Multi-level barriers to reaching HIV testing among young heterosexual African migrants from HIV-endemic countries in Ottawa

Abstract

The Joint United Nations Programme on HIV and AIDS (UNAIDS) and the Public Health Agency of Canada wish to reach, test and treat at least 90 percent of undiagnosed people living with HIV. Fourteen percent (9,090 of 63,100) of Canadians living with HIV were unaware of their status by the end of 2016. Evidence about barriers before and after reaching testing is required to inform policy and practice in planning more equitable HIV testing interventions. We conducted face-to-face semi-structured interviews among twenty young heterosexual African migrants from HIV-endemic countries between May and October 2017. Participants included fourteen men and six women aged 18–29 years to identify barriers to reaching HIV testing services in Ottawa. We used Grounded Theory informed by a socio-ecological framework and a framework of access to care. Participants described access barriers and enablers at the testing stages of approachability, acceptability, and availability. Participants were, however, often unable to recognize the need for HIV testing, unable to actively seek and choose HIV testing and reach HIV testing at the intrapersonal, interpersonal, organizational, community, and policy levels. Lack of outreach programs and inability to obtain required information about HIV testing options was a major access barrier among young men in this study. Young heterosexual African women experienced unique barriers even after reaching testing, such as, not being taken seriously by healthcare providers. Our analysis showed multi-level determinants influence our populations HIV testing, both before and after reaching testing services. These determinants have practical implication for researchers, policymakers, affected communities and patients.