Beyond Documentation: Racialized Legal Status as a Political Determinant of Health Among Latines with HIV in the United States

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Abstract
Objective: Latines in the United States (US) experience disproportionate HIV-related inequities, exacerbated by immigration-related legal precarity and exclusionary policies. This study explores how racialized legal status (RLS), a mechanism by which race-neutral legal classifications disproportionately burden minorities, impacts the lived experiences of Latines with HIV (LWH) across the HIV care continuum. Methods: We conducted a secondary qualitative analysis of in-depth interviews with 21 LWH, 15 healthcare providers, and 10 key informants in Prince George’s County, Maryland. Drawing on RLS framework, data was analyzed thematically, focusing on emergent themes related to immigration, politics, and legal status and their impact on LWH. Results: Policies linking access to health and social services to legal status intensified economic instability and social exclusion, thus leading to suboptimal disease management. Fear of deportation, institutional mistrust, discrimination, and intersectional stigma contribute to healthcare avoidance, disrupting continuity and engagement across the HIV care continuum. Institutions providing services to LWH struggle to circumvent barriers caused by RLS, straining local and community-based resources. Conclusions: RLS erodes whole-person care by creating barriers for healthcare and social services access. Addressing inequities among Latines requires multilevel responses that reduce exclusionary policies and support the well-being of individuals at the intersection of immigration status and chronic disease management.
Funding Information
  • NIH-funded Center (P30 AI050409)
  • National Institutes of Health (K24 NR020508)

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