HIV care engagement: The case of African immigrants in New York City

Background:

Prevention of HIV infection depends on repairing failures at every stage in the “HIV Care Continuum” – testing, linkage, engagement, retention and adherence. At the request of the New York City Department of Health and Mental Hygiene (NYCDOHMH) we conducted a qualitative study in a particularly vulnerable population, African immigrants living in NYC.

Methods:

We conducted in-depth interviews with 20 HIV+ African immigrant adults from 8 countries about experiences with testing, treatment, and barriers to care.  Interviews were taped and transcribed. A multidisciplinary team iteratively developed a codebook of emergent themes and analyzed the data using grounded theory.

Results:

Three factors explained care engagement: (1) trust in their providers, who were described as caring, available, and providing high quality care; (2) need to stay well to care for children and families; and (3) gratitude to the US for providing life-saving care, in contrast to the absence of care and high AIDS mortality in Africa. Barriers to care included: (1) belief that HIV+ people will be deported; (2) extreme HIV stigma risks ostracism from the African immigrant community they depend on for housing, jobs and support in NYC; and (3) life stressors, including gender-based violence.

Conclusion:

Once African immigrants are engaged in care, and their fears of deportation and banishment are addressed, they are likely to achieve viral load suppression. However, the burden of HIV in Africa haunts Africans in NYC; community level interventions are needed to address HIV stigma and immigration concerns.