Between silence and support: machismo, familismo, and HIV care among gay Latino men in South Texas.

In the USA, gay Latino men living with HIV face compounding marginalisation within both Latino and LGBTQ communities that shapes engagement across the HIV care continuum. The role of machismo and familismo in HIV status disclosure and antiretroviral therapy (ART) adherence among members of this population remains understudied, particularly in the Southern USA, where cultural values and conservative norms converge. Guided by an intersectional framework, the theory of planned behaviour, and cognitive appraisal theory, between September and October 2022, semi-structured interviews were conducted with 11 gay Latino men living with HIV (ages 21 to 60 or older) in South Texas. All interviews were conducted in English. Data were analysed using thematic analysis. Two themes revealed how machismo and familismo shaped HIV care engagement in contrasting ways. Latino cultural expectations and Southern conservatism created barriers through machismo expectations, a 'double silence', triple identity conflict, and gendered disclosure patterns. These same values became facilitators of ART adherence when support existed, through 'staying alive for family' and 'chosen family' motivations. Machismo and familismo simultaneously act as barriers to HIV status disclosure and motivators for ART adherence among gay Latino men living with HIV in South Texas. HIV care models should leverage familismo-driven motivations while addressing disclosure barriers.