Over the past few years, more and more immigrants from countries with high incidence of HIV/Aids have been settling in rural Alberta. Dr. Tam Donnelly, with the University of Calgary's Faculty of Nursing, set out to learn more about the health-care experience of these newcomers.
The study focused on issues such as access to care, the effect of early detection, use of HIV protection activities and the role that language barriers, cultural differences, social stigma and discrimination can play. The study will help to design a new health intervention program that will detect, treat and prevent future transmission of HIV in rural Alberta.
According to AIDS Calgary, there are approximately 1,400 people living with HIV/AIDS in the city. Of 234 new HIV cases reported provincially in 2008, almost half were in Calgary.
Some newcomers arriving from countries where HIV medications are not available and the disease is a death sentence are unaware that treatments exist. According to Donnelly, this can be a major challenge to early detection and treatment.
"They are not familiar with our health-care system and the cultural practices or how to access the health-care system," said Donnelly.
"With immigrants specifically, what adds to this problem is not knowing the system, not having a support system and lack of language proficiency," said Shokoofeh Moussavi, Settlement and Integration department manager with the Calgary Immigrant Women's Association.
The study suggests educational campaigns should be an important tool for increasing immigrants' knowledge of HIV and the health-care system. It also suggests that working with community leaders and members can empower newcomers to address the problem, said Donnelly.
"We do not have an HIV clinic in our area so we have to get to Calgary, so it's the transportation and the time out of work or whatever it is that needs to happen in order to get to those appointments, so that's the disadvantage is it's quite a ways away for us," said executive director of the Aids Society of southeastern Alberta Anita Lees.
Health-care providers should be educated about different cultures and the best ways to work with immigrants, said Bukurie Mino, settlement program team leader at the Center for Newcomers.
"Ideally, we should have information translated into different languages so that it is accessible to these people," said Donnelly.
"When the client has very limited language skills, it's difficult for [health care providers] to get the information across and try to explain about the problem, try to explain the treatment, try to explain to [immigrants] who to seek help from and how to seek help."
Mino related that although there are interpreting services for some larger ethnic groups, many groups still go without.
Moussavi agreed that language barriers make communication much more difficult.
HIV protection activities like condom use can be unpopular and misunderstood among newcomers, explained Donnelly. She added that it is important to increase HIV protection activities to help prevent transmission.
The study hopes to promote early detection by establishing a more supportive and safe health-care environment for immigrants.
The social stigma and discrimination associated with HIV/AIDS and inadequate knowledge of treatment options are the main reasons for a lack of early detection identified by the study.
"Within our communities here, our rural communities here, there hasn't been a lot [of educational campaigns]," said Lees. "To this point it's been very minimal."
Moussavi said that she believes more can be done to remove the stigma associated with the disease, adding that there are very few educational advertisements and programs in Calgary.
"The more education is given the more people talk openly about it," said Moussavi.
Moussavi said that many HIV-positive immigrants are afraid to come forward, even to tell their friends and family.
With the release of the study's technical report in June 2009, the first of three phases of Donnelly's study were completed. The next two phases will focus on implementing the suggestions.
"I think the message that we need to ensure to [immigrants] is that if you get diagnosed early, you can access medication so that you can still live a long, productive, quality life," said Donnelly.
"It's not necessarily a death sentence anymore."