HIV Stigma, Testing Attitudes and Health Care Access Among African-Born Men Living in the United States

Bova, Carol A.; Nnaji, Chioma; Woyah, Augustus; Duah, Akwasi

doi:10.1007/s10903-014-0136-2

Cited by 18 publications

(15 citation statements)

References 12 publications

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“…Expectations of community isolation for issues such as HIV, STIs and unplanned pregnancy contributed to low levels of testing and interactions with healthcare providers [ 29 , 31 ]. In the case of HIV, there was a perception that HIV only happened to ‘bad’ people, which lowered individual perception of risk [ 55 ]. Previous studies have identified the important role that addressing stigma and increasing social support has in improving knowledge, safe sex behavior and improving sexual health service uptake [ 44 , 52 , 56 , 57 , 58 ].…”

Section: Discussionmentioning

confidence: 99%

Sexual Health Help-Seeking Behavior among Migrants from Sub-Saharan Africa and South East Asia living in High Income Countries: A Systematic Review

Rade

Crawford

Lobo

et al. 2018

IJERPH

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The number of migrants has increased globally. This phenomenon has contributed to increasing health problems amongst migrants in high-income countries, including vulnerability for HIV acquisition and other sexual health issues. Adaptation processes in destination countries can present difficulties for migrants to seek help from and gain access to health services. This study examined migrants’ from sub-Saharan Africa (SSA) and South East Asia (SEA) sexual health help-seeking behavior in high-income countries with universal health coverage. The systematic review followed PRISMA guidelines and was registered with PROSPERO. Several databases were searched from 2000 to 2017. Of 2824 studies, 15 met the inclusion criteria. These consisted of 12 qualitative and three quantitative studies conducted in Australia, Spain, the United Kingdom, Belgium, Scotland, Ireland, and Sweden. Migrants experienced a range of difficulties accessing health services, specifically those related to sexual health, in high-income countries. Few studies described sources of sexual health help-seeking or facilitators to help-seeking. Barriers to access were numerous, including: stigma, direct and indirect costs, difficulty navigating health systems in destination countries and lack of cultural competency within health services. More culturally secure health services, increased health service literacy and policy support to mitigate costs, will improve health service access for migrants from SSA and SEA. Addressing the structural drivers for stigma and discrimination remains an ongoing and critical challenge.

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Section: Discussionmentioning

confidence: 99%

Sexual Health Help-Seeking Behavior among Migrants from Sub-Saharan Africa and South East Asia living in High Income Countries: A Systematic Review

Rade

Crawford

Lobo

et al. 2018

IJERPH

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“…We observed consistency in descriptions of stigma among participants from different regions of Africa and who entered HIV care at different time points over the past two decades. Many previous investigations have documented high levels of HIV-related stigma in the African immigrant community, [20][21][22][23] potentially driven by lower levels of both HIV knowledge and lower levels of risk perception compared to US-born persons. 8,21,24 Undocumented immigrants, who have less access to preventive health services and lower levels of educational attainment than persons with legal immigration status, 25,26 may depend to a higher degree on informal social support networks where HIV-related stigma is high.…”

Section: Discussionmentioning

confidence: 99%

“…21 Other studies of African immigrants at risk for or living with HIV have only peripherally examined the role of immigration status. 8,14,22,23,30,31 By exploring the fears, uncertainties, and structural factors undocumented African immigrants experience surrounding HIV testing and linkage to care, particularly as these relate to their immigration status and social networks, our study provides important insights into barriers to engagement in the earliest steps in the HIV care continuum.…”

