“Migratory grief” and structural barriers to care: a community-engaged qualitative study of immigration-related stress among immigrants living with or at risk of HIV

Background: Immigrants experience poorer HIV outcomes and poor mental health. How immigration-related stressors affect engagement with HIV care and mental health care is unclear.This study aimed to use community-based participatory research (CBPR) approaches to explore how immigration-related stressors impact HIV and mental health care for immigrants living with HIV. Methods: We conducted a qualitative interview study with semi-structured interviews of immigrants in New York City with or at risk of HIV. A Community Advisory Board of immigrants aided in study development and interpretation of findings. Purposive sampling was used to balance HIV status and immigration detention experience. Interviews focused on experiences accessing health care and social resources. We analyzed the data using an iterative, grounded theory approach. Key results: We conducted 19 interviews. 17/19 participants were from Latin America, 12/19 were trans or genderqueer, 10/19 were living with HIV and 9/19 had immigration detention experiences. Key themes included: stress from resource scarcity was partially addressed by services specific to people with HIV; entry into medical care was facilitated by targeted services for people with HIV; structural barriers limited engagement in mental health services, and community-based connections were instrumental in overcoming structural barriers. Conclusions: Our findings show how structural barriers to social and health-related resources impact those living with and at risk of HIV, which are partially addressed by resources specific to people with HIV and community-based support. This study highlights the need for status-neutral, structural level approaches to improve access to resources for immigrants.