HIV treatment delays among immigrant latinos: Testing a model for social influence and trust

Background: Annual incidence of HIV among Latinos in the U.S. is three times higher than non-Latino whites. Compared to U.S.-born Latinos, immigrants from Mexico and Central America have greater odds of a late HIV diagnosis, are more likely to have an opportunistic infection at HIV diagnosis, and experience increased risk of death. The objectives of this study were to validate the internal factor structure of a Spanish-language physician trust scale among immigrant Latino men and women living in North Carolina and estimate the structural relationships between sojourner social support, acculturative factors, and physician trust adjusting for length of residence in the U.S. Methods: Data were collected from immigrant Latinos using respondent driven sampling and venue based sampling. Assessments were administered by native Spanish-speakers. Data were analyzed using EQS software and structural equation modeling. Results: Eighty four percent of participants (N=366) were from Mexico. Preliminary results indicate a second-order factor structure for Physician Trust (the second-order factor) with first-order factors of Provider and Researcher Trust. The effects of Social-ethnic Relations and Language/media Preference on Physician Trust were mediated by Social Support. These structural relationships were not significantly different for men and women. Conclusions: The hypothetical factor structure of physician trust was confirmed. Multiple pathways to physician trust suggest interrelationships between language/media use and social influences may be leveraged to reduce HIV testing and treatment delays during the processes of migration and accommodation. Directionality of associations will be established in longitudinal research currently underway.