A Comparative Study of HIV Positive African Migrants' Efforts to Gain Health Services in the U.K. and U.S

Purpose: There is a dearth of studies that detail the processes underlying African migrants’ efforts to gain health services in the UK and US. The purpose of the presentation is to present the results of parrelell studies designed to detail the efforts of HIV positive African migrants' in the UK and US to gain access to vitally needed health services.

Methods: The Grounded Theory Method was used throughout the conduct of this study, due to the method’s ability to integrate data and offer a structured method through which data may be analyzed and interpreted. Since this study involved contact with individuals vested in the issue at hand, in their naturalistic environment, this was an ideal method through which to conduct a study of this nature.  One of the primary challenges of the study was to gain adequate data that reflected the broad range of experiences within the HIV positive African community. Due to their experience with multiple cases involving HIV positive migrants, social care workers at agencies that provide services to undocumented African migrants were selected. Data was collected from workers at 16 Non-Governmental Organizations (NGOs) that offer assistance to undocumented migrants in the UK and US. Each of these agencies was visited in person by study personnel.

Results: The pattern of access to care within general practice clinics was highly inconsistent when considering African migrant’s ability to reliably access services. The data revealed the existence of several vitally important processes: 1) All African migrants to the UK are granted access to care at the GM clinics upon arrival to the UK. COnversely, African migrants' to the US face significant challenges in gaining access to care in general practice settings. 2) There is wide agreement on the part of participants that their clients are losing eligibility to receive care at the GM clinics once they have failed on appeal of negative asylum decisions. Under the US system, migrants', due to current regulations, face significant challenges in gaining government aupported access to health services 3) Pulically supported HIV care clinics in the UK and US, regardless of size, have been seen to inconsistently enforce the prohibition on providing care to the undocumented. Factors such as healthcare worker unwillingness to deny care to their previously legal clients were cited repeatedly. 4) There are cases wherein African migrants who previously had access to publicly funded clinics in the UK and US, have lost their access due to losing their asylum claims on appeal. A prime factor in such cases tended to be associated with hospitalization during acute illness, which resulted in administrators performing eligibility checks. 5) Undocumented migrants were able to maintain access to health services through their GP, however, GPs are not able to provide HIV specific therapy. Thus, undocumented African migrants maintain limited access to healthcare via the GP, and at times when they experience life-threatening illness. Otherwise, they eventually lose the ability to gain treatment with common anti-retroviral therapies. A comparative analysis of the data yields a highly complex interaction between individual migrants efforts to survive in the countries that they have immigrated to superimposed over their efforts to gain care for their HIV disease. The result is a pattern wherein migrants frequently prioritize daily subsistence and housing needs abover their health related needs. This results in progressive health related challenges.

Conclusion: The findings obtained in this study reflect upon a complex representation of the interaction between the basic social processes underlying African migrants’ efforts to gain healthcare services and their efforts to maintain their lives in their new countries. The findings identified a pattern wherein migrants are often forced to prioritize daily life needs above their medical needs. This results, eventually in degradation of their health and their need to seek healthcare in an acute care setting. Thus, limits to health access result in significant health related expenditures and concurrent human suffering and loss of productivity. The presentation, in concluding, calls for reforms that will address the needs of this hghly volnerable population in a humane manner.