scholarly journals Mandatory HIV screening, migration and HIV stigma in Canada: exploring the experiences of sub-Saharan African immigrants living with HIV in western Canada

2020 ◽  
Vol 40 (2) ◽  
pp. 38-46
Author(s):  
Aniela dela Cruz ◽  
San Patten ◽  
Inusa Abdulmalik ◽  
Jean Harrowing ◽  
Marc Hall ◽  
...  
Keyword(s):  
Qualitative Data ◽  
Hiv Stigma ◽  
Hiv Care ◽  
Hiv Screening ◽  
Canadian Province ◽  
Hiv Care Cascade ◽  
Care Cascade ◽  
Canadian Immigration ◽  
Sub Saharan ◽  
Living With Hiv

Introduction In this mixed-methods pilot study, we examined the intersections of the current Canadian immigration policy, mandatory HIV screening during the Immigration Medical Exam (IME) and enacted and internalized stigma for HIV-positive immigrants from sub-Saharan Africa (SSA) in a western Canadian province. We focus on qualitative findings from this study. Methods Using the Internalized HIV Stigma Scale (IHSS), we collected data from eight immigrants from SSA living with HIV in a western Canadian province. We then conducted semistructured interviews with seven of the eight participants. Due to the small sample size, survey data were summarized using descriptive analysis. Qualitative data were analyzed through constant comparative analysis. Results The following key themes emerged from analysis of qualitative data: experiences of HIV-related emotional distress during the IME; varied experiences of HIV testing during the IME; and inconsistent patterns of linkage to medical care, psychosocial supports and engagement in the HIV care cascade. Conclusion Findings from this pilot study cannot be generalized to the broader population of immigrants living with HIV in Canada. However, we found that the experiences of internalized HIV stigma and enacted stigma during the IME potentially influence the long-term engagement in the HIV care cascade during the process of migration and settlement in Canada. Further study in this population is recommended to examine the intersections of current mandatory HIV screening process during the Canadian immigration process, migration, settlement, culture, stigma and engagement in the HIV care cascade.

scholarly journals Estimating the HIV undiagnosed population in Catalonia, Spain: descriptive and comparative data analysis to identify differences in MSM stratified by migrant and Spanish-born population

BMJ Open ◽  
2018 ◽  
Vol 8 (2) ◽  
pp. e018533 ◽  
Author(s):  
Juliana Maria Reyes-Urueña ◽  
Colin N J Campbell ◽  
Núria Vives ◽  
Anna Esteve ◽  
Juan Ambrosioni ◽  
...  
Keyword(s):  
Hiv Transmission ◽  
Retention In Care ◽  
Hiv And Aids ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Hiv Care Cascade ◽  
Care Cascade ◽  
Undiagnosed Hiv ◽  
Sex With Men ◽  
Living With Hiv

ObjectiveUndiagnosed HIV continues to be a hindrance to efforts aimed at reducing incidence of HIV. The objective of this study was to provide an estimate of the HIV undiagnosed population in Catalonia and compare the HIV care cascade with this step included between high-risk populations.MethodsTo estimate HIV incidence, time between infection and diagnosis and the undiagnosed population stratified by CD4 count, we used the ECDC HIV Modelling Tool V.1.2.2. This model uses data on new HIV and AIDS diagnoses from the Catalan HIV/AIDS surveillance system from 2001 to 2013. Data used to estimate the proportion of people enrolled, on ART and virally suppressed in the HIV care cascade were derived from the PISCIS cohort.ResultsThe total number of people living with HIV (PLHIV) in Catalonia in 2013 was 34 729 (32 740 to 36 827), with 12.3% (11.8 to 18.1) of whom were undiagnosed. By 2013, there were 8458 (8101 to 9079) Spanish-born men who have sex with men (MSM) and 2538 (2334 to 2918) migrant MSM living with HIV in Catalonia. A greater proportion of migrant MSM than local MSM was undiagnosed (32% vs 22%). In the subsequent steps of the HIV care cascade, migrants MSM experience greater losses than the Spanish-born MSM: in retention in care (74% vs 55%), in the proportion on combination antiretroviral treatment (70% vs 50%) and virally suppressed (65% vs 46%).ConclusionsBy the end of 2013, there were an estimated 34 729 PLHIV in Catalonia, of whom 4271 were still undiagnosed. This study shows that the Catalan epidemic of HIV has continued to expand with the key group sustaining HIV transmission being MSM living with undiagnosed HIV.

