“I’m Scared, Just like Every Latino”: Racism, Intersectionality, and Minority Stress As Barriers to Health and HIV Services Among Highly Marginalized Latinos.

Background: Latinos experience the highest rates of new HIV diagnoses in San Francisco, California. However, a limitation in better understanding the root causes of HIV disparities among Latinos has been generalizing findings for them as a monolithic population. Latinos are comprised of diverse groups that include highly marginalized populations, who may have different experiences of inequitable access to health care systems and vulnerability to HIV. We used qualitative methods to explore how Latino intersectional identities based on nationality, indigenous status, sexuality, and gender influenced access and engagement to HIV services.

Methods: We developed a semi-structured interview in English and Spanish to explore how racism affects access and engagement in HIV services among highly marginalized Latinos. Throughout November-December 2024, we recruited highly marginalized Latinos from the San Francisco Bay Area who identified as immigrants, indigenous, sexual minorities, and/or transgender women. Interviews were administered in person, audio recordings were transcribed verbatim in the original language, and rapid qualitative analysis was used to identify themes.

Results: Overall, 25 Latinos (10 cisgender gay men, 11 transgender women, and 4 missing data; 10/25 identified as indigenous) completed in-depth individual interviews; 18 reported being immigrants and 13 were monolingual Spanish speakers. We identified five themes: 1) Latino immigrants’ experiences of discrimination in their native countries shaped their understanding and response to racism in the United States; 2) Latinos encountered racial microaggressions from other racial groups that reinforced xenophobic attitudes and discrimination related to English proficiency when utilizing health and HIV services; 3) Latinos discussed how microaggressions influenced social capital among Latinos, which enhanced or limited access to resources based on national, indigenous, and gender identity; 4) Latino immigrants described being in survival mode due to minority stress and constantly worried about their basic needs, which undermined concerns of preventative mental and medical health; and 5) Latinos emphasized the importance of peers from diverse backgrounds as a trusted source in delivering culturally informed health and HIV services for Latinos.

Conclusion: The majority of Latinos encountered racial microaggressions, but Latinos who identified as trans women and/or indigenous reported higher levels of marginalization and minority stress from within the Latino as well as other racial groups. Latina trans women had a difficult time accessing gender affirming health care and gaining entry into the formal labor market, regardless of their immigration status. Latino indigenous people were more likely than other participants to describe coming from rural areas, speaking Spanish as a second language, and less likely to pursue an education. Overall, highly marginalized Latinos established social networks to support each other and overcome barriers to access health and HIV services. Findings underscore the importance of social capital and peer-based interventions to integrate diverse highly marginalized Latinos towards playing an active role in delivering health care and HIV services to their community.