Stigma trajectories, disclosure, access to care, and peer-based supports among African, Caribbean, and Black im/migrant women living with HIV in Canada: findings from a cohort of women living with HIV in Metro Vancouver, Canada.

Background: African, Caribbean, and Black im/migrant women experience a disproportionate burden of HIV relative to people born in Canada, yet there is scarce empirical evidence about the social and structural barriers that influence access to HIV care. The objectives of this study is to estimate associations between African, Caribbean, and Black background and stigma and non-consensual HIV disclosure outcomes, and to understand how experiences of stigma and im/migration trajectories shape access to HIV care and peer supports among African, Caribbean, and Black im/migrant women living with HIV in Canada.

Methods: This mixed-methods analysis draws on interviewer-administered questionnaires and semi-structured interviews with self-identifying African, Caribbean, and Black women living with HIV in the community-based SHAWNA (Sexual Health and HIV/AIDS: Women's Longitudinal Needs Assessment) cohort. Bivariate and multivariable logistic regression using generalized estimating equations (GEE) were performed to estimate associations between African, Caribbean, and Black background and stigma and non-consensual HIV disclosure outcomes. Drawing on a social and structural determinants of health framework, qualitative analysis of interviews elucidated the interplay between migration trajectories, stigma, racialization, and HIV.

Results: Amongst our participants (n = 291), multivariable GEE analysis revealed that African, Caribbean, and Black participants (n = 15) had significantly higher odds of recently being outed without consent as living with HIV (AOR 2.34, 95% CI 0.98-5.57). Additionally, African, Caribbean, and Black participants had higher odds of recent verbal or physical abuse due to their HIV status (AOR 2.11, 95% CI 0.65-6.91). Reflecting on their im/migration trajectories, participants' narratives (n = 9) highlighted experiences of political violence and conflict, trauma, stigma, and discrimination associated with HIV in their place of origin and the racialization and stigmatization of HIV in Canada. Fear of disclosure without consent was linked to barriers of accessing care and peer-based supports.

Conclusion: Our findings indicate that im/migration trajectories of African, Caribbean, and Black women living with HIV are critically related to accessing HIV care and supports in Canada and compound HIV stigma and discrimination. HIV disclosure without consent complicates access to care and social/peer support, underscoring the need for privacy, confidentiality, and the importance of building trust in the context of clinical encounters. The results of this study emphasize the critical need for culturally sensitive trauma-informed care models rooted in peer-based approaches.