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

Abstract

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.

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

“…Retained studies indicated that these populations often lacked knowledge and education about HIV care and services, and were often unfamiliar with the health care system and overarching culture in their host countries. 58 , 60 , 68 , 77 , 78 , 80 , 84 , 85 , 97 , 101 , 102 , 105 …”

“… 56 A multidisciplinary team including nurses, community health workers, case managers, social workers, or health advisors facilitated continuity of care for MLWH and helped address several barriers. 56 , 77 , 79 , 81 , 84 , 86 , 95 , 96 , 100 , 101 , 112 For instance, team members in some jurisdictions found ways to obtain care for MLWH without health insurance. 56 , 77 , 81 They also resolved critical needs such as those related to housing, acquiring health insurance, receiving food assistance, and accompaniment of MLWH to clinical or legal appointments.…”

“… 56 , 77 , 81 They also resolved critical needs such as those related to housing, acquiring health insurance, receiving food assistance, and accompaniment of MLWH to clinical or legal appointments. 56 , 79 , 95 , 100 , 101 …”

“… 63 In two other studies, the importance of having integrated community-based interventions or services was highlighted, which may have facilitated MLWH's retention in HIV care and treatment. 78 , 101 …”

Racial and ethnic disparities in HIV diagnoses among heterosexually active persons in the United States nationally and by state, 2018

“…Lastly, the higher observed rates among Black women may be partially a surveillance artifact. Black women who move to the US from countries with high HIV prevalence are more likely to be diagnosed late and enter care late [ 51 , 52 ]; these individuals are identified as new diagnoses in surveillance systems.…”