Obstacles and Pathways on the Journey to Access Home and Community Care by Older Adults Living With HIV/AIDS in British Columbia, Canada: Thrive, a Community-Based Research Study

Abstract

Older adults living with HIV (OALHIV) (i.e., age ≥50) now constitute over 50% of all people accessing HIV treatment in British Columbia (BC), Canada. As OALHIV age, the need for supportive care in non-acute settings, including home and community care (HCC), is increasing. The Thrive research project was co-created alongside OALHIV in BC to support people to thrive with a good quality of life (as contrasted with just surviving). Phase 1 of the project linked treatment and demographic records for 5603 OALHIV accessing care in BC. Phase 2 took a community-based research approach with semi-structured interviews to understand obstacles and pathways experienced by 27 OALHIV in accessing HCC. This article summarizes previously published Phase 1 findings and explores Phase 2 findings in-depth. On the HCC journey traveled by OALHIV in BC, there are four main junctures at which obstacles and pathways appear: (1) before referral, (2) during the referral process, (3) at the assessment, and (4) while receiving services. Obstacles are largely related to fluctuating HCC priorities and funding cuts tied to election cycles, requiring systemic and policy changes to enable positive outcomes and impacts in the provision of HCC services. These obstacles can be transformed into pathways through public policy and client-centered, culturally safe care.

Systematic Review: HIV, Aging, and Housing—A North American Perspective, 2012–2023

“…Provider competency, staff members' trust in HIV care, and readiness for the elderly HIV population should be enhanced through training to reduce barriers associated with stigma, discrimination, sexuality, and transgender subpopulations [15,17,25,33,36,48]. The presence of the terms barrier, stigma, and housing in our LSA top twenty terms in our corpus sheds insight and answers our research questions, in that stigma and discrimination levels (based on HIV status and sexuality) are prevalent and act as barriers to subsidized housing, long-term care, and HIV care facilities, and antiretroviral treatment adherence [15,17,19,22,35,36]. A structural barrier that impedes persistent viral suppression, adherence to anti-retroviral therapy, and access to vital HIV medical services (holistic care) is housing instability [49].…”