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HIV – “an uninvited visitor"; a qualitative study of HIV-infected African migrants with missed appointments in an outpatient clinic in Denmark

Charlotte Dyrehave, Christian Wejse, Helle Therkildsen Maindal, Lotte Oerneborg Rodkjaer


Background: Lower adherence and lower retention to HIV-care among migrant populations is an emerging problem among people with HIV, probably due to social and cultural disparities. The aim was to explore reasons for missed appointments and non-adherence to treatment among African HIV-infected migrants in Denmark to identify important areas for optimizing healthcare.

Method: We conducted a qualitative study and semi-structured interviews were carried out with 13 HIV-infected African migrants who had missed appointments in the outpatient clinic. Data were analyzed using thematic analysis.

Results: The major finding was that participants experienced that the HIV diagnosis was accompanied by a complex life situation and patients faced several challenges constituting barriers to non-adherence and retention to care. Five themes emerged: (1) Trauma, (2) Religion, (3) HIV-related stigma, (4) Loneliness/lack of support and (5) Competing problems. The lack of acceptance of HIV was a key aspect across all themes. Complexity and social context of patients’ lives added to the challenges, as well as the hospital setting not providing a health literacy responsive environment.

Conclusion: There are several barriers at both individual, social and system level to adherence to treatment and care, thus it is important to address the specific cultural background and specific conditions of life of patients infected with HIV. Future development of migrant-friendly interventions should be more person-centered and socially and culturally targeted to increase attendance, adherence and health literacy.


Adherence, cultural context, health literacy, HIV, lack of support, loneliness, migrants, minority groups, missed appointments, person-centred care, retention to care, self-management, spiritual and religious care, stigma, trauma

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Mocroft, A., Ledergerber, B., Katlama, C., Kirk, O., Reiss, P., d’Arminio Monforte, A., Knysz, B., Dietrich, M., Phillips, A,N,, Lundgren, J.D. & EuroSIDA Study Group. (2003). Decline in the AIDS and death rates in the EuroSIDA study: an observational study. Lancet 362 (9377) 22-29.

Lohse, N., Hansen, A.B., Pedersen, G., Kronborg, G., Gerstoft, J., Sørensen, H.T., Vaeth, M. & Obel, N. (2007). Survival of Persons with and without HIV Infection in Denmark, 1995-2005. Annals of Internal Medicine 146 (2) 87-95.

DeMasi, R.A., Graham, N.M., Tolson, J.M., Pham, S.V., Capuano, G.A., Fisher, R.L., Shaefer, M.S., Pakes, G.E., Sawyerr, G.A. & Eron, J.J.Jr. (2001). Correlation between self-reported adherence to highly active antiretroviral therapy (HAART) and virologic outcome. Advances in Therapy 18 (4) 163-173.

Bangsberg, D.R., Perry, S., Charlebois, E.D., Clark, R.A., Roberston, M., Zolopa, A.R. & Moss, A. (2001). Non-adherence to highly active antiretroviral therapy predicts progression to AIDS. AIDS 15 (9) 1181-1183.

Othieno, J. (2007). Understanding How Contextual Realities Affect African Born Immigrants and Refugees Living with HIV in Accessing Care in the Twin Cities. Journal of Health Care for the Poor and Underserved 18 (3) 170-188.

Kreps, G.L. & Sparks, L. (2008). Meeting the health literacy needs of immigrant populations. Patient Education and Counseling 71 (3) 328-332.

Osborn, C.Y., Paasche-Orlow, M.K., Davis, T.C. & Wolf, M.S. (2007). Health Literacy. American Journal of Preventive Medicine 33 (5) 374-378.

Barfod, T., Sorensen, H., Nielsen, H., Rodkjaer, L. & Obel, N. (2006). ‘Simply forgot’ is the most frequently stated reason for missed doses of HAART irrespective of degree of adherence. HIV Medicine 7 (5) 285-290.

Dalgaard, L.S., Søgaard, O.S., Jensen-Fangel, S., Larsen, C.S., Sönnerborg, A. & Østergaard, L. (2012). Use of InfCare HIV to identify and characterize suboptimally treated HIV patients at a Danish HIV clinic: A cross-sectional cohort study. Scandinavian Journal of Infectious Diseases 44 (2) 108-114.

