Abstract
BackgroundThe outcome of HIV treatment has dramatically improved since the introduction of antiretroviral therapy. Studies confirm that if treatment of HIV is initiated when the immune system is not severely affected by the virus the prognosis for the outcome is significantly better. There is also evidence that many immigrants come late for their first HIV test. If found to be HIV positive, and if the immune system is already significantly affected, this will compromise the treatment outcome. This study was performed in an attempt to understand the barriers for early HIV testing in a migrant population from Ethiopia and Eritrea in Stockholm, Sweden.MethodsParticipants were theoretically sampled and consisted of individuals who had immigrated from Ethiopia and Eritrea. Data were collected using 14 focus group discussions and seven semi-structured interviews. The analysis was performed according to a Grounded Theory approach using the paradigm model.ResultsDenial and fear of knowing one’s HIV status dominated all aspects of behavior in relation to HIV. The main strategy was a “fogging” of the issue of HIV. People were said to not want to know because this would bring social isolation and exclusion, and it was often believed that treatment did not help. This attitude had strong roots in their culture and past experiences that were brought along to the new country and maintained within the immigrant community. The length of time spent in Sweden seemed to be an important factor affecting the “fogging of the HIV issue”.ConclusionsIn bridging the gap between the two cultures, Swedish authorities need to find ways to meet the needs of both earlier and newly arrived immigrants as well as the second generation of immigrants. This will require adjusting and updating the information that is given to these different sub-groups of Ethiopian and Eritrean immigrants. Appropriate access to healthcare for a diverse population obviously requires more than simply providing the healthcare services.
Highlights
The outcome of Human Immunodeficiency Virus (HIV) treatment has dramatically improved since the introduction of antiretroviral therapy
People were said to not want to know—even if they suspected that they might be HIV positive—because this could bring social isolation and exclusion and it was not believed that treatment improved health
We found that the Ethiopian and Eritrean migrant population in Sweden consists of three different groups, and two of them had different reasons for leaving their countries
Summary
The outcome of HIV treatment has dramatically improved since the introduction of antiretroviral therapy. Studies confirm that if treatment of HIV is initiated when the immune system is not severely affected by the virus the prognosis for the outcome is significantly better. A major portion of the immigrant population in Sweden come late for their first HIV testing [1], and these individuals have a considerably higher risk dying of AIDS More than 60% of all newly diagnosed HIV cases in Sweden in 2011 were so-called late presenters [2], meaning that they were diagnosed at a stage when treatment is already recommended. The majority of these patients were immigrants. Previous research has found a high prevalence of delayed diagnosis of HIV infection in immigrants and in ethnic minorities, especially among sub-Saharan Africans in the UK, Spain, and France and among Latinos and Asian Americans in the US, Canada, and the UK [3,4]
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