‘HIV ended up in second place’ − prioritizing social integration in the shadow of social exclusion: an interview study with migrants living with HIV in Sweden

Abstract

Background Migrants are overrepresented among people living with HIV in Sweden as they often face conditions that increased their risk and vulnerability for HIV/STI infections prior, during or after migration. Yet, there is limited research on their experiences and perceptions of living with HIV in the Swedish context. This study aims to explore migrants’ experiences of living with HIV in Sweden. Methods This is a qualitative study based on in-depth interviews with 13 migrants from 11 countries living with HIV in Sweden. Interviews were analysed with thematic analysis using an intersectional perspective to explore the interactions of multiple social identities such as ethnicity, socio-economic status, gender, age, and sexual orientation that shape an individual’s or group’s experiences. Results The analysis resulted in a main theme: ‘Prioritizing social integration-HIV ends up in second place’, which is based on four subthemes: ‘Better opportunities in the new country than what the home country could offer’, ‘Better conditions for LGBTQI people than in the home country’, ‘Navigating a new system: linguistic and bureaucratic challenges’ and ‘Feeling like a second-class resident: racism, xenophobia and multiple discrimination’. The results suggest that migrants living with HIV in Sweden experience social integration as a greater challenge than HIV infection. Although the new country offers opportunities for better living conditions, many participants described being challenged in their daily life by linguistic and structural barriers in their encounters with public services. They are facing multiple discrimination simultaneously as migrants due to their multiple and intersecting identities (e.g. being non-white, foreigners/foreign-born and non-Swedish speakers), which is compounded by HIV status and thus limit their opportunities in the new country and too often result in an existence of exclusion. Conclusion The study shows that most of the challenges that migrants living with HIV face are related to their status as migrants rather than HIV status, which is often not known by the public or authorities. These challenges are similar, but still differ depending on social position, previous experiences, time since arrival and since diagnosis. This emphasizes the importance of both intersectional, intersectoral and multisectoral approaches to address reported issues.

Sexual health challenges in migrant, immigrant, and displaced populations 2022–2023

“…Lack of health insurance coverage and prohibitive costs have been identified as major barriers to urgent HIV care postresettlement [58]. Inadequate basic needs (housing, employment) may lead MIDP to prioritise other needs over sexual health [17,36,59]. Furthermore, inadequate health system navigation support and insensitive provider interactions may affect how those precarious immigration status accessed sexual health care [60].…”

“…Many of the challenges that migrant people face relate to social determinants of health, including poverty and cultural and language barriers, rather than HIV/STI status itself. Therefore, larger investment in community support groups, peer-educators and interpreters will not only improve may improve HIV/STI and other sexual health disparities [59,86]. Developing supportive environments through peer-led advocacy and provider sensitivity training could help produce long-term, sustainable improvements to sexual health while at the same time, enhance sex equity [88–90].…”

Prevalence of perceived discrimination, determinants and associations with self-rated general and sexual health, healthcare utilization and self-perceived integration: a cross-sectional survey of migrants in Sweden

“…Sweden may be attractive to LGBTQI + migrants fleeing persecution in their home countries as they can be granted protection according to Swedish law. A qualitative study involving LGBTQI + migrants living with HIV in Sweden suggested that current legislation in Sweden makes it a safe and secure country where LGBTQI people can live a normal life and access HIV treatment without discrimination [ 13 ]. Previous research has also shown that self-perceived discrimination is related to gender, ethnic origin and religion [ 12 , 18 ].…”

“…Discrimination against migrants can take place for different reasons and in different settings, including schools, labour markets, workplaces, public and health care services [ 12 , 13 , 16 ]. According to Schutze et al, preconceived notions about migrants can affect the welfare services that they receive in Sweden [ 17 ].…”

Migration experiences and reported commercial and non-commercial sexual behaviors among newly diagnosed HIV infections in China: a cross-sectional study

“…As a major global public health issue, approximately 38.4 million people worldwide were living with HIV (human immunodeficiency virus) at the end of 2021, and a significant number of new infections are reported each year (1.5 million globally in 2021) [ 1 ]. Migration has been proved as a potential risk factor for this significant rise in new HIV infections because of biological, socio-economic, and structural factors [ 2 – 5 ]. For example, evidence from the USA, Russia, and the Netherlands all reported that migrants were vulnerable to HIV infection with sexual risk behaviors and tended to become the “bridge population” between destination country and home country [ 6 – 11 ].…”