FACT SHEET
Newcomers living with HIV and Viral Hepatitis Co-infection
BARRIERS • H IV diagnosis through the Immigration Medical Examination (IME) may not provide adequate counselling or comprehensive treatment options, initiation and retention. • T he burdens and responsibilities associated with the overall immigration process lead to the prioritization of immigration and settlement duties at the expense of managing health. • N on-citizen status can prevent access to financial coverage for treatment and a range of care and support services required to achieve successful treatment outcomes, as well as to maintain an overall satisfactory health state. • S ocio-economic status can be negatively affected by legislative barriers. Financial hardship, inaccessible housing, employment opportunities and childcare can all impact the willingness and ability of people to actively prioritize and manage their health. • T he burden of single parenthood and associated low-income and poverty limits resources needed to ensure successful treatment outcomes for many people new to Canada, specifically women. • L ocations and operating hours of services often do not accommodate the needs of new Canadian immigrants. Many newcomers must prioritize standard working hours for navigating immigration services at the expense of giving primacy to their health.
• L ack of confidentiality acts as a barrier to treatment, as well as regular care and support services. The fear of others in the community finding out the individual’s HIV status often deters them from seeking necessary care. • R acial stereotyping and discriminatory practices by health services toward newcomers contributes to avoidance of health services. Newcomers may feel that they are not receiving fair and equitable treatment and may be reluctant to pursue or continue treatment. • N ewcomers may avoid services that they feel they do not identity with, including existing ASOs that are tailored toward specific populations, such as gay men, people who use drugs, Aboriginal people or commercial sex workers. New Canadian immigrants may avoid services that they feel are not reflective of their needs.
Number and proportion of reported HIV cases by exposure category and race/ethnicity Toronto (1980-2004, n=945) and Ottawa (1983-2004, n=300) Toronto
Ottawa
• L inguistic barriers make it increasingly difficult for newcomers to understand the full range of treatment options available. • T reatment side effects, including side effects on mental health and physical appearance, have deterred some newcomer women from accessing treatment for not only fear of being identified as HIV-positive, but also due to the desire to maintain physic and appearance. • V oluntarily and openly disclosing HIV status may result in complete social isolation and expulsion from cultural communities. In order to maintain these relationships, many newcomers are compelled to hide their HIV status and are reluctant in seeking treatment and services. • M any traditional healing practices are often viewed as ineffective and counterproductive to Western medical treatment approaches, serving as a barrier to holistic treatment access.
HIV-endemic - Black 528 (55.9%)
HIV-endemic - Black 243 (81.0%)
IDU - Black 15 (1.6%)
IDU - Black 5 (1.7%)
MSM-IDU - Black 9 (0.95%)
MSM-IDU - Black 2 (0.67%)
MSM - Black 200 (21.2%)
MSM - Black 23 (7.7%)
Other - Black 193 (20.4%)
Other - Black 27 (9.0%)
• C ultural practices that may be considered harmful, such as female genital cutting and vaginal drying for sexual intercourse, are withheld from providers and lead to suboptimal care.
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TOOLS FOR ACTION • Eliminate biases, ignorance and discriminatory practices within the healthcare setting, including racial stigma, gender bias and cultural discrimination. Members who engage in discriminatory and racially-offensive behaviour should be held accountable. • Advocate and support greater access to programs and services that address the needs and realities of newcomers. This includes having services open with convenient hours of operation, available translators and transportation assistance. • Services to assist newcomers with settling into Canada should be readily available. Such services should direct newcomers to resources and support mechanisms that are required to obtain affordable housing and childcare services, employment and health services. Organizations, stakeholders, service providers and the general public should mobilize themselves and advocate that the development of an effective housing strategy is given priority on political agendas. • Encourage newcomers to take part and get involved in designing services for new immigrants in Canada. This will help develop programs and services that are reflective of their needs and that promote best practices and evidencebased information. • Health care providers should be educated on cultural and traditional healing and treatment options other than mainstream medicine. This initiative could be supported through incentivized continuing medical education conferences and events.
• Social and legal support should be readily available for newcomers who are victims of discrimination and/or who are denied treatment. • Employment services that assist newcomers in training, developing skills and finding employment should be effortlessly accessible to newcomers. • In addition to the development of culturally sensitive programs and services, tracking the responses of governments on all levels is important. This involves the development of surveillance and evaluation tools that assess the progress of such programs and services. • Programs that support negotiating disclosure of HIV should be available to newcomers. Follow-up services should also be made available post-disclosure to offer any additional support or counselling if necessary. • Services and programs need to be developed with genderequitable policies and formulated with tools and strategies of how gender-based barriers will be overcome. • Existing organizations must re-evaluate the ability of their organizations to facilitate the needs of women, such as childcare services and workshops that assist with positive body and self imaging. • Remove legislative barriers that inhibit newcomers from accessing health insurance necessary to cover the costs of basic healthcare.
• Provide legal and social supports to newcomer women who are living with HIV and are victims of violence and abuse. Set policies that promote transparency by ensuring women who provide disclosure of abuse are not going to compromise their status in the immigration process. • Organizations should develop inclusionary frameworks that support the need for rights-based and non-judgemental approaches towards newcomers living with HIV. These frameworks should be developed with a social determinants of health approach in mind.
The Canadian Treatment Action Council is Canada’s national civil society organization led by and for people living with HIV and viral Hepatitis co-infection focusing on access to treatment, care and support. www.ctac.ca • www.facebook.com/CTAC.CCSAT • twitter.com/CTAC_CCSAT 555 Richmond St. W. Suite 612, Toronto, Ontario, M5V 3B1 • 1-877-237-2822
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