ABSTRACT
African immigrants are disproportionately affected by HIV compared to U.S.-born individuals, and early HIV testing is the key challenge in ending the HIV epidemic in these communities. HIV-related stigma appears to be the most significant barrier to testing for HIV among African communities in King County, WA. In this formative study, we conducted thirty key informant interviews and five focus group discussions (n = total 72 participants) with Ethiopian, Somali, and Eritrean people living with HIV, health professionals, religious and other community leaders, and lay community members in King County to better understand HIV-related and intersectional stigmas' impact on HIV testing behaviors. We used inductive coding and thematic analysis. Participants from all communities reported similar themes for HIV-related and intersectional stigmas' influences on HIV testing behaviors. Misconceptions or poor messaging, e.g., regarding treatability of HIV, as well as normative or religious/moral beliefs around pre/extramarital sex contributed to HIV-related stigma. Intersecting identities such as immigrant status, race/ethnicity, and having a non-English language preference, all intermingle to further influence access to the U.S. healthcare system, including for HIV testing. These findings can be used to inform future research on community-led approaches to addressing early HIV testing amongst African immigrant communities.
RESUMEN: Los inmigrantes africanos son afectados por el VIH de manera desproporcionada en comparación con individuos nacidos en E.E.U.U. y el testeo temprano de VIH es el desafío clave para parar la epidemia de VIH en estas comunidades. El estigma relacionado con el VIH parecería ser la barrera más importante al testeo temprano de VIH entre las comunidades africanas en el condado de King, Washington. En este estudio formativo hemos realizado treinta entrevistas con informantes clave y cinco grupos de discusión (n = 72 participantes totales) con participantes etíopes, somalíes, y eritreos viviendo con el VIH, profesionales de la salud, líderes religiosos y de la comunidad, y otros miembros de la comunidad en el condado King para desarrollar un mejor conocimiento de los estigmas interseccionales y relacionados con el VIH. Usamos métodos de codificación inductiva y análisis temático. Participantes de todas las comunidades reportaron temas similares al describir como los estigmas interseccionales y relacionados con el VIH influyen en los comportamientos de acceso a pruebas de VIH. Malentendidos o mensajes inadecuados, por ejemplo, sobre la tratabilidad del VIH y las creencias normativas o religiosas/morales entorno al sexo pre/extramarital, contribuyeron al estigma relacionado con el VIH. Las identidades que se intersecan, como el estatus migratorio, raza/etnia, y no hablar inglés como lenguaje preferido, se entremezclan para influir de mayor manera el acceso al sistema de salud estadounidense, incluyendo para las pruebas de VIH. Estos hallazgos pueden ser usados para informar futuros proyectos de investigación sobre estrategias lideradas por la comunidad para abordar el diagnóstico temprano de VIH en la comunidad de inmigrantes africanos.
Subject(s)
Emigrants and Immigrants , HIV Infections , HIV Infections/diagnosis , HIV Infections/prevention & control , HIV Testing , Humans , Social Stigma , Washington/epidemiologyABSTRACT
African immigrants make up a large subgroup of Black/African-Americans in the US. However, because African immigrant groups are typically categorized as "Black," little is known about their preventative healthcare needs. Differences in culture, life and healthcare experiences between African immigrant populations and US-born people may influence preventive health care uptake. Thus, policymakers and healthcare providers lack information needed to make informed decisions around preventive care for African immigrants. This formative study was conducted among the largest East African immigrant communities in King County, WA. We recruited religious leaders, community leaders, health professionals, and lay community members to participate in thirty key informant interviews and five focus group discussions (n = 72 total), to better understand preventative healthcare attitudes in these communities. Through inductive coding and thematic analysis, we identified factors that impact preventative healthcare attitudes of the Somali, Ethiopian and Eritrean immigrant communities and deter them from accessing and utilizing healthcare. Cultural beliefs and attitudes around preventative healthcare, mistrust of westernized healthcare, religious beliefs/views, intersecting identities and shared immigrant experiences all influence how participants view preventative healthcare. Our results suggest that interventions that address these factors are needed to most effectively increase uptake of preventative healthcare in African immigrant communities.
Subject(s)
Emigrants and Immigrants , Health Services Accessibility , Black People , Female , Focus Groups , Humans , Qualitative ResearchABSTRACT
Studies of African immigrant health in the U.S. have traditionally focused on infectious diseases. However, the rising burden of non-communicable diseases (NCDs) indicates the increasing importance of general preventive health care. As part of a series of community health events designed for African-born individuals in King County, Washington, we administered key informant interviews (KIIs) with 16 health event participants, medical professionals, and community leaders to identify barriers and facilitators to use of preventive health care among African-born individuals. We used descriptive thematic analysis to organize barriers according to the socio-ecological model. Within the individual domain, KII participants identified lack of knowledge and awareness of preventive health benefits as barriers to engagement in care. Within the interpersonal domain, language and cultural differences frequently complicated relationships with health care providers. Within the societal and policy domains, healthcare costs, lack of insurance, and structural racism were also reported as major barriers. Participants identified community outreach with culturally competent and respectful providers as key elements of interventions to improve uptake. In conclusion, African immigrant communities face several barriers, ranging from individual to policy levels, to accessing health services, resulting in substantial unmet need for chronic disease prevention and treatment. Community-centered and -led care may help facilitate uptake and engagement in care.
