clinical settings perceived or experienced interpersonal forms of racism. To date, the evidence suggests the relationship between racism and HCC engagement is mixed. Racism is salient among Black people living with or at risk for HIV. It appears not to impede HIV testing, though it may limit retention in HIV care, especially among men who have sex with men.