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Tefera GM, Yu M, Robinson EL, Winter VR, Bloom T. Transition, Adjustment, and Healthcare Avoidance: African Immigrant Women's Experiences and Perceptions of Navigating Primary Healthcare in the USA. Healthcare (Basel) 2024; 12:1504. [PMID: 39120207 PMCID: PMC11311796 DOI: 10.3390/healthcare12151504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 07/10/2024] [Accepted: 07/22/2024] [Indexed: 08/10/2024] Open
Abstract
This study explores the transition and adjustment of African immigrant women, particularly Ethiopian immigrant women (EIW), as they navigate the U.S. healthcare system and their ability to access and utilize healthcare services. A qualitative cross-sectional design with a mix of purposive and snowball sampling techniques was utilized to recruit EIW (N = 21, ≥18 years) who arrived in the U.S. within the last five years. One-on-one in-depth interviews were conducted to collect data. The interviews were audio-recorded, transcribed verbatim, and analyzed thematically using Nvivo12 software. The thematic analysis revealed three major themes: (1) settling into new life in the U.S. delays EIWs' ability to access primary healthcare; (2) adjusting to the U.S. healthcare system: confusions and mixed perceptions; and (3) avoidance of care: EIW's reasons for PHC visits changed in the U.S. Participants avoided healthcare, except for life-threatening conditions, general check-ups, and maternal healthcare services. Transitional support for legal, residential, employment, and health information could help tackle the challenges of accessing primary healthcare for EIW. Future research should analyze access to healthcare in relation to the everyday struggles of immigrant women, as well as legal and complex structural issues beyond acculturative issues.
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Affiliation(s)
- Gashaye M. Tefera
- College of Social Work, Florida State University, Tallahassee, FL 32306, USA
| | - Mansoo Yu
- School of Social Work, University of Missouri, Columbia, MO 65201, USA; (M.Y.); (E.L.R.)
- Department of Public Health, University of Missouri, Columbia, MO 65201, USA
| | - Erin L. Robinson
- School of Social Work, University of Missouri, Columbia, MO 65201, USA; (M.Y.); (E.L.R.)
| | | | - Tina Bloom
- School of Nursing, Notre Dame of Maryland University, Baltimore, MD 21210, USA;
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Sabri B, Perrin N, Hagos M. The being safe, health and positively empowered pilot randomized controlled trial: A digital multicomponent intervention for immigrant women with cumulative exposures to violence. CULTURAL DIVERSITY & ETHNIC MINORITY PSYCHOLOGY 2024:2024-50863-001. [PMID: 38330368 PMCID: PMC11306415 DOI: 10.1037/cdp0000635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
OBJECTIVES Pre- and postmigration exposures to violence are significant social determinants of immigrant women's health, safety, and well-being, with Black immigrant women being at high risk because of many coming from conflict-zone countries. The existing literature does not report the development and testing of a multicomponent digital intervention to address safety and health issues among immigrant women with cumulative exposures to violence. This pilot randomized controlled trial evaluated preliminary efficacy of a multicomponent digital intervention (BSHAPE) to improve health and safety outcomes for immigrant women with cumulative violence exposures, posttraumatic stress disorder and/or depression symptoms, and human immune deficiency virus (HIV) risk behaviors. METHOD The intervention was developed based on formative qualitative work and input from women. In the randomized controlled trial, 144 Black immigrant women, average age being 33.6 years, were randomly assigned to either the BSHAPE arm (n = 72) or a control arm (n = 72). Data were collected at four time points over 12 months. A generalized estimating equation analysis was performed to examine group differences in change in outcomes over time. RESULTS Compared to the control arm, participants in BSHAPE showed significant improvement in multiple outcome measures (e.g., HIV/STI risk). CONCLUSION This pilot trial of BSHAPE showed promising results for immigrant women with lifetime exposures to violence, poor mental health, and HIV risk. The study also provided useful information to further improve BSHAPE for a full-scale efficacy trial. The digital BSHAPE can be especially advantageous for violence-affected immigrant women who face numerous barriers to accessing in-person care for their safety and health needs. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Bushra Sabri