scholarly journals Strategies for retention of heterosexual men in HIV care in sub-Saharan Africa: A systematic review

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0246471
Author(s):  
Sylvia Kusemererwa ◽  
Dickens Akena ◽  
Damalie Nakanjako ◽  
Joanita Kigozi ◽  
Regina Nanyunja ◽  
...  
Keyword(s):  
Sub Saharan Africa ◽  
Hiv Care ◽  
Heterosexual Men ◽  
Inclusion Criteria ◽  
Community Based ◽  
Art Programs ◽  
Hiv Care Cascade ◽  
Care Cascade ◽  
Retention In Hiv Care ◽  
Sub Saharan

Expansion of Antiretroviral Therapy (ART) programs in sub-Saharan Africa (SSA) has increased the number of people accessing treatment. However, the number of males accessing and being retained along the human immunodeficiency virus (HIV) care cascade is significantly below the UNAIDS target. Male gender has been associated with poor retention in HIV care programs, and little is known about strategies that reduce attrition of men in ART programs. This review aimed to summarize any studies on strategies to improve retention of heterosexual males in HIV care in SSA. An electronic search was conducted through Ovid® for three databases (MEDLINE®, Embase and Global Health). Studies reporting interventions aimed at improving retention among heterosexual men along the HIV care cascade were reviewed. The inclusion criteria included randomized-controlled trials (RCTs), prospective or retrospective cohort studies that studied adult males (≥15years of age), conducted in SSA and published between January 2005 and April 2019 with an update from 2019 to 2020. The search returned 1958 articles, and 14 studies from eight countries met the inclusion criteria were presented using the PRISMA guidelines. A narrative synthesis was conducted. Six studies explored community-based adherence support groups while three compared use of facility versus community-based delivery models. Three studies measured the effect of national identity cards, disclosure of HIV status, six-monthly clinic visits and distance from the health center. Four studies measured risk of attrition from care using hazard ratios ranging from 1.2–1.8, four studies documented attrition proportions at an average of 40.0% and two studies an average rate of attrition of 43.4/1000PYs. Most (62%) included studies were retrospective cohorts, subject to risk of allocation and outcome assessment bias. A pooled analysis was not performed because of heterogeneity of studies and outcome definitions. No studies have explored heterosexual male- centered interventions in HIV care. However, in included studies that explored retention in both males and females, there were high rates of attrition in males. More male-centered interventions need to be studied preferably in RCTs. Registry number: PROSPERO2020 CRD42020142923 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020142923.

scholarly journals Decolonising the HIV Care Cascade: Policy and Funding Recommendations from Indigenous Peoples Living with HIV and AIDS

2020 ◽  
Vol 15 (1) ◽  
pp. 48-60
Author(s):  
Sean Arthur Hillier ◽  
Eliot Winkler ◽  
Lynn Lavallée
Keyword(s):  
Access To Care ◽  
First Nations ◽  
Indigenous Peoples ◽  
Hiv And Aids ◽  
Hiv Care ◽  
Policy Recommendations ◽  
Hiv Care Cascade ◽  
Care Cascade ◽  
Pervasive Health ◽  
Living With Hiv

Indigenous Peoples in settler colonial nations, like Canada, continue to experience the intergenerational trauma, racism, socioeconomic disadvantages, and pervasive health disparities resulting from centuries of systemic oppression. Among these is the disproportionate burden of HIV in Canada’s Indigenous population, coupled with a lack of access to care and services. One method of assessing systems-level gaps is by using the HIV care cascade, whereby individuals are diagnosed, antiretroviral treatment is initiated, and viral suppression is achieved and maintained. The cascade, as it stands today, does not yield positive outcomes for Indigenous Peoples living with HIV. In order to close existing gaps, the authors sought to decolonise the HIV care cascade by rooting it in funding and policy recommendations provided directly by Indigenous Peoples living with HIV. This research presents 29 recommendations that arose when First Nations participants living with HIV partook in traditional storytelling interviews to share their life’s journey and offer suggestions for improving access to care and services. Said recommendations are to localize testing and diagnosis (while upholding confidentiality), improve access to culturally-appropriate care and services, provide targeted programming for Indigenous women and heterosexual men, and increase funding for provincial disability benefits; important steps in decolonising the HIV care cascade.

