An exploratory study on the mental health of immigrants, refugees and non-status people living with HIV in Toronto

Abstract

Purpose -Canadian HIV/AIDS researchers, service providers and policy-makers are faced with new challenges of providing effective and inclusive care that meets the needs of the changing populations infected with and affected by HIV. Since 2005 immigrants and refugees from ethno-racial minority communities have comprised close to 20 percent of all new HIV infections in Canada. Anecdotes shared by PLWHAs and service providers indicated that mental health challenges faced by newcomer PLWHAs was a priority concern for HIV prevention, treatment and care. This paper reports on the results of an exploratory study, which examined the complex factors that influence the mental health of immigrants and refugees living with HIV/AIDS (IR-PLWHAs). Design/methodology/approach -This exploratory study is informed by a critical social science paradigm, which acknowledges that the everyday reality is shaped by interlocking systems of social processes and unequal power relations. The paper used a qualitative interpretative design and focus groups to explore the intersecting effects of living with HIV/AIDS, migration and settlement, and HIV stigma and discrimination on the mental health of IR-PLWHAs. Findings -The paper found that in addition to social and economic marginalization, IR-PLWHAs experienced multiple stressors associated with their HIV status: neurocognitive and physical impairments, HIV stigma and discrimination, and fear of deportation. The paper also found that the experiences of stigma and discrimination among IR-PLWHAs were complex and contextual, closely linked to their social positions defined by the intersecting dimensions of race, class, gender, citizenship, sexualities, body norms, and HIV status. The paper concludes that effective HIV prevention, treatment and care, and mental health promotion in newcomer and ethno-racial minority communities must consider the bio-psycho-social connections of different stressors and the interlocking systems of oppression faced by IR-PLWHAs. Research limitations/implications -This study was exploratory in nature with a small number of participants who were recruited through AIDS organizations in Toronto. Consequently, the recruitment strategy may reach only those who were connected to the AIDS organizations. The paper believes that IR-PLWHAs who were not connected to the AIDS organizations might experience even more social exclusion and marginalization. These factors may limit the transferability of this study. Originality/value -This is the first study that explores the bio-psycho-social connections and intersecting determinants of mental health among immigrants and refugees living with HIV and AIDS in Canada. The results of this study contribute to cross-sector dialogue among practitioners and researchers in the HIV/AIDS, mental health, and immigration and settlement services sectors. Keywords Mental health, Bio-psycho-social connections, HIV/AIDS, Immigrants and refugees, Intersecting determinants of health, Stigma and discrimination Paper type Research paper

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

“…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].…”

“…It is well recognized that migrants often experience higher levels of stigma, mental illness, and challenges with accessing, building, and maintaining social support [ 51 ]. The further burden of living with HIV can amplify these challenges [ 8 , 15 , 50 , 52 , 53 ]. For example, whereas migrants in general struggle with obtaining legal status in their new country, newly-diagnosed MLWH express heightened concern around deportation as a result of stigma, discrimination, and fear from their positive diagnosis [ 8 , 15 ].…”

Viewpoints of Other Scientists on Migration, Mental Health and PTSD: Review of Relevant Literature

“…In addition, the consequences of these stressors may be more profound on immigrants and refugees living with HIV/AIDS infection (IR-PLWHAs). In an exploratory study, Wong, Li, Poon, and Fung (2013) showed that IR-PLWHAs suffer economic and social marginalization, stigma and discrimination which are closely connected to their gender, race, sexualities, citizenship, HIV status, and social class.…”

Toward health equities, social justice, and emancipatory calls for knowledge development in nursing

“…Generally, there are groups, including immigrants and refugees, that are reluctant to seek health care due to different cultural beliefs and practices. [32][33][34] In order to address the needs of such groups, the nurse needs to be well prepared and have knowledge and awareness of cross-culture conflict and should also follow culturally safe practices for that group. Indeed, intersectionality welcomes the idea of cultural claiming, where culture is seen as a defense that women from minority cultures (e.g.…”

“…Syrian refugee women) use against predominant cultures. [32][33][34][35] In other words, the intersection of gender, race, and cultural oppression call for a commitment to emancipatory and intersectionality-guided nursing practices that permit marginalized cultural groups to protect their cultures and identities.…”