- Johns Hopkins University School of Nursing, Baltimore, MD
| | - Nancy Perrin
- Johns Hopkins University School of Nursing, Baltimore, MD
| | - Meron Hagos
- Johns Hopkins University School of Nursing, Baltimore, MD
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Elmileik E, Turnbull I. Impact of HIV/AIDS on African-born Women Living in the United States: a Systematic Review. J Racial Ethn Health Disparities 2023; 10:680-707. [PMID: 35132608 DOI: 10.1007/s40615-022-01256-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 01/25/2022] [Accepted: 01/31/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is paucity of surveillance data about African-born women (ABW) living with HIV/AIDS in the USA. Out of the 50 US states, only Washington state and Minnesota report HIV surveillance data about African-born people, and Minnesota is the only state that reports data about ABW, specifically. In Minnesota, ABW have the largest prevalence rate of HIV/AIDS among all women. In Washington state, foreign-born Black people have the highest incidence of HIV behind white people and foreign-born Hispanic people. This study aims to better understand the impact HIV/AIDS on ABW. METHODS This systematic review is based on articles available on three databases (PubMed, Embase, and Cochrane Library). Databases were searched for articles that included quantitative and/or qualitative findings about the impact of HIV/AIDS on ABW in the USA. RESULTS Several themes were identified including disproportionate impact of HIV/AIDS on ABW, barriers to care, low sexual health knowledge, HIV-related stigma, and limited HIV testing. Based on 2013 data, the incidence of HIV among ABW was 12 times higher than the incidence among women in the general US population. In 2008-2014, ABW had the smallest decline in HIV diagnosis rate when compared to US-born men and women, African-born men, and Caribbean-born men and women. Barriers that ABW face when trying to access care include, language barriers, fear of deportation and difficulty navigating the US healthcare system. CONCLUSION ABW living in the USA are uniquely impacted by HIV/AIDS. Lasting negative health consequences can be mitigated by improving HIV surveillance and investing in further studies about this population.
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Affiliation(s)
- Eiman Elmileik
- Michigan State University College of Human Medicine, East Lansing, MI, USA.
| | - Ivy Turnbull
- AIDS Alliance for Women, Infants, Children, Youth & Families, Washington, D.C., WA, USA
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Agbemenu K, Aidoo-Frimpong G, Auerbach S, Jafri A. HIV attitudes and beliefs in U.S.-based African refugee women. ETHNICITY & HEALTH 2022; 27:499-508. [PMID: 32228028 DOI: 10.1080/13557858.2020.1740175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 03/03/2020] [Indexed: 06/10/2023]
Abstract
ABSTRACTObjective: The Buffalo, New York region is one of the leading refugee resettlement areas in the country, settling 94% of African refugees in 2014. However, little is known about their health beliefs, particularly regarding sexual health and HIV. This study's purpose was to describe HIV attitudes and beliefs in a sample of African refugee women, a population that is increasingly present in the country, yet seldom represented in the literature.Design: A convenience sample of 101 African refugee women were recruited via snowball technique in Buffalo, New York. Data were collected from July 2017-July 2018, via paper-pen survey, and were analyzed using descriptive statistics.Results: Participants had low levels of education, but high HIV screening rates. Inconsistencies between knowledge of HIV acquisition and behaviors relating to HIV positive individuals may indicate HIV stigma among the population.Conclusion: Novel strategies geared towards educational levels and societal norms to educate African refugee women about HIV are urgently needed.
