Mandatory HIV screening, migration and HIV stigma in Canada: exploring the experiences of sub-Saharan African immigrants living with HIV in western Canada

Abstract

Introduction In this mixed-methods pilot study, we examined the intersections of the current Canadian immigration policy, mandatory HIV screening during the Immigration Medical Exam (IME) and enacted and internalized stigma for HIV-positive immigrants from sub-Saharan Africa (SSA) in a western Canadian province. We focus on qualitative findings from this study. Methods Using the Internalized HIV Stigma Scale (IHSS), we collected data from eight immigrants from SSA living with HIV in a western Canadian province. We then conducted semistructured interviews with seven of the eight participants. Due to the small sample size, survey data were summarized using descriptive analysis. Qualitative data were analyzed through constant comparative analysis. Results The following key themes emerged from analysis of qualitative data: experiences of HIV-related emotional distress during the IME; varied experiences of HIV testing during the IME; and inconsistent patterns of linkage to medical care, psychosocial supports and engagement in the HIV care cascade. Conclusion Findings from this pilot study cannot be generalized to the broader population of immigrants living with HIV in Canada. However, we found that the experiences of internalized HIV stigma and enacted stigma during the IME potentially influence the long-term engagement in the HIV care cascade during the process of migration and settlement in Canada. Further study in this population is recommended to examine the intersections of current mandatory HIV screening process during the Canadian immigration process, migration, settlement, culture, stigma and engagement in the HIV care cascade.

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

“…After individual-level barriers, an inadequate clinical environment appeared to be the largest threat to retention in HIV care and treatment. 56 , 61 , 65 , 66 , 68 , 70 , 71 , 73 , 77 , 78 , 80 , 83–85 , 90 , 94 , 100 , 102 , 105 , 112 Several factors determined the inadequacy of a clinical environment for MLWH. Lack of space and capacity were associated with increased numbers of patients in clinics and thereby longer waiting times.…”

“…Failure to give MLWH sufficient or tailored information is likely to hinder linkage. 71,85 In addition, one study reported that women could be linked to HIV care through pregnancy and childcare services, while men appeared to lack a comparable front door to care. 65 Community-level barriers.…”

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

“…Immigration applicants living with HIV experience stigma within the Canadian IME, migration, and settlement process ( dela Cruz et al., 2020 ). Stigma is defined as an undesirable attribute of an individual that affects the person's status in society ( Goffman, 1963 ).…”

“…For example, dela Cruz and colleagues ( dela Cruz, 2014 ) found that many immigration applicants did not recall receiving any pre-test counseling, and thus were not even aware that they had been tested when they received their HIV-positive diagnosis during the IME. In another study, immigration applicants reported insensitive, flippant and cursory post-test counseling, leaving people with a sense of shame, fear and apprehension about their health and immigration prospects ( dela Cruz et al., 2020 ). Furthermore, participants rarely recalled receiving any advice, referrals or even reassurance from IME physicians about accessing treatment in Canada.…”

“…Appropriate post-HIV testing counselling is critical in supporting the person living with HIV and overall public health management of HIV. Inadequate post-test counseling, including follow up care and specialist referrals can result in HIV treatment interruptions or delays during the immigration and settlement process ( dela Cruz et al., 2020 ). Furthermore, insensitive delivery of a positive HIV test result can leave individuals with a sense of alienation from health care and support services.…”