Immigrant women living with HIV in Spain: a qualitative approach to encourage medical follow-up

Abstract

BackgroundImmigrant women living with HIV generally have worse adherence to medical treatment and follow-up when compared to native women and immigrant or native men. The general aim of this study was to improve healthcare services for HIV-positive women and to better understand why some of them discontinue treatment. The specific objectives were: (1) to explore the barriers and facilitators to medical follow-up among women and (2) to use the findings to create a guide for healthcare professionals with strategies and tools to encourage the immigrant women to continue with their healthcare treatment.MethodsWe conducted a qualitative, patient-centred research based on semi-structured interviews in order to understand the drivers and barriers for HIV positive immigrant women to adhere to medical follow-up. A total of 26 women in active or discontinued treatment (from sub-Saharan Africa (10), Latin America (8) and Spain (8)) were interviewed in 2012 using a purposive sampling methodology. The semi-structured interviews were transcribed and analysed based on the grounded theory approach and the framework method. Three researchers took part in the triangulation of results.The study was approved by the Ethical Committee of the Hospital Universitario Ramón y Cajal.ResultsThe study revealed eight categories that impacted adherence to treatment and medical follow-up: doctor-patient relationship, relationship between body and HIV, employment, gender roles, representations of AIDS, emotional support received, trust in biomedical system, and psychological condition. Specific barriers and facilitators related to these categories were identified. In immigrant women, the influence of these barriers was greater than in Spanish women.Recommendations for healthcare professionals based on this study have been compiled in an informative brochure.ConclusionsSocial, cultural, and psychological aspects as well as self-perception of body changes, gender roles, and the relationship with the healthcare system, are key elements that may affect the adherence to medical treatment of immigrant women living with HIV.Qualitative research focused on the comprehensive experience of living with HIV can be useful for creating tools that pave the way to detect barriers and facilitators to medical follow-up in specific populations.

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

“…All selected studies included migrants from Southeast Asia and sub-Saharan African countries living in high income countries, specifically those with UHC. Of these 15 studies, seven were conducted in Australia [ 26 , 27 , 28 , 29 , 30 , 31 , 32 ]; two in the UK [ 33 , 34 ] and one study in Sweden [ 35 ], Ireland [ 36 ], Spain [ 37 ], Belgium [ 38 ], and Scotland respectively [ 39 ]. Of the 15 studies, eight studies examined migrants from sub-Saharan African countries [ 29 , 31 , 33 , 34 , 36 , 38 , 39 , 40 ]; two studies examined migrants from Southeast Asia countries [ 26 , 35 ]; and five studies explored migrants from mixed regions [ 27 , 28 , 30 , 32 , 37 ].…”

Provider-Initiated HIV Testing for Migrants in Spain: A Qualitative Study with Health Care Workers and Foreign-Born Sexual Minorities

“…Strategies deployed to communicate test results that “cheat users a bit” (E.g. asking an HIV+ user for consent to test for HIV after the test has already been performed) could undermine this crucial factor to effectively promote HIV uptake amongst migrants [ 56 , 57 ].…”

Women from afar: an observational study of demographic characteristics and mortality among foreign‐born women living with HIV in the Women’s Interagency HIV Study (WIHS) in the United States 1994‐2016

“…In this study of the demographic characteristics and mortality of foreign‐born WLWH in the WIHS, we found that most were young and educated, but low income and often unemployed. Age, education, income, employment, social support and access to health services as well as changing HIV treatment guidelines have been highlighted as critical determinants of health and some studies have suggested that these micro and macro factors exert powerful influences on long‐term outcomes and death among foreign born persons[14‐17,27‐29]. Our findings reveal that these demographic characteristics, including access to health insurance and use of ART are all significantly associated with birthplace and are critical to long‐term health outcomes.…”

“…Foreign‐born populations, especially women are generally disadvantaged in terms of accessing health care due to a complex set of social and structural factors [5,9‐11], all of which exert powerful negative influences on short‐ and long‐term health outcomes[6,9,12‐17]. Studies suggest that foreign‐born women are more susceptible to the less desirable outcomes of HIV due to low socioeconomic and educational status, language barriers, poor access to health providers, lack of transportation, and lack of documented legal status, among others, and may be negatively impacted in accessing or utilizing services because of similar factors [17,18].…”