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Affiliation(s)
- Kafuli Agbemenu
- School of Nursing, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Gloria Aidoo-Frimpong
- Department of Community Health and Health Behavior, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Samantha Auerbach
- School of Nursing, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Aleena Jafri
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
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Daniel NA, Hassan SA, Mohamed F, Sheikh N, Basualdo G, Schwartz R, Gebreselassie BT, Beyene YK, Gabreselassie L, Bayru K, Tadesse B, Libneh HA, Shidane M, Benalfew S, Ali A, Rao D, Kerani RP, Patel RC. Harambee! 2.0: The Impact of HIV-Related and Intersectional Stigmas on HIV Testing Behaviors Among African Immigrant Communities in Seattle, Washington. AIDS Behav 2022; 26:149-164. [PMID: 34368910 PMCID: PMC8349708 DOI: 10.1007/s10461-021-03396-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2021] [Indexed: 02/07/2023]
Abstract
African immigrants are disproportionately affected by HIV compared to U.S.-born individuals, and early HIV testing is the key challenge in ending the HIV epidemic in these communities. HIV-related stigma appears to be the most significant barrier to testing for HIV among African communities in King County, WA. In this formative study, we conducted thirty key informant interviews and five focus group discussions (n = total 72 participants) with Ethiopian, Somali, and Eritrean people living with HIV, health professionals, religious and other community leaders, and lay community members in King County to better understand HIV-related and intersectional stigmas' impact on HIV testing behaviors. We used inductive coding and thematic analysis. Participants from all communities reported similar themes for HIV-related and intersectional stigmas' influences on HIV testing behaviors. Misconceptions or poor messaging, e.g., regarding treatability of HIV, as well as normative or religious/moral beliefs around pre/extramarital sex contributed to HIV-related stigma. Intersecting identities such as immigrant status, race/ethnicity, and having a non-English language preference, all intermingle to further influence access to the U.S. healthcare system, including for HIV testing. These findings can be used to inform future research on community-led approaches to addressing early HIV testing amongst African immigrant communities.
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Affiliation(s)
| | - Shukri A Hassan
- Department of Medicine, UW, 325 9th Ave, Seattle, WA, 98105, USA
| | - Farah Mohamed
- Department of Medicine, UW, 325 9th Ave, Seattle, WA, 98105, USA
- Somali Health Board, Tukwila, WA, USA
| | - Najma Sheikh
- Department of Global Health, UW, Seattle, WA, USA
| | | | - Rahel Schwartz
- Ethiopian Community in Seattle, Seattle, WA, USA
- Ethiopian Health Board, Seattle, WA, USA
| | | | | | | | | | | | | | | | | | - Ahmed Ali
- Somali Health Board, Tukwila, WA, USA
- Department of Global Health, UW, Seattle, WA, USA
| | - Deepa Rao
- Department of Global Health, UW, Seattle, WA, USA
| | - Roxanne P Kerani
- Department of Medicine, UW, 325 9th Ave, Seattle, WA, 98105, USA
| | - Rena C Patel
- Department of Medicine, UW, 325 9th Ave, Seattle, WA, 98105, USA.
- Department of Global Health, UW, Seattle, WA, USA.
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Aidoo-Frimpong G, Orom H, Agbemenu K, Collins RL, Morse GD, Nelson LE. Exploring Awareness, Perceptions, and Willingness to Use HIV Pre-Exposure Prophylaxis: A Qualitative Study of Ghanaian Immigrants in the United States. AIDS Patient Care STDS 2022; 36:8-16. [PMID: 34910883 PMCID: PMC8905245 DOI: 10.1089/apc.2021.0156] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
HIV/AIDS disproportionately burdens African immigrants in the United States. Oral pre-exposure prophylaxis (PrEP) is an effective prevention tool for people at high HIV risk, yet uptake is low among racial and ethnic minorities-particularly immigrants. This study explores the awareness, perception, and willingness to use PrEP among Ghanaian immigrants in the United States. WhatsApp, a social media platform, was used to recruit and conduct semi-structured oral interviews with 40 Ghanaian immigrants in March 2020. Interview questions explored awareness of PrEP (whether the participants knew or had knowledge of PrEP before the study), perceptions of PrEP and PrEP users, and willingness to use PrEP. Interviews were audiorecorded, and transcribed. We used NVivo-12 Plus to analyze transcripts for emergent themes. Our sample consisted of Ghanaian adult immigrants (N = 40, 57% male, 71% college educated, age = 32.8 ± 5.7 years, 68% had lived in the United States between 1 and 10 years) residing in 12 US cities. Four major themes emerged: (1) low awareness of PrEP; (2) positive perception of PrEP for HIV prevention; (3) divergent views on PrEP users; and (4) mixed views on willingness to use PrEP. This study presents formative qualitative work, which suggests that Ghanaian immigrants, despite having low awareness of PrEP, may be willing to use PrEP. A key study implication was that stigma reduction interventions might facilitate PrEP scale-up in this population.
