Older adults living with HIV (OALHIV) are a fast-growing demographic who rely on home and community care (HCC) services. Cultural safety (an environment free of racism that fosters feelings of safety and respect) is integral to HCC services. We conducted 27 semi-structured interviews with OALHIV in Vancouver, British Columbia about their HCC experiences. Excerpts about cultural safety were qualitatively analyzed using Two-Eyed Seeing. Our themes—Voices from across Turtle Island, Voices from the African continent, Western Perspectives, and Universal Principles—indicate that cultural safety is important yet lacking. While specific aspects of culturally safe HCC services varied between and within cultural groups, some aspects were shared by participants across groups (e.g., respect, compassion, and non-judgment).

Older adults living with HIV (OALHIV) (i.e., age ≥50) now constitute over 50% of all people accessing HIV treatment in British Columbia (BC), Canada. As OALHIV age, the need for supportive care in non-acute settings, including home and community care (HCC), is increasing. The Thrive research project was co-created alongside OALHIV in BC to support people to thrive with a good quality of life (as contrasted with just surviving). Phase 1 of the project linked treatment and demographic records for 5603 OALHIV accessing care in BC. Phase 2 took a community-based research approach with semi-structured interviews to understand obstacles and pathways experienced by 27 OALHIV in accessing HCC. This article summarizes previously published Phase 1 findings and explores Phase 2 findings in-depth. On the HCC journey traveled by OALHIV in BC, there are four main junctures at which obstacles and pathways appear: (1) before referral, (2) during the referral process, (3) at the assessment, and (4) while receiving services. Obstacles are largely related to fluctuating HCC priorities and funding cuts tied to election cycles, requiring systemic and policy changes to enable positive outcomes and impacts in the provision of HCC services. These obstacles can be transformed into pathways through public policy and client-centered, culturally safe care.

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