“I die silently inside”. Qualitative findings from a study of people living with HIV who migrate to and settle in Canada

Cruz, Añiela M. dela; Maposa, Sithokozile; Patten, San; Abdulmalik, Inusa; Magagula, Patience; Mapfumo, Sipiwe; Abate, Tsion Demeke; Carter, Andrea; Spies, Peggy; Harrowing, Jean N.; Hall, Marc; Afzal, Arfan Raheen; Caine, Vera

doi:10.1016/j.jmh.2022.100088

Cited by 6 publications

(5 citation statements)

References 41 publications

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“…We saw how disparate provincial subsidies for allied health care, and disparate criteria for medication coverage [28] could disrupt access to HIV care continuity and equity. The challenge of scarce speciality resources in rural settings, changes to employment and health insurance, and relocation-that were reported by our participants-are consistent with prior work showing how economically disadvantaged persons may be compelled to juggle adherence to HIV treatment and care with access to private insurance and ability to pay out-of-pocket expenditures [26,29].…”

Section: Discussionsupporting

confidence: 89%

“…Racialized persons and especially immigrants were more frequently represented in these narratives in our study. These findings reverberate with the findings of other studies conducted in Canada with racialized newcomers affected by HIV [26,27]. Logie and colleagues suggest that couples in Canada who report difficulties in accessing healthcare services due to immigration, drug use, employment precariousness, incarceration, and other marginalizing circumstances require more intensive support from their family, friends, and local communities [9].…”

Section: Discussionmentioning

confidence: 68%

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“Live a normal life”: Constructions of resilience among people in mixed HIV status relationships in Canada

et al. 2023

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Positive Plus One is a mixed-methods study of long-term mixed HIV-serostatus relationships in Canada (2016–19). Qualitative interviews with 51 participants (10 women, 41 men, including 27 HIV-positive and 24 HIV-negative partners) were analyzed using inductive thematic analysis to examine notions of relationship resilience in the context of emerging HIV social campaigns. Relationship resilience meant finding ways to build and enact life as a normal couple, that is, a couple not noticeably affected by HIV, linked to the partner with HIV maintaining viral suppression and achieving “undetectable = untransmittable” (U = U). Regardless of serostatus, participants with material resources, social networks, and specialized care were better able to construct resilience for HIV-related challenges within their relationships. Compared to heterosexual couples and those facing socioeconomic adversity, gay and bisexual couples were easier able to disclose, and access capital, networks and resources supporting resilience. We conclude that important pathways of constructing, shaping, and maintaining resilience were influenced by the timing of HIV diagnosis in the relationship, access to HIV-related information and services, disclosure, stigma and social acceptance.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 68%

“Live a normal life”: Constructions of resilience among people in mixed HIV status relationships in Canada

et al. 2023

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“…Additionally, those from Africa or the Caribbean, those who were less than 35, and those who were not fluent in French experienced a significantly higher degree of internalized stigma. To some extent, these findings are consistent with those of other studies conducted in Canada and other regions among MLWH, PLWH, and general populations of international migrants [47][48][49][50][51][52][53][54][55][56].…”

Section: Psychosocial Vulnerabilitiessupporting

confidence: 91%

Patient-reported outcomes and experiences of migrants enrolled in a multidisciplinary HIV clinic with rapid, free, and onsite treatment dispensation: the ‘ASAP’ study

