Disparities in access to and use of HIV-related health services in the Netherlands by migrant status and sexual orientation: a cross-sectional study among people recently diagnosed with HIV infection

Abstract

BackgroundMigrants often face barriers to accessing healthcare. We examined disparities in access to and use of HIV-related health services between migrant and non-migrant people recently diagnosed with HIV living in the Netherlands, taken into account sexual orientation. Also, we examined differences in experiences in living with HIV between these groups.MethodsWe used a questionnaire and clinical data collected between July 2013 and June 2015 among migrant and non-migrant participants of the European cross-sectional aMASE (Advancing Migrant Access to health Services in Europe) study in the Netherlands. Using univariable logistic regression analyses, we compared outcomes on between migrants and non-migrants, stratified by sexual orientation (with non-migrant men having sex with men [MSM] as the reference group).ResultsWe included 77 migrant MSM, 115 non-migrant MSM, 21 migrant heterosexual men, 14 non-migrant heterosexual men and 20 migrant women. In univariable analyses, all heterosexual groups were less likely to ever have had an HIV-negative test before their diagnosis and were more likely to be diagnosed late than non-migrant MSM. All migrant groups were more likely to have experienced difficulties accessing general healthcare in the Netherlands and were less likely to have heard of post-exposure prophylaxis than non-migrant MSM. Migrants frequently reported uncertainty about their rights to healthcare and language barriers. Most (93%) participants visited a healthcare facility in the 2 years before HIV diagnosis but only in 41% an HIV test was discussed during that visit (no statistical difference between groups). Migrant heterosexuals were more likely to have missed appointments at their HIV clinic due to the travel costs than non-migrant MSM. Migrant MSM and women were more likely to have experienced HIV discrimination in the Netherlands than non-migrant MSM.ConclusionDisparities in access to and use of HIV-related health services and experiences exist by migrant status but also by sexual orientation. Our data suggests heterosexual men and women may particularly benefit from improved access to HIV testing (e.g., through provider-initiated testing), while migrant MSM may benefit from improved access to HIV prevention interventions (e.g., pre-exposure prophylaxis).

Barriers and Facilitators Affecting the HIV Care Cascade for Migrant People Living with HIV in Organization for Economic Co-Operation and Development Countries: A Systematic Mixed Studies Review

“…Lack of proficiency in the host country's language among MLWH was the second most reported barrier impeding initial access to care and treatment at the individual level. 56 , 58 , 62 , 63 , 65 , 66 , 68 , 70 , 77 , 80 , 82 , 85 , 86 , 94 , 102 , 105 Language seemed to amplify navigation-related challenges in particular. 77 , 102 For example, physically navigating clinics and hospitals in North Carolina was made difficult due to lack of Spanish signage.…”

“…58,60,68,77,78,80,84,85,97,101,102,105 Concerns, uncertainty, or lack of awareness regarding their eligibility for care as a result of their immigration and HIV status seemed to delay MLWH's entry into HIV care and treatment. 58,60,62,65,75,81,94,100,101,105 In cases where MLWH could be eligible for subsidized or free HIV care and treatment, delays were potentially experienced by some due to lack of relevant documentation. 70,77,110 For example, in some jurisdictions, proof of residence was required to receive free medical examinations.…”

Impact of infectious disease epidemics on xenophobia: A systematic review

“…Sixteen studies were considered eligible for inclusion ( Fig. 1 ) ( Bil et al., 2019 ; He et al., 2020 ; Krings et al., 2012 ; Gilles et al., 2013 ; Huang et al., 2011 ; Joffe et al., 2011 ; Des Jarlais et al., 2006 ; Zheng et al., 2005 ; Rzymski and Nowicki, 2020 ; Kam, 2019 ; Stuermer et al., 2017 ; Earnshaw et al., 2019 ; Kim et al., 2016 ; Prati and Pietrantoni, 2016 ; Goodwin and Sun, 2014 ; Eicher et al., 2014 ).…”

“…For example the 1860–1890 epidemic in San Francisco, US, where Chinese migrants were perceived as smallpox carriers and blamed for spreading the disease, supposedly because they had disregarded the sanitary laws, although the number of infected people were still lower among the Chinese population ( Craddock, 1995 ). Humans have been affected by six pandemics/epidemics since 1900: the 1918 influenza pandemic, the 1957–1958 H2N2 virus pandemic, the 1968 H3N2 pandemic, the 1981 – today HIV/AIDS epidemic, the 2009 H1N1 pandemic and the novel Coronavirus disease 2019 (COVID-19) pandemic ( Bil et al., 2019 ; Eisinger and Fauci, 2018 ). As emerging infectious diseases are expected to increase over time ( Jones et al., 2008 ), it is important to understand their full societal effects.…”

Migration and Sexual Health Services Use – Results from the German Health and Sexuality Survey (GeSiD)

“…Migrant populations in Canada and Germany were found to have lower vaccination proportions against human papillomaviruses (HPV), and have a lower awareness towards the HPV immunization compared to the native population (Remschmidt et al, 2014;Sadry et al, 2013). In the Netherlands, migrants were later diagnosed with HIV, and had a higher likelihood of experiencing difficulties in the use of general healthcare services as well as a lower awareness towards post-exposure prophylaxis than non-migrants (Bil et al, 2019). A lower knowledge about different sexually transmitted infections (STIs) was also found in 9th grade school children with a migration background in a sample in Germany compared to non-migrant children (von Rosen et al, 2018).…”