Timely treatment of HIV infection is a public health priority, yet many HIV-positive persons delay treatment initiation. We conducted a community-based study comparing HIV-positive persons who received an HIV diagnosis at least 3 months ago but had not initiated care (n=100) with a reference population of HIV-positive persons currently in care (n=115) to identify potential barriers to treatment initiation. Study participants were mostly male (78.0%), and persons of color (54.9% Latino, 26.3% black), with median age 37.8 years. Median time since HIV diagnosis was 3.7 years. Univariate analysis revealed that those never in care differed substantially from those currently in care with regard to sociodemographics; HIV testing and counseling experiences; perceived barriers to care; and knowledge, attitudes, and beliefs regarding HIV. Factors independently associated with never initiating HIV care were younger age (adjusted odds ratio [AOR]=0.93; 95% confidence interval [CI]: 0.88, 0.99), shorter time since diagnosis (AOR=0.87; 95% CI: 0.77, 0.98), lacking insurance (AOR=0.11; 95% CI: 0.03, 0.35), not knowing someone with HIV/AIDS (AOR=0.09; 95% CI: 0.03, 0.30) not disclosing HIV status (AOR=0.13; 95% CI: 0.02, 0.70), not receiving help making an HIV care appointment after diagnosis (AOR=0.04; 95% CI: 0.01, 0.14), and not wanting to think about being HIV positive (AOR=3.57; 95% CI: 1.22, 10.46). Our findings suggest that isolation and stigma remain significant barriers to initiating HIV care in populations consisting primarily of persons of color, and that direct linkages to HIV care at the time of diagnosis are critical to promoting timely care initiation in these populations.

Women of color comprise a growing proportion of U.S. HIV/AIDS cases and are poorly represented in HIV/AIDS clinical trials. Improved understanding of reasons for low Latina representation in HIV/AIDS clinical trials is needed to promote participation and improve study generalizability. We studied barriers and facilitators to HIV/AIDS trial participation in HIV-positive Latinas in the U.S.-Mexico border region. Forty HIV-positive Latinas, 10 HIV/AIDS service providers, and 4 HIV/AIDS trial recruiters were consented and received interviewer-administered structured surveys. Fisher's exact tests were used to explore differences between women who had and who had not participated in clinical trials. Latinas were Mexican born (70%), preferred health information in Spanish (62.5%), had a mean age of 38 years (range 21-60), had a household income < or = 15,000 dollars/year (62.5%), crossed the border at least once/month (45%), and reported residing in Mexico (15%). We found no significant differences between women who participated in a clinical trial (60%) and those who had not (40%) across language, age, education, and border crossing (p > 0.05). Sixty-three percent of Latinas perceived individual-level barriers (e.g., fear, shame, and stigma), and 10% mentioned system-level barriers (e.g., lack of transportation or language-appropriate services); 70% of providers mentioned system barriers. HIV stigma was not reported as a barrier by providers. The role of stigma in recruitment of HIV-positive Latinas into clinical trials and differences in perceptions of barriers between Latina participants and service providers merit further exploration. Improved understanding of individual and system barriers to clinical trials participation in a binational context is warranted.