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Affiliation(s)
- Gloria Aidoo-Frimpong
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, State University of New York, Buffalo, New York, USA.,Address correspondence to: Gloria Aidoo-Frimpong, MA, MPH, Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, State University of New York, 3435 Main Street, 321 Kimball Tower, Buffalo, NY 14214-8028, USA
| | - Heather Orom
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Kafuli Agbemenu
- School of Nursing, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - R. Lorraine Collins
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Gene D. Morse
- Pharmacy Practice (Medicine, Pediatrics), University at Buffalo, State University of New York, Buffalo, New York, USA
| | - LaRon E. Nelson
- Yale School of Nursing, MAP Center for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto—St. Michael's Hospital, Toronto, Canada
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de Jezus SV, Ilha da Silva A, Alexandre Arcêncio R, de Faria Marcos Terena N, dos Santos Pinheiro J, Souza Sacramento D, de Souza Silva Freitas P, Carminati Siqueira P, Mocelin HJS, Maria Silva Araújo V, da Silva Lima R, Nascimento do Prado T, Maia Martins Sales C, Noia Maciel EL. Local action plan to promote access to the health system by indigenous Venezuelans from the Warao ethnic group in Manaus, Brazil: Analysis of the plan´s development, experiences, and impact through a mixed-methods study (2020). PLoS One 2021; 16:e0259189. [PMID: 34780501 PMCID: PMC8592448 DOI: 10.1371/journal.pone.0259189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 10/14/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The provision of care and monitoring of health are essential for indigenous Venezuelans from the Warao ethnic group, who are at risk of decimation. OBJECTIVE Analyze a Local Action Plan (LAP) to promote access to the health system of indigenous Venezuelans from the Warao ethnic group (IVWEG) in Manaus, Brazil. METHOD A mixed-methods study was performed. Quantitative data were collected to assess the provision of care and monitoring of health conditions in IVWEG through a survey that was self-completed by healthcare providers. Qualitative narrative data were collected to gain insight into IVWEG that seek care. We applied descriptive statistics, grouping analysis (GA) by hierarchical levels, and multiple correspondence analysis (MCA). Content analysis was applied to qualitative data. RESULTS 106 healthcare providers participated in the study, with the following characteristics: 94 (88.7%) females, 67 (63.2%) pardo race/color, 40 (37.7%) working in primary healthcare, and 49 (46.2%) nurses. In addition, 43 (40.6%) of the healthcare providers reported providing care to IVWEG. Among the providers, 89 (84%) had received training for assisting IVWEG. Additionally, 30 IVWEG were enrolled for interviews in the qualitative phase. The barriers to seeking care were language, distance to health units, and lack of money for transportation. The LAP proved to facilitate access to the health system by indigenous Venezuelans from the Warao ethnic group in Manaus. The study contributed to knowledge on a LAP addressed to IVWEG and helped improved their access to the health system, providing appropriate training for healthcare providers and other relevant actors by implementing a coherent and consistent public health policy at the local level.
