Unpacking the Challenges Experienced By Immigrants and Refugees Living with HIV: A HIV Transformative Post-COVID-19 Model

Background: The Public Health Agency of Canada estimated that more than 62,000 people were living with HIV in Canada in 2018. According to the 2021 Alberta Health Annual Report, a total of 21,702 cases of STIs/HIV were reported in the province of Alberta, making it the fourth highest number of people living with HIV in the country. The outbreak of the COVID-19 pandemic has intensified heightened risks for severe physical and mental health issues for people, especially immigrants and refugees living with HIV (IRLH). When seeking healthcare services, the IRLH, with no access to outpatient care, often resort to the emergency room. Further, many emergency departments have had to change their procedures to manage the influx of COVID-19 patients. Such changes in the delivery of healthcare services have, in turn, caused a reduction in access to care for many IRLH. Given the knowledge gaps in the literature, this paper aims to propose a community led HIV transformative post-COVID-19 model.

Methods: The concurrent parallel mixed-methods approach was used to explore the intersectional oppressions experienced by IRLH, focusing on the COVID-19 pandemic. Quantitative data were collected using a self-developed survey (n=124), and qualitative data were collected through three photovoice sessions (n=13) among IRLH across Alberta. We reached out to the potential participants through the support of local community partners serving the IRLH across Alberta. Snowball and criterion sampling strategies were used for the recruitment of participants.

Findings: The participants who attended the photovoice sessions eloquently stressed that COVID-19 and lockdown measures had escalated their vulnerabilities to mental health and psychosocial challenges, and socio-economic marginalization. The survey results indicated that 51.5% reported having issues accessing healthcare services during COVID-19 compared to 38.4% before the COVID-19 pandemic. Similarly, we found that about 58% reported having problems finding housing services during COVID-19 compared to 47.5% before COVID-19. About 77% of the respondents reported having difficulties finding legal services during COVID-19 compared to 40.8% before COVID. The bivariate analysis indicated a positive correlation between respondents’ level of social support during COVID-19 and their state of well-being, r(102)=.33, p=.001. We also found a negative correlation between respondents’ perceived stigma level and their well-being, r(100)=.446, p<.001. These results corroborated the findings from the photovoice data. Using social determinants of health lenses, the findings from the photovoice confirmed that the IRLH experienced intersectional oppression, including food insecurity, housing, mental health and psychosocial challenges, unemployment, and access to health care and social services during COVID-19.

Conclusion: The COVID-19 pandemic has taken a dramatic toll on the IRLH. They experienced a wide range of challenges, including childcare, food security, employment, and housing. This resulted in deteriorated levels of physical and mental health. It is critically important to develop well-coordinated health programming services between healthcare providers, public health programs, and HIV programs in light of the COVID-19 pandemic to address the challenges and barriers the IRLH face in their social determinants of health support systems. Finally, equitable healthcare programs and resource must be considered when addressing the challenges experienced by the IRLH.