Section: Discussionmentioning

confidence: 99%

Undocumented African Immigrants' Experiences of HIV Testing and Linkage to Care

Ross

Akiyama

Slawek

et al. 2019

AIDS Patient Care and STDs

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In the United States, undocumented African immigrants living with HIV enter care late, potentially leading to adverse individual and population health outcomes, yet little is known about the specific experiences of HIV diagnosis and linkage to care among this population. We conducted individual, semi-structured interviews with adults who were undocumented African immigrants living with HIV in New York City. Interviews explored perspectives regarding individual, social, institutional, and societal barriers and facilitators of HIV testing and linkage to care. Of 14 participants from 9 different African countries, 9 were women and the median age was 44 years (interquartile range: 42-50). Participants described fear of discovery by immigration authorities as a substantial barrier to HIV testing and linking to initial medical appointments. Actual and perceived structural barriers to both testing and care linkage included difficulty obtaining health insurance and a belief that undocumented immigrants are ineligible for any health services. Participants also expressed reluctance to be tested because of HIV-related stigma within the immigrant communities that they heavily relied on. After diagnosis, however, participants overwhelmingly described a positive role of health and social service providers in facilitating linkage to HIV care. Concerns about immigration status and HIV-related stigma are significant barriers to HIV testing and linkage to care among undocumented African immigrants. Multilevel efforts to reduce stigma and increase awareness of available services could enhance rates of HIV testing and care linkage in this population.

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“…In a recent assessment of 875 Black men with HIV risk behaviors in Brooklyn who reported multiple female partners and condomless sex in the past 6 months, 76% were FB Blacks and only 51% reported HIV testing in the past year (56). Reasons for low HIV testing rates among FB men have included privacy concerns and misconceptions about HIV transmission (66). Another study found that barriers to HIV testing for recent vs. long term immigrants were also due to health access, fatalism and anticipated HIV stigma (6).…”

Section: Fb Black Men and Multi-level Barriers To Hiv Testingmentioning

confidence: 99%

“…Community-level factors that impact HIV testing for both FB and US-born Black men include HIV-associated stigma (99)(100)(101)(102)(103), low normative expectations regarding HIV testing (53,104), and endorsement of HIV conspiracy beliefs and medical and/or government mistrust (66,105) that are rooted in historical societal abuses, which create distrust in HIV screening services and higher refusal rates when routine testing is offered (106,107). However, distinct to FB Black men, there is the challenge of assimilating to US culture and society that may similarly create barriers to access to health prevention screening (108)(109)(110), including HIV testing.…”

Section: Community-level Factorsmentioning

confidence: 99%

Intersectional Stigma and Multi-Level Barriers to HIV Testing Among Foreign-Born Black Men From the Caribbean

Taylor

DeHovitz

Hirshfield

2020

Front. Public Health

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Testing is the entry point into the HIV care continuum that includes linkage to and retention in prevention services, and adherence to prevention strategies, including repeat HIV testing. Despite US policy approaches to expand HIV testing to diverse clinical care and community settings, disparities in HIV testing among Black populations persist. Foreign-born (FB) Black persons from the Caribbean have higher annual rates of HIV diagnosis and a higher percentage of late-stage HIV diagnosis, compared with US-born Black persons; and most HIV infections among FB Blacks are among men. In this article, we provide an overview of HIV testing barriers among FB Black men who engage in HIV risk-taking behaviors (e.g., condomless sex with male and/or female partners of unknown HIV serostatus). Barriers to HIV testing for both FB and US-born Black men, include HIV stigma (anticipated, perceived, internalized), low perceived HIV risk, medical or government mistrust, and perceived low access to testing resources. We examine beliefs about masculinity and gender roles that may perpetuate heteronormative stereotypes associated with perceptions of low HIV risk and barriers to HIV testing. We also discuss the impact of recent immigration policies on accessing HIV testing and treatment services and how intersectional stigmas and structural forms of oppression, such as racism, prejudice against select immigrant groups, and homophobia that may further amplify barriers to HIV testing among FB Black men. Finally, we review comprehensive prevention approaches, and suggest innovative approaches, that may improve the uptake of HIV testing among FB Black men.

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HIV Stigma, Testing Attitudes and Health Care Access Among African-Born Men Living in the United States

Cited by 18 publications

References 12 publications

Sexual Health Help-Seeking Behavior among Migrants from Sub-Saharan Africa and South East Asia living in High Income Countries: A Systematic Review

Sexual Health Help-Seeking Behavior among Migrants from Sub-Saharan Africa and South East Asia living in High Income Countries: A Systematic Review

Undocumented African Immigrants' Experiences of HIV Testing and Linkage to Care

Intersectional Stigma and Multi-Level Barriers to HIV Testing Among Foreign-Born Black Men From the Caribbean

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