Session: Intersecting Injustices: Structural Barriers to Care for Black Immigrants and Refugees in the U.S (Society for Social Work and Research 30th Annual Conference Anniversary)

This symposium brings together four interrelated studies that examine the structural inequities shaping health and human service experiences among Black immigrants and refugees in the United States. As one of the fastest-growing immigrant populations, Black immigrants now exceed 4.3 million in the U.S., having nearly doubled in the past two decades. African-born individuals also comprise a significant proportion of recent refugee arrivals. Yet despite this growth, Black immigrants remain disproportionately impacted by systemic racism, xenophobia, and institutional neglect. They face compounding barriers to care - rooted in both racialization and migration histories - that restrict access, erode trust, and deepen health and social disparities.

Using an intersectional lens, the first study explores how Black immigrant women navigate U.S. social and human service systems. Drawing on qualitative interviews, it highlights persistent challenges - such as bureaucratic inaccessibility, cultural disconnects, and identity-based discrimination - while also amplifying participants' calls for institutional change centered on equity and inclusion. The second study builds on these insights by examining trust in healthcare among African immigrants. Based on in-depth qualitative data, it illustrates how cumulative negative experiences - from disrespectful provider interactions to systemic cultural insensitivity - foster deep mistrust and disengagement from care. The third study focuses on Somali refugees managing chronic conditions, using survey and path analysis to identify key influences on healthcare utilization. Findings underscore the roles of insurance coverage, perceived health, and post-migration stress, while also highlighting how structural and psychosocial challenges shape care-seeking behaviors. This study emphasizes the need for trauma-informed, community-responsive care models. Building on these individual- and community-level insights, the fourth study uses nationally representative data from the Annual Survey of Refugees to examine racialized disparities in healthcare access. Despite reporting fewer cost-related delays, Black refugees did not experience better access to care - highlighting a disconnect between affordability and meaningful healthcare engagement. Multilevel models identified employment, insurance, and civic trust as facilitators, while poor health, discrimination, and literacy barriers hindered access. These findings challenge cost-based models and underscore structural exclusion and racialized disconnection as central barriers to refugee health equity.

Together, these four studies offer multidimensional perspectives on how Black immigrants and refugees navigate systems not designed for their lived realities. By bridging in-depth qualitative research with national-level data, the symposium exposes entrenched inequities and advances pathways for structural reform. It calls for racially just, culturally responsive, and migration-conscious approaches that confront the intersecting forces of race, migration, and systemic exclusion shaping health and well-being in the United States.