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Barriers and Facilitators to HIV Care for Persons Living with HIV in Manitoba Diagnosed Between 2018 and 2021

Keywords: HIV care, HIV barriers and facilitators, syndemic, participatory action research, COVID19


Background: Manitoba reported increased HIV diagnoses and newly-diagnosed people not linked to care, with an overrepresentation of Persons Living with HIV (PLHIV) experiencing houselessness, substance use, and mental health conditions disproportionately affecting young women. This study aims to understand experiences, barriers, and facilitators to HIV care for PLHIV in Manitoba diagnosed between 2018-2021.

Methods: Informed by participatory action research, health equity, and the expertise of people with lived experience, this qualitative study draws upon in-depth semi-structured face-to-face interviews. We interviewed PLHIV who are and are not engaged in care to explore their experiences with HIV services, life changes due to Covid-19, trauma, and substance use.

Results: Most participants highlighted how trusting and empathetic relationships with HIV frontline care providers and family members were key facilitators in connecting with and continuing care. New immigrants appreciated HIV care providers facilitating their transition into HIV care in Manitoba, especially navigating start of care and paying for medications. PLHIV noted the importance of HIV care providers offering more options and accommodating to needs in maintaining medical appointments and medication adherence during COVID-19 service disruptions. Participants discussed various barriers to care, noting uncomfortable experiences with some healthcare providers at diagnosis and perceived stigma and discrimination in home communities that have negatively affected their care. Some PLHIV reported feeling isolated in their home communities as they cannot share their status due to fear of discrimination from community members. Participants voiced a desire for satellite HIV-specific services, universal ART coverage, and opportunities for connection and support with other PLHIV.

Conclusions: This is the first study exploring what facilitates/hinders care for PLHIV in Manitoba. Our results highlight the need to work with communities towards eliminating HIV-related stigma and discrimination in community and health care settings as well as to educate/expand primary care HIV services into community health settings.

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