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

Abstract

Migrants, particularly from low- and middle-income countries, are at a heightened risk of adverse HIV outcomes. HIV testing may improve these outcomes. We reviewed and synthesised studies into migrants and HIV testing (outcome variable), published between January 1997 and April 2014. Papers using quantitative, qualitative and mixed methods designs, and samples with adult (≥18 years) migrants from low- and middle-income countries in high-income countries were included in the paper. Of 3155 papers retrieved, 31 met the inclusion criteria and are included in the review. A large number of barriers and facilitators to HIV testing were identified across the individual, social and structural levels. A number of study design and methodological issues, however, inhibited a comprehensive synthesis. There is no doubt that addressing HIV testing in migrants in high-income countries is complex; however, it has important implications for individual, community and population health, and a strong, empirically based response is warranted.

Anti-LGBT and Anti-immigrant Structural Stigma: An Intersectional Analysis of Sexual Minority Men's HIV Risk When Migrating to or Within Europe

“…5 However, existing research on stigma and MSM migrants’ HIV-prevention needs is limited by small samples of migrant MSM, lack of variation in structural forms of stigma in both sending and receiving contexts, and reliance on self-reported stigma exposure. 6,7 …”

Men from Sub-Saharan Africa Living in Worker Hostels in France: A Hidden Population with Poor Access to HIV Testing

“…Only 37 % of the migrant men living in worker hostels who participated in health educational sessions in their living settings had been tested for HIV at least once in their lifetime, compared to a proportion of 57 % among a representative sample of men living in the Paris area in 2010 [6]. Fear of stigma and lack of confidentiality have been reported as preventing HIV testing in migrants [4]. With nearly half of participant likely illegal immigrants as indicated by their lack of common health insurance coverage, this pilot study evidenced a large feasibility of health information sessions and personal health review organized in living settings.…”

“…A study of newly HIVdiagnosed patients reported that 45 % of sub-Saharan migrants who discovered their infection had never been tested, even though nearly all had medical encounters during the 3 years preceding the diagnosis [10]. Demographic, migratory and behavioral factors have been associated with HIV testing in migrants [4]. Intrinsic cultural factors have been advanced for delayed diagnosis while barriers in accessing the health system are more likely at the root of missed opportunities [11].…”

“…Modeling of France's so-called ''hidden HIV epidemic'' has suggested that a large proportion of these undiagnosed HIV-infected individuals are non-French heterosexual men [3]. Migrants have been identified as being at risk for late presentation with awareness being raised of barriers to earlier testing, and specific HIV testing recommendations have been made to address this population in most European countries [4]. In Paris, people living in migrant worker hostels constitute a hard-to-reach, predominantly male (94 %) population for which there are few public health statistics, population health surveys or, until now, targeted healthrelated interventions.…”

Percepción de la vivencia del acceso oportuno al diagnóstico del VIH, en personas viviendo con VIH/SIDA: Acceso oportuno al test de VIH

“…así también, el estigma, que puede entenderse como discriminación en esta investigación, es mencionado como uno de los elementos que más dificultan el acceso al examen ya que las personas entienden que el solicitarlo es revelar la posibilidad de estar contagiado y exponerse a la sociedad y a su juicio 9,17,18 , en especial de la población homosexual 19 . El tiempo de espera del resultado 15 , así como la falta de confianza en los profesionales 12,20 y la falta de percepción de riesgo 7,8,15,21 son dificultades o barreras descritas en la literatura 22 pero no fueron descritos por los participantes de este estudio. Por el contrario, la confianza en los profesionales, fue descrita como un facilitador.…”