title: Fogging the issue of HIV - barriers for HIV testing in a migrated population from Ethiopia and Eritrea.
abstract: BACKGROUND
  The outcome of HIV treatment has dramatically improved since the introduction of antiretroviral therapy. Studies confirm that if treatment of HIV is initiated when the immune system is not severely affected by the virus the prognosis for the outcome is significantly better. There is also evidence that many immigrants come late for their first HIV test. If found to be HIV positive, and if the immune system is already significantly affected, this will compromise the treatment outcome. This study was performed in an attempt to understand the barriers for early HIV testing in a migrant population from Ethiopia and Eritrea in Stockholm, Sweden.
  
  
  METHODS
  Participants were theoretically sampled and consisted of individuals who had immigrated from Ethiopia and Eritrea. Data were collected using 14 focus group discussions and seven semi-structured interviews. The analysis was performed according to a Grounded Theory approach using the paradigm model.
  
  
  RESULTS
  Denial and fear of knowing one's HIV status dominated all aspects of behavior in relation to HIV. The main strategy was a "fogging" of the issue of HIV. People were said to not want to know because this would bring social isolation and exclusion, and it was often believed that treatment did not help. This attitude had strong roots in their culture and past experiences that were brought along to the new country and maintained within the immigrant community. The length of time spent in Sweden seemed to be an important factor affecting the "fogging of the HIV issue".
  
  
  CONCLUSIONS
  In bridging the gap between the two cultures, Swedish authorities need to find ways to meet the needs of both earlier and newly arrived immigrants as well as the second generation of immigrants. This will require adjusting and updating the information that is given to these different sub-groups of Ethiopian and Eritrean immigrants. Appropriate access to healthcare for a diverse population obviously requires more than simply providing the healthcare services.
authors: Center for Family Medicine (CeFAM), Karolinska Institute, Alfred Nobels Allé 12, 141 83, Huddinge, Sweden. pille.lindkvist@ki.se.
authors: Pille
authors: P
authors: Lindkvist
authors: Division of Global Health, (IHCAR), Karolinska Institute, Stockholm, Sweden. eva.johansson@ki.se.|Nordic School of Public Health, Gothenburg, Sweden. eva.johansson@ki.se.
authors: Eva
authors: E
authors: Johansson
authors: Center for Family Medicine (CeFAM), Karolinska Institute, Alfred Nobels Allé 12, 141 83, Huddinge, Sweden. ingrid.hylander@ki.se.
authors: Ingrid
authors: I
authors: Hylander
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D003469:Culture; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D019017:Eritrea / Q000208:ethnology; D005002:Ethiopia / Q000208:ethnology; D005239:Fear; D005260:Female; D017144:Focus Groups; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000208:ethnology* / Q000523:psychology; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D057545:Social Stigma; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors
references: AIDS Patient Care STDS. 2005 Oct;19(10):672-83
references: 16232051
references: J Acquir Immune Defic Syndr. 2006 Dec 1;43(4):491-4
references: 17031318
references: Int J STD AIDS. 2007 May;18(5):312-7
references: 17524190
references: HIV Med. 2008 Jul;9 Suppl 2:6-12
references: 18557863
references: HIV Med. 2008 Jul;9 Suppl 2:23-5
references: 18557866
references: Int J STD AIDS. 2005 Oct;16(10):702-6
references: 16212720
references: Health Policy. 2010 Sep;97(1):26-31
references: 20347504
references: East Afr Med J. 2009 Sep;86(9):411-6
references: 21644410
references: Eur J Public Health. 2013 Dec;23(6):1039-45
references: 23002238
references: AIDS. 2008 Jan 2;22(1):115-22
references: 18090399
references: AIDS Educ Prev. 2009 Dec;21(6):582-93
references: 20030501