HIV/AIDS and African immigrant women in Philadelphia: Structural and cultural barriers to care

Abstract

Although African immigration to American cities is increasing, there is little published demographic or epidemiological data on this population. As growing numbers of HIV-positive Africans seek care at public health centres in the city of Philadelphia, medical personnel are confronted with the challenges of serving this population. This qualitative study explores the perspectives of HIV service providers who are treating this new patient group, and it examines the cultural and structural barriers African women face in the area of HIV prevention, testing, and treatment in the city of Philadelphia. These barriers include legal status, linguistic problems, fear of the American health system, misunderstandings about modes of transmission of HIV, and lack of awareness about antiretroviral treatment. Culturally appropriate education about HIV prevention and treatment needs to be developed for African immigrants, and medical personnel need to understand the experiences, fears, and concerns of this population.

Recent Immigrants Show improved Clinical Outcomes at a Tertiary Care HIV Clinic

“…Recent immigrants to Canada face several obstacles including language barriers, cultural differences, uncertain immigration status, and employment and housing issues (3,(7)(8)(9)). An HIV diagnosis adds an additional stress, and gaining access to care and treatment provides additional challenges.…”

Factors Associated with Retention and Viral Suppression Among a Cohort of HIV+ Women of Color

“…[2][3][4][5][6] Homelessness has been found to be associated with retention, 7 as has lack of transportation, perceived stigma, 8 lack of HIV awareness, fear of the healthcare system, and legal status for immigrants. 3 Financial barriers, the extent of coverage and out of pocket costs have also kept HIV + individuals from engaging in care, 2,9 as have concerns about whether clinics are known in the community as an HIV/AIDS treatment program, and how the organization is structured to provide care. 8,9 Medication adherence has also been affected by the side effects, dosage schedule, and the effects taking medications may have on interpersonal relationships.…”

Knowledge, attitudes, and beliefs about HIV/AIDS of Sudanese and Bantu Somali immigrant women living in Omaha, Nebraska

“…Although the role of higher education in understanding HIV infection is debatable, education may facilitate behavior change and promote the adoption of safer sexual behaviors, including condom use [36,51,63]. In their review, Hargreaves and Glynn concluded that new HIV infections were increasingly seen among less educated women [61].…”

“…Systems factors in Omaha may have affected the women's ability to access voluntary counseling and testing for HIV. Often, structural, cultural, and linguistic barriers; stigma; discrimination; xenophobia; and exploitation decrease or discourage access to HIV/AIDS education or health services [6,[15][16][17][18][19][47][48][49][50][51][52][53].…”

“…Previously validated questionnaires that have been used by organizations such as the World Health Organization, the United Nations Program on HIV/AIDS, and the CDC, and in similar studies [19,45,46] were adapted for this study. The questionnaire and pretest were translated into Arabic and Nuer and were pilot tested before use.…”