scholarly journals Improving Engagement in the HIV Care Cascade: A Systematic Review of Interventions Involving People Living with HIV/AIDS as Peers

2016 ◽  
Vol 20 (10) ◽  
pp. 2452-2463 ◽  
Author(s):  
Becky L. Genberg ◽  
Sylvia Shangani ◽  
Kelly Sabatino ◽  
Beth Rachlis ◽  
Juddy Wachira ◽  
...  
Keyword(s):  
Systematic Review ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Hiv Care Cascade ◽  
Care Cascade ◽  
Living With Hiv ◽  
Hiv Aids

scholarly journals Trends in HIV care cascade engagement among diagnosed people living with HIV in Ontario, Canada: A retrospective, population-based cohort study

PLoS ONE ◽  
2019 ◽  
Vol 14 (1) ◽  
pp. e0210096 ◽  
Author(s):  
James Wilton ◽  
Juan Liu ◽  
Ashleigh Sullivan ◽  
Beth Rachlis ◽  
Alex Marchand-Austin ◽  
...  
Keyword(s):  
Cohort Study ◽  
Population Based ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Hiv Care Cascade ◽  
Care Cascade ◽  
Living With Hiv

scholarly journals Effect of Female Sex Work Targeted Community-based Interventions Along the HIV Treatment Cascade in Sub-Saharan Africa: A Systematic Review and Meta-analysis

2020 ◽  
Author(s):  
Lydia Atuhaire ◽  
Olatunji Adetokunboh ◽  
Constance Shumba ◽  
Peter S Nyasulu
Keyword(s):  
Hiv Testing ◽  
Meta Analysis ◽  
Hiv Care ◽  
Hiv Diagnosis ◽  
Community Based Interventions ◽  
Community Based ◽  
Hiv Services ◽  
Hiv Care Cascade ◽  
Care Cascade ◽  
Sub Saharan

Abstract Background: Female Sex Workers are extremely vulnerable and highly susceptibility to being infected with human immunodeficiency virus. As a result, community based targeted interventions have been recommended as one of the models of care to improve access to HIV services and continued engagement in care. However little is known about the specific community intervention packages that have optimal effect on FSWs access and retention in HIV care. This paper synthesized evidence on the effectiveness of community-based interventions that provided HIV services to FSWs across all stages of HIV care cascade.Methods: We defined the 5 steps that make up the HIV care cascade and categorized them as outcomes, namely HIV testing, HIV diagnosis, linkage to care, ART use and viral suppression. We conducted a systematic search of randomized controlled trials, cohort and cross sectional studies done in sub-Saharan African countries and published from 2004 to 2020. We reviewed studies with data on the implementation of community interventions for any of the HIV care cascade stage. The data were analyzed using random effects meta-analysis where possible and for the rest of the studies, data were synthesized using summary statistics. Results: The significant impact of the community interventions was observed on HIV testing, HIV diagnosis and ART use. However, for HIV testing and ART use, the improvement was not sustained for the entire period of implementation. There were minimal interventions that had impact on HIV diagnosis, with only one community service delivery model showing significance. Generally, the interventions that had reasonable impact are those that implemented targeted and comprehensive package of HIV services provided at one location, and with unique strategies specific to each cascade stage.Conclusions: The effect of community-based interventions varies across the different stages of HIV care cascade with impact observed in specific strategies with features unique to each cascade stage. Moreover, positive effects of these strategies were short term and with small-scale implementation. As such, the information on long-term treatment outcomes, and the extent to which FSWs remain engaged in care is sparse. There is need to conduct a further research to deepen the assessment of the effectiveness of community-based interventions on HIV care cascade for FSWs. This will enhance identification of evidence based optimal interventions that will guide effective allocation of scarce resources for strategies that would have a significant impact on HIV service delivery.Systematic review registration: PROSPERO CRD42020157623.

scholarly journals An expanded HIV care cascade: ART uptake, viral load suppression and comorbidity monitoring among adults living with HIV in Asia

2021 ◽  
Author(s):  
Rimke Bijker ◽  
◽  
Nagalingeswaran Kumarasamy ◽  
Sasisopin Kiertiburanakul ◽  
Sanjay Pujari ◽  
...  
Keyword(s):  
Viral Load ◽  
Hiv Care ◽  
Viral Load Suppression ◽  
Hiv Care Cascade ◽  
Care Cascade ◽  
Living With Hiv
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