“It's Our Superpower”: A Mixed-Methods Study to Understand Motivation and Capabilities for HIV Management Among African American/Black and Latine Emerging Adults Living with HIV

Background and Purpose: Despite substantial advances in HIV prevention and treatment, African American/Black and Latine emerging adults continue to experience the highest burden of HIV in the US, underscoring persistent inequities across the HIV care continuum. Yet, factors shaping their engagement in HIV care remain understudied, particularly among subpopulations such as those with unsuppressed HIV viral load and among immigrant populations.

Methods: This sample was drawn from a longitudinal study with African American/Black and Latine emerging adults living with HIV (N=271), that included individuals without HIV viral suppression and those born outside the US. A subset was purposively selected for semi-structured qualitative interviews (N=41). The study was guided by social action theory. We used a sequential explanatory mixed-methods design to explore the relationships among motivational appraisals (e.g., core goals for health), generative capabilities (e.g., adherence self-efficacy, resilience), and HIV management. Primary outcomes were HIV care engagement and viral suppression. Quantitative baseline data were analyzed using descriptive statistics and structural equation modeling (SEM). Quantitative findings informed the qualitative research questions. Qualitative data were analyzed using a theory-driven, inductive, directed content analysis approach. Results were then integrated using the joint display method.

Results: Participants were 25 years old (SD=2), on average. Approximately two-thirds (66%) identified as cisgender, and one-third (33%) identified as transgender or gender-expansive (e.g., non-binary, gender-fluid, genderqueer). The majority were sexual minorities (93%), more than half identified as Latine (59%), and nearly half were immigrants (49%). Overall, 28% of participants were not well engaged in routine HIV care, and 19% were not virally suppressed. Motivation, adherence self-efficacy, and medication outcome expectancies were high regardless of viral suppression. In the SEM, self-efficacy had a positive direct effect on motivation (B=0.24, p<0.01). Resilience (B=0.02, p=0.04) and self-efficacy (B=0.23, p<0.01) each had positive direct effects on outcome expectancies. Motivation (B=0.26, p=0.02) had a positive direct effect on HIV care engagement. There were no statistically significant direct effects on viral suppression. In the qualitative findings, participants focused mainly on medication and viral suppression, but not HIV care. We organized the qualitative findings into four themes: 1) why participants took medication (e.g., desire for longevity, to be “normal” and attractive, and to avoid transmitting HIV); 2) how they took medication (e.g., learning over time, creating routines and habits); 3) factors that interfered (e.g., structural barriers and disruptions could overwhelm motivation); and 4) issues salient to immigrants (e.g., moving to the US for better care, honoring family by taking medication).

Conclusions/Implications: This mixed-methods study advances knowledge on motivational appraisals, generative capabilities, and HIV management among African American/Black and Latine emerging adults living with HIV. Findings identify multiple intervention targets and underscore that motivation and capabilities for HIV management require supportive structural and social contexts. Results highlight the role of social work in advancing multilevel strategies to promote equitable engagement across the HIV care continuum.