Arora,

Vicente,

Engler

et al. 2024

AIDS Res Ther

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Background Scholars recommend providing migrants living with HIV (MLWH) with free treatment, rapidly, once linked to care to optimize their HIV-related experiences and health outcomes. Quantitative evaluations of patient-reported measures for MLWH in such models are necessary to explore the viability of these recommendations. Methods Within a 96-week prospective cohort study at a multidisciplinary HIV clinic, participants received bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) for free and rapidly following care linkage. Eight patient-reported measures were administered at weeks 4, 24, and 48: (1) mMOS-SS to measure perceived social support; (2) IA-RSS to measure internalized stigma; (3) K6 to measure psychological distress; (4) PROMIS to measure self-efficacy with treatment taking; (5) G-MISS to measure perceived compliance with clinicians’ treatment plans; (6) HIVTSQ to measure treatment satisfaction; (7) CARE to measure perceived provider empathy; and (8) PRPCC to measure perceived clinician cultural competence. Linear mixed modelling with bootstrapping was conducted to identify significant differences by sociodemographics and time. Results Across weeks 4, 24, and 48, results suggest that MLWH enrolled in this study experienced moderate levels of social support; elevated levels of HIV-related stigma; moderate levels of distress; high self-efficacy with daily medication self-management; great compliance with clinicians’ treatment plans; high treatment satisfaction; high perceived empathy; and high perceived cultural competence. Experience of social support (i.e., mMOS-SS scores) differed significantly by birth region. Experience of HIV-related stigma (i.e., IA-RSS scores) differed significantly by birth region, age, and language. Experience of distress (i.e., K6 scores) differed significantly by sexual orientation. Experience of treatment satisfaction (i.e., HIVTSQ scores) differed significantly by birth region and age. No significant differences were identified by time for any measure. Conclusion Overall, participants expressed positive experiences around treatment and care, alongside comparably lower perceptions of social support, internalized stigma, and distress, potentially underscoring a need to embed targeted, well-funded, and accessible mental health support within HIV care models.

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“…Panel physicians prioritized notifying public health agencies about HIV diagnosis over linking immigrants to care, as public health policy requires panel physicians and diagnostic centers to forward all HIV positive results to the responsible public health agency. These findings are consistent with those from other studies that have examined the impact of immigration and public health policies and institutional practices on HIV testing, linkage to healthcare, psychosocial support, and engagement in the HIV care cascade [65,[80][81][82].…”

Section: Plos Global Public Healthsupporting

confidence: 91%

Unmasking legislative constraints: An institutional ethnography of linkage and engagement in HIV healthcare for African, Caribbean, and Black people in Ontario, Canada

Odhiambo

Forman

Nelson

et al. 2022

PLOS Glob Public Health

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The Human Immunodeficiency Virus (HIV) epidemic significantly impacts African, Caribbean, and Black (ACB) immigrants in Canada. Health scholarship has revealed striking injustices within Canada’s public healthcare system that restrict access to healthcare and violate the human rights of ACB immigrants living with HIV who are marginalized. We conducted an institutional ethnography to comprehensively understand how HIV healthcare in Ontario is organized and experienced by ACB immigrants, focusing on unjust and discriminatory legislative frameworks and institutional practices regulating access to publicly funded healthcare resources and services. We interviewed 20 ACB immigrants and 15 healthcare workers, including specialists, primary care providers, immigration physicians, and social workers. We found a disjuncture between the organization of HIV healthcare in Ontario and how ACB immigrants experienced access to care. We uncovered how immigration, public health and healthcare laws and related institutional practices intersect to produce structural violence which create barriers and missed opportunities to timely linkage and engagement in HIV healthcare. Black immigrants’ accounts revealed that they underwent mandatory HIV under the Immigration Medical Examination policy (IME) without providing informed consent and receiving pre and post-test counselling. Furthermore, Black immigrants did not receive referrals and were not adequately linked to care following HIV diagnosis. Troubling encounters with immigration and public health state agents and healthcare legislative barriers including difficulty finding a physician, the 3-month waiting period under the Ontario Health Insurance Plan (OHIP), long wait times, lack of drug coverage, and stigma, discrimination, and anti-Black racism shaped and affected Black people’s linkage and engagement in HIV care. We elucidate how the legislative and structural organization of healthcare regulated and constrained health service access for ACB immigrants living with HIV, including their ability to “achieve” HIV undetectability.

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“I die silently inside”. Qualitative findings from a study of people living with HIV who migrate to and settle in Canada

Cited by 6 publications

References 41 publications

“Live a normal life”: Constructions of resilience among people in mixed HIV status relationships in Canada

“Live a normal life”: Constructions of resilience among people in mixed HIV status relationships in Canada

Patient-reported outcomes and experiences of migrants enrolled in a multidisciplinary HIV clinic with rapid, free, and onsite treatment dispensation: the ‘ASAP’ study

Unmasking legislative constraints: An institutional ethnography of linkage and engagement in HIV healthcare for African, Caribbean, and Black people in Ontario, Canada

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