Dyrehave, C. (2015). Treatment adherence and health literacy among African HIV-infected individuals in Denmark. Qualification Year report.

Simoni, J.M., Huh, D., Wilson, I.B., Shen, J., Goggin, K., Reynolds, N.R., Remien, R.H., Rosen, M.I. Banmgsberg, D.R. & Liu, H. (2012). Racial/Ethnic Disparities in ART Adherence in the United States: Findings From the MACH14 Study. Journal of Acquired Immune Deficiency Syndromes 60 (5) 466-472.

Bärnighausen, T., Chaiyachati, K., Chimbindi, N., Peoples, A., Haberer, J. & Newell, M-L. (2011). Interventions to increase antiretroviral adherence in sub-Saharan Africa: a systematic review of evaluation studies. The Lancet Infectious Diseases 11 (12) 942-951.

Degrie, L., Gastmans, C., Mahieu, L., Dierckx De Casterlé, B. & Denier, Y. (2017). How do ethnic minority patients experience the intercultural care encounter in hospitals? A systematic review of qualitative research. BMC Medical Ethics 18 (1) 2.

Oelholm, A.M. (2014). Indvandrermedicinsk Klinik (IMK). Hospitalsbaseret forløbskoordination for patienter af anden etnisk herkomst end dansk. Odense, Denmark. Available at:

Braun, V. & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology 3 (2) 77-101.

Kvale, S. (1996). Interviews : an introduction to qualitative research interviewing. Thousand Oaks, CA: Sage.

Paterson, B.L. (2001). The Shifting Perspectives Model of Chronic Illness. Journal of Nursing Scholarship 33 (1) 21-26.

Henrickson, M., Brown, D.B., Fouché, C., Poindexter, C.C. & Scott, K. (2017). ‘Just Talking About It Opens Your Heart’: meaning- making among Black African migrants and refugees living with HIV. Culture, Health & Sexuality 15 (8) 910-923.

Anderson, J. & Doyal, L. (2004). Women from Africa living with HIV in London: a descriptive study. AIDS Care 16 (1) 95-105.

Ndirangu, E.W. & Evans, C. (2008). Experiences of African Immigrant Women Living with HIV in the U.K.: Implications for Health Professionals. Journal of Immigrant and Minority Health 11 (2) 108-114.

Arrey, A.E., Bilsen, J., Lacor, P. & Deschepper, R. (2015). It’s My Secret: fear of Disclosure among Sub-Saharan African Migrant Women Living with HIV/AIDS in Belgium.PLoS One 10 (3) e0119653.

Mambet Doue, C. & Roussiau, N. (2016). The Role of Mediators in the Indirect Effects of Religiosity on Therapeutic Compliance in African Migrant HIV-Positive Patients. Journal of Religion and Health 55 (6) 1850-1863.

Soerensen, O. (2017). Department of Public Health Aarhus University 2017. Coping and HIV-related stigma amongst HIV-infected African migrants living in Denmark - a qualitative study. Unpublished data.

Rodkjaer, L., Sodemann, M., Ostergaard, L. & Lomborg, K. (2011). Disclosure Decisions. Qualitative Health Research 21 (9) 1249-1259.

Smith, R., Rossetto, K. & Peterson, B.L. (2008). A meta-analysis of disclosure of one’s HIV-positive status, stigma and social support. AIDS Care 20 (10) 1266-1275.

Airhihenbuwa, C.O. & Webster, J.D.W. (2004). Culture and African contexts of HIV/AIDS prevention, care and support. SAHARA Journal 1 (1) 4-13.

Smith, B.J., Tang, K.C. & Nutbeam, D. (2006). WHO Health Promotion Glossary: new terms. Health Promotion International 21 (4) 340-345.

Perazzo, J., Reyes, D. & Webel, A. (2017). A Systematic Review of Health Literacy Interventions for People Living with HIV. AIDS and Behavior 21 (3) 812-821.



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