Access and engagement with comprehensive HIV care : an intersectional examination of the experiences of migrant women living with HIV

Abstract

Background: Migrant women living with HIV (mWLWH) experience intersecting oppressions that impact their access to and engagement with healthcare services. Despite this acknowledgement, few studies have examined the experiences of mWLWH. Moreover, despite advances in the conceptualization of HIV care towards comprehensive models of care, current approaches continue to be guided by biomedical models of health that emphasize viral suppression and fail to analyze the socio-structural factors underlying health inequities. Purpose: Grounded in an intersectional theoretical perspective, this interpretive description study examined mWLWH’s healthcare experiences in British Columbia (BC) and the socio-structural factors shaping their access to and engagement with comprehensive HIV care. This study included two sources of data: 1) semi-structured interviews with mWLWH (n = 10) and care providers (n = 14), and 2) document review. Documents reviewed included government policies, reports, and documents and were analyzed to nuance interview data and contextualize participant experiences. Findings: Analyses indicate that mWLWH experienced challenges to accessing comprehensive HIV care. Care engagement was facilitated through the implementation of multidisciplinary HIV care models that prioritized peer support and advocacy and embedded opportunities for relationship-building within clinical encounters. Care engagement was further influenced by socio-structural processes operating within healthcare, immigration, and housing systems to marginalize mWLWH. Specifically, processes pertaining to healthcare coverage and medication adherence required mWLWH to navigate complex, bureaucratic, and paternalistic requirements that subjected them to additional surveillance and consequently positioned them as potential dangers to others and burdens to Canadian systems. Findings also demonstrate how migration status, as a political category dictating migrants’ rights and access to services, shapes mWLWH’s experiences within healthcare systems. Lastly, findings show how the racialized and gendered nature of migration processes operate within healthcare practices and encounters. Implications: Recommendations include changes to policies and practices of healthcare and migrations systems to support mWLWH’s health. Possible strategies include supporting regularization for all migrants, removing the 3-month wait period in BC to facilitate timely access to care, and further expanding multidisciplinary clinic models. These strategies should build on and prioritize the leadership of existing community support and advocacy networks.