Access Barriers to Reaching Human Immunodeficiency Virus Testing Services in Ottawa: Mixed Methods Study

Abstract

Barriers to reaching human immunodeficiency virus (HIV) testing prevent Canada from achieving The Joint United Nations Programme on HIV and AIDS (UNAIDS) target of 90 percent of undiagnosed people living with HIV knowing their HIV status by 2020 and receive treatment.(1) Fourteen percent (9,090 of 63,100) of Canadians living with HIV were unaware of their status by the end of 2016.(1)(p.9)Individuals exposed to HIV through heterosexual contact are overrepresented (28%) among the undiagnosed people living with HIV in Canada compared to other groups, such as men who have sex with men (18%) and people who inject drugs (20%).(2)(par.15)The reasons preventing this population to present themselves for testing in Ottawa, Ontario, remain poorly understood in the literature. Most of the literature on barriers to accessing HIV testing focuses on the traditional key groups who are likely to test, and limits analysis of these barriers on one or two levels. Equally, health service providers rarely understand challenges behind HIV testing for particularly young heterosexual African migrant men. These challenges may be contributing key barriers to HIV testing. On other hand, late presentation to treatment remains a global issue. Psychosocial outcomes especially after a new positive diagnosis can delay reaching early treatment and prevention services. Indeed, all test results negative or positive have consequences. Even those with a new negative test can return to risk taking behaviour if they delay accessing prevention education. Yet no systematic study exists in this area essential for quality improvement. Programming more equitable HIV testing services will require more comprehensive evidence about challenges and barriers behind accessing HIV testing and treatment to achieve UNAIDS target of 90 percent of undiagnosed people living with HIV knowing their status and receive treatment. This research aimed to contribute to this evidence through two phases. Phase 1 used the Joanna Briggs Institute methods to implement a scoping review on psychosocial outcomes and their measurements immediately following a new HIV diagnosis. This review considered all participants who tested for HIV – whether their results were positive or negative, as any test results have consequences, and regardless of age, sex, or setting – reported in published articles between 2007 -to the present date. Paper 1 presents the scoping review. Phase 2 relied on a qualitative methodology using Grounded Theory informed by a socio-ecological framework and a framework of access to healthcare to understand experiences of accessing HIV testing services in two parts: 1) to examine barriers to reaching HIV testing among young heterosexual African migrants, focusing on young men, in Ottawa (Paper 2); and 2) to identify challenges experienced by health service providers who make accessible HIV testing services to this population in Ottawa (Paper 3). There is some ambiguity in the use of the terms “first generation immigrants” and “second generation immigrants” (or children of first immigrants). In this study, the term migrants referred to both. Selecting participants from both groups (first and second generation) was important to include a wide variety of experiences and interpretations that reflect the study population. Furthermore, the term “health service providers” was used to refer to both healthcare providers and frontline service providers. Healthcare providers referred to those who conduct HIV testing in health facilities, whereas frontline service providers referred to those who provide care and support services needed by members in their communities before and after testing within AIDS organizations and community-based organizations.