Accessing primary care: HIV+ Caribbean immigrants in the Bronx

This article describes an ecology of health seeking behavior among Bronx residing HIV+ Caribbean immigrants participating in an arm of a U.S. government-funded multi-site evaluation of peer services in the utilization of HIV primary care. Standardized repeat measures were administered at baseline and three four-month intervals. Clinical markers were obtained through medical chart review. Additionally, local data included ethnographic interviews, focus groups, and progress notes. Clinical outcomes were positive for the 55 subjects, 23 of whom were undocumented. Alienation from family, women's vulnerability to family violence, and difficulties with disclosure, employment, and health care were compounded by undocumented immigration status. Retention was encouraged by the community based site, high levels of peer interaction, and supportive services. Without consideration of broader contexts, peer driven interventions are potentially limited and the realities of immigrant health care are misunderstood through lack of recognition of competing needs.