Objectives:
Studies find lower adherence and low retention to HIV-care among migrant populations. Limited health literacy is a known barrier to adherence. It is important to identify subgroups at risk to non-adherence to tailor treatments for their specific needs. We did a pilot survey among 64 HIV-infected African migrants in Denmark and found that 39% did not attend their appointments during a six-month period. The aim of this study was to gain insights into the
reasons for missed appointments and non-adherence in this group.
Methods:
Semi-structured interviews were carried out with 13 HIV-infected African migrants at the Department of Infectious Diseases at Aarhus University Hospital, Denmark from May to November 2016. They were interviewed in their home. Digital audio-recordings of the interviews were transcribed and analyzed using thematic analysis.
Results:
The majority of the interviewed reported complex life-situations, facing several challenges and barriers for not attending their scheduled appointments and reasons to non-adherence.
Six thematic areas were identified to classify factors associated with adherence and retention to care:1) Traumatic suffering, 2) Cultural and religious dilemmas, 3) HIV-related stigma, 4) Competing problems, 5) Loneliness and 6) Difficulties navigating in the healthcare system. Lack of acceptance of HIV was consistent in all six themes. Religion was a mental support when facing problems with HIV.
Conclusion:
Our study demonstrated that HIV-infected African migrants have several challenges living with HIV, and revealed important barriers to adherence and attendance on both individual, social and system level. The cultural background, and the specific life situation should be considered, when targeted interventions are developed to increase attendance, adherence
and health literacy.