HIV risk and barriers to care for African-born immigrant women: a sociocultural outlook

Abstract

BackgroundData from the Minnesota Department of Health (MDH) HIV/AIDS Surveillance Report 2015 show that African-born (AB) women continue to be disproportionately affected by HIV. In 2015, these women accounted for more than half (54%) of all new cases of HIV reported among females in Minnesota and 34% of all known female cases in the state. This study was a needs assessment for HIV pre-exposure prophylaxis (PrEP) in vulnerable subgroups within the AB population and adequacy of HIV care for AB persons. The primary objective of this study was to gain an insight into the strategies that will limit the spread of HIV infection and enhance HIV care among AB immigrants.MethodsCommunity advocates, community-based organizations (CBOs), clinicians, and other HIV-related service providers were invited to participate in a focus group, structured interview or complete an assessment tool using the same questionnaire about HIV and PrEP among AB persons. A thematic analysis was then conducted on the open-ended questions addressing perceived barriers.ResultsFindings suggest the following gender-specific sociocultural factors that drive HIV transmission and constitute barriers to HIV treatment for AB women: domestic/intimate partner violence, gender-biased stigma, discriminatory cultural beliefs and normative values/expectations, unprotected sex with husbands who have sex with other men, gender discordance in health care (preference for female provider), and sexual/reproductive health illiteracy.RecommendationBased on recommendations, a community-based sexual and reproductive health education is being initiated with a curriculum that will be 1) broad (inclusive but not limited to HIV), 2) culturally sensitive/responsive, and 3) at appropriate literacy level for all women, including those who have little or no formal education.

Attitudes and beliefs of immigrants regarding HIV and AIDS in Mopani district, South Africa

“…Furthermore, there is an assumption that once a woman enters into a contract of marriage, the husband has the right to unlimited sexual access to his wife (Jewkes, Dunkle, Nduna, & Shai, 2010;Rodrigues et al, 2019). Similarly, the study by Okoro and Whitson (2017) found that culturally, women were expected to be subordinate to men and were dictated by customs accordingly. The authors further indicated that women were not empowered to deal with issues of sexual abuse, and therefore, they are unwilling to discuss the experiences with others.…”

“…The current study findings reveal that immigrants need to be empowered to deal with sociocultural barriers that are firmly entrenched and influence their behaviours, ignorance on sexual health and the need to develop 'destigmatise HIV' strategies. The lack of sexual health literacy by African immigrant women was also a key finding in the studies conducted by Okoro and Whitson (2017). The authors, therefore, recommended that sexual and reproductive health education needs to be both culturally responsive and at an appropriate literacy level (Okoro & Whitson, 2017).…”

HIV Infection-Related Care Outcomes among U.S.-Born and Non-U.S.-Born Blacks with Diagnosed HIV in 40 U.S. Areas: The National HIV Surveillance System, 2016

“…These differences can exacerbate negative health outcomes at the individual, interpersonal, community, and societal levels [ 8 ]. Non-U.S.-born persons with HIV infection can experience discrimination based on syndemic factors, including socioeconomic disadvantages and immigration-related legal problems in addition to their HIV infection [ 9 , 10 ].…”

Perspectives on Factors Related to HIV Risk and Preventative Interventions at Multiple Levels: A Study of African Immigrant Women Survivors of Cumulative Trauma

“…In the HIV surveillance data from multiple regions in the U.S. (California, Georgia, King County [Washington State], Massachusetts, Minnesota, New Jersey, New York City, and Virginia), AI accounted for 3.8% of HIV diagnoses, though they constituted only 0.6% of the population (Kerani et al, 2008; Koku et al, 2016). Studies point to a disproportionate burden of human immunodeficiency virus (HIV) among AI women (AIW) in the U.S. (Blanas et al, 2013; Kerani et al, 2008; Okoro & Whitson, 2017). Approximately 41% of HIV diagnoses in the eight US regions occurred among AIW (Blanas et al, 2013; Kerani et al, 2008; Koku et al, 2016).…”

“…In a study of practitioners serving AI in Minnesota, factors increasing HIV risk among AI included intimate partner violence (IPV), gender-based stigma, cultural beliefs, unprotected sex with husbands who have sex with other men and sexual/reproductive health illiteracy (Okoro & Whitson, 2017). AIW are likely to have experienced trauma pre-migration (Andersson et al, 2008; Small, Nikolova, & Narendorf, 2013) as well as post-migration (Akinsulure-Smith, Chu, Keatley, & Rasmussen, 2013; Mose & Gillum, 2016; West, 2016).…”