Barriers to and facilitators of accessing HIV services for street-involved youth in Canada and Kenya

Abstract

Introduction UNICEF estimates that there are as many as 100 million street-involved youth (SIY) globally. Marginalized conditions put SIY at higher risk of HIV and adverse outcomes once HIV-positive. The objective of this analysis was to describe barriers and facilitators of accessing HIV prevention, testing, and treatment services as Phase I of an implementation study evaluating the use of peer navigators to increase access to HIV services. Methods Semi-structured interviews, focus group discussions (FGD), and theatre testing were conducted with individuals who identify as SIY, health care providers, and community stakeholders living in Canada (Toronto, Montreal, London) and Kenya (Eldoret, Huruma, Kitale). Data were analyzed using a directed content approach, guided by the socio-ecological model (SEM). Results Across the six sites were 195 participants: 64 SIY, 42 healthcare providers, and 97 community-based stakeholders. Barriers were identified at the societal (e.g. intersectional stigma and discrimination), public policy (e.g., inadequate access to basic needs, legal documentation, lack of health insurance, and limited community-based funding), institutional (e.g. lack of inclusive education and training, inadequate HIV educational outreach, and restrictive service provision), interpersonal (e.g., ineffective communication from healthcare providers), and intrapersonal levels (e.g. lack of trust and associated fear, low perception for healthcare, and lack of self-esteem). These contributed to limited HIV services utilization among SIY. Conversely, numerous facilitators were also identified at the public policy (e.g. affordable HIV services and treatment), institutional (e.g. available and accessible HIV prevention tools, HIV education and awareness programs, and holistic models of care), interpersonal level (e.g., systems navigation support, peer support, and personal relationships), and intrapersonal levels (e.g. self-efficacy) as positively supporting SIY access to HIV services. Conclusion Intersectional stigma was a critical barrier in all sites, and policies and programs that foster welcoming environments for youth from diverse backgrounds and living circumstances may be better able to respond to the HIV service needs of this high risk population. Social support and navigation services were reported to facilitate access to HIV services in all sites.

COVID-19 Vaccination among a Population Experiencing Homelessness: A Survey in Italy

“…The reason for the lack of using this source might be that homeless people may have more difficulty in accessing a primary care physician or preventive healthcare services and in obtaining health information; therefore, there is a lack of opportunity to improve their level of knowledge. This is consistent with the broader literature showing that the physician-patient relationship acts as a barrier for underserved communities, and such individuals may access healthcare services less often [47][48][49] as well as the observation that the COVID-19 pandemic has negatively affected access to health-related information and sources of healthcare worldwide [50][51][52][53]. On the other hand, the surveyed respondents indicated that the most common information resources used were mass media and the internet.…”

Barriers and facilitators to implementing Advanced HIV Disease screening at secondary referral hospital -Malawi: Asequential exploratory mixed method-study

“…Most respondents reported poor AHD screening coordination among implementers due to communication challenges owing to the absence of ground telephone system and other social platforms for communicating and sharing relevant AHD updates. Communication system barriers existing between healthcare providers and their clients have also been documented elsewhere [24]. Thus, the use of social mobile platforms (SMPs) with instant messaging applications such as WhatsApp is highly recommended.…”

“…AHD services could also be integrated into ART and TB programmes which are well established and su ciently supported by MoH PEPFAR implementing partners. Integration of related health programs reduces duplication of services, is cost-effective, and as well as e cient [23,24].…”

How the COVID-19 Pandemic Influenced HIV Care: Are We Prepared Enough for Future Pandemics? An Assessment of Factors Influencing Access, Utilization, Affordability, and Motivation to Engage with HIV Services amongst African, Caribbean, and Black Women

“…Likewise, other studies showed that COVID-19 pandemic resulted in fear and low motivation to use health services and maintain adherence. This lack of motivation was due to low income and hunger, which took priority over adherence to appointments and medications [36,37]. Nevertheless, for some other participants, their motivation to use HIV care services was not affected by the pandemic.…”