TABLE 1.

Common Barriers to Linking or Retaining HIV-Infected Patients in HIV Medical Care

Barriers (Reference Number)	Examples of Potential Means of Mitigating Barriers
Psychosocial
Low self-efficacy19	Strength-based case management
Health illiteracy19	HIV counseling and education, appropriate and varied educational materials
Concerns for confidentiality20	Explain and post confidentiality protections, provide private spaces for triage and examination
Concerns for stigma21	Nonjudgmental and inclusive approach and clinic environment
Language barriers19,22	Access to translation services through staff on site or by phone
Cultural barriers16,22	Cultural competency training, hiring cultural concordant staif
Substance use23	Screening for, and access or referrals to, substance-abuse programs
Mental illness16	Screening for, and access or referrals to, mental health services
Isolation20	Peer patient navigation, support group, case management
Socioeconomic
Homeless17	Access to HIV/AIDS housing resources
Poverty16,17	Access to jobs training, social security disability benefits, or poverty reduction programs.
Lack of transportation18	Providing HIV care appointments at locations convenient to the patient; directly providing transportation assistance
Lack of insurance16,18	Providing health insurance enrollment service at the clinic or referrals to such
Health care system Complexity of health care systems17,18	Colocating HIV care and STD clinics; strong referral or linkage systems
Complexity of insurance systems18,19	Providing health insurance enrollment service at the clinic or referrals to such; ongoing support and education for using benefits