All Black People Are Not Alike: Differences in HIV Testing Patterns, Knowledge, and Experience of Stigma Between U.S.-Born and Non–U.S.-Born Blacks in Massachusetts

Abstract

Non-U.S.-born black individuals comprise a significant proportion of the new diagnoses of HIV in the United States. Concurrent diagnosis (obtaining an AIDS diagnosis in close proximity to an initial diagnosis of HIV) is common in this subpopulation. Although efforts have been undertaken to increase HIV testing among African Americans, little is known about testing patterns among non-U.S.-born black people. A cross-sectional survey was self-administered by 1060 black individuals in Massachusetts (57% non-U.S.-born) to assess self-reported rates of HIV testing, risk factors, and potential barriers to testing, including stigma, knowledge, immigration status, and access to health care. Bivariate analysis comparing responses by birthplace and multivariate logistic regression assessing correlates of recent testing were completed. Non-U.S.-born individuals were less likely to report recent testing than U.S.-born (41.9% versus 55.6%, p < 0.0001). Of those who recently tested, the majority did so for immigration purposes, not because of perceived risk. Stigma was significantly higher and knowledge lower among non-U.S.-born individuals. In multivariate analysis, greater length of time since immigration was a significant predictor of nontesting among non-U.S.-born (adjusted odds ratio [AOR] 0.56, 95% confidence interval [CI] 0.36-0.87). Poor health care access and older age were correlated to nontesting in both U.S.-and non-U.S.-born individuals. Our findings indicate that differences in HIV testing patterns exist by nativity. Efforts addressing unique factors limiting testing in non-U.S.-born black individuals are warranted.

Sexually Transmitted Infection Related Stigma and Shame Among African American Male Youth: Implications for Testing Practices, Partner Notification, and Treatment

“…13,15,23,29 Some have attributed this to ''anticipated stigma,'' which can be measured using a different scale, and is designed to assess the extent to which individuals anticipate negative intra-and interpersonal consequences should they contract HIV/STIs in the future, and operates independently of personal endorsement of stigmatizing beliefs or stereotypes. 30,31 Although our research did not investigate anticipated stigma or potential delays in seeking care, we did see a large percentage of youth not seeing doctors regularly (34%). However in this area of San Francisco, where outreach services are numerous, a large proportion of men had been tested for STI and HIV, although approximately 18% of those tested had been tested in jail or juvenile hall; in California, all youth are STI tested at entry to correctional unit facilities.…”

Late HIV Diagnosis: Differences by Rural/Urban Residence, Florida, 2007–2011

“…41,42,[53][54][55][56][57][58][59] Having an undocumented immigration status was associated with not ever being tested for HIV in a study in South Flordia. 52 Reasons identified in other studies for foreign birth being associated with delayed diagnosis include stigma, 56,60,61 language barriers, 58,61 and less knowledge about HIV. 56,61 Late HIV/AIDS diagnosis in urban areas was associated with heterosexual compared with MSM and IDU modes of HIV transmission.…”

Barriers and Facilitators to HIV Testing in Migrants in High-Income Countries: A Systematic Review

“…Research on migrants in Australia, the US, Canada and Europe highlight migrants' vulnerability to HIV, with rates exceeding those of the general host population [7][8][9][10][11][12]. A striking example of this comes from Belgium where, between 2002 and 2006, figures showed that, despite accounting for \1 per cent of the population, migrants from Sub-Saharan Africa accounted for nearly half (45.7 per cent) of newly diagnosed cases of HIV [11].…”