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Affiliation(s)
- Sonia Vivian de Jezus
- Graduate Studies Program in Public Health, Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
- Instituto de Ciências da Saúde, Universidade Federal de Mato Grosso, Sinop, Mato Grosso, Brazil
| | - Adriana Ilha da Silva
- Epidemiology Laboratory, Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
| | - Ricardo Alexandre Arcêncio
- Escola de Enfermagem de Ribeirão Preto, Graduate Studies Program in Public Health Nursing, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
- Brazilian TB Research Network, REDE-TB, Rio de Janeiro, Brazil
| | | | - Jair dos Santos Pinheiro
- Brazilian TB Research Network, REDE-TB, Rio de Janeiro, Brazil
- Municipal Health Department, Manaus, Amazonas, Brazil
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Graduate Studies Program in Tropical Medicine (PhD), Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
| | | | | | | | | | | | | | | | | | - Ethel Leonor Noia Maciel
- Epidemiology Laboratory, Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
- Brazilian TB Research Network, REDE-TB, Rio de Janeiro, Brazil
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Development, feasibility, acceptability and preliminary evaluation of the internet and mobile phone-based BSHAPE intervention for Immigrant survivors of cumulative trauma. Contemp Clin Trials 2021; 110:106591. [PMID: 34626840 DOI: 10.1016/j.cct.2021.106591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 09/14/2021] [Accepted: 10/04/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Cumulative trauma exposures can have a profound effect on women's health and well-being. Black immigrant women are disproportionately affected by cumulative trauma experiences that place them at risk for multiple health issues such as reproductive sexual health problems and HIV, or mental health problems such as PTSD. The trauma-informed internet and mobile phone-based Being Safe, Healthy, and Positively Empowered (BSHAPE) intervention was designed to comprehensively assess for cumulative traumatic experiences, for current safety, and to address women's co-occurring healthcare needs through educational, psychoeducational, and mindfulness-based stress-reduction components. PURPOSE This paper describes the development, feasibility, acceptability, and preliminary evaluation of the computer and phone delivered BSHAPE intervention among adult Black immigrant women survivors of cumulative trauma. METHOD Seventy women participated in the feasibility, acceptability, and preliminary evaluation of BSHAPE, with outcomes assessed at post-intervention. The feasibility and acceptability outcomes assessed were enrollment, adherence, and perceptions of the intervention. Preliminary evaluation outcomes included perceived stress, stress management, trauma coping self-efficacy, mindfulness, mental health (MH), HIV/STI risk, general empowerment, and empowerment related to safety. CONCLUSIONS Findings suggest that a BSHAPE intervention is feasible and acceptable. Overall, women reported satisfaction with BSHAPE and provided suggestions for improvement. Women showed significant reduction in perceptions of stress, improved stress-management, enhanced self-efficacy, reduced HIV/STI risk, and improved MH, overall empowerment, as well as empowerment related to safety. The findings of this study will be useful in further refining BSHAPE and testing it in a full-scale randomized controlled trial. TRIAL REGISTRATION NCT03664362.
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Corley A, Sabri B. Exploring African Immigrant Women's Pre- and Post-Migration Exposures to Stress and Violence, Sources of Resilience, and Psychosocial Outcomes. Issues Ment Health Nurs 2021; 42:484-494. [PMID: 32886021 PMCID: PMC7930131 DOI: 10.1080/01612840.2020.1814912] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This qualitative study seeks to identify pre- and post-migration stressors experienced by African women who had immigrated to the United States along with the vulnerability and resilience factors that exacerbate or mitigate the negative health effects of these experiences. Seventeen interviews and six focus groups were conducted with 39 African immigrant women. Participants reported encountering experiences of political instability and armed conflict pre-migration and intimate partner violence pre- and post-migration. Religious faith was an important source of resilience for women. Findings support the design of culturally appropriate interventions to improve the mental health of vulnerable African immigrant women.
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Affiliation(s)
- Andrew Corley
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Bushra Sabri
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
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A Review of Cultural Influences on Risk for HIV and Culturally-Responsive Risk Mitigation Strategies Among African Immigrants in the US. J Immigr Minor Health 2021; 23:1280-1292. [PMID: 33428074 DOI: 10.1007/s10903-020-01138-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2020] [Indexed: 10/22/2022]
Abstract
There is a paucity of research on HIV risk factors and risk reduction among African immigrants living in the US. This is despite the fact that the literature on HIV prevention and treatment continues to grow. We conducted a focused review to identify cultural factors contributing to the high incidence of HIV among African immigrants and best practices to increase engagement in HIV prevention services in this population. We conducted a search for empirical research published between 2009 and 2019, yielding 17 relevant studies with 16 unique samples. Inadequate knowledge about HIV transmission, low HIV risk perception, and stigma may be barriers to engaging in HIV prevention. Targeted interventions included bundled HIV testing, flexible scheduling, and involvement of community leaders in intervention planning and implementation. Implications for practice and directions for future research among this population are discussed.
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