Online Program

Correlates of barriers to HIV testing: A comparison of immigrant and US born black individuals

Monday, November 4, 2013

Bisola Ojikutu, MD MPH, Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA
Chioma Nnaji, MPH, MEd, Multicultural AIDS Coalition, Boston, MA
Philip Gona, PhD, University of Massachusetts, Worcester, MA
Juliet Sithole-Berk, MPA, Multicultural AIDS Coalition, Jamaica Plain, MA
Background: HIV/AIDS disproportionately affects black immigrants in the US, and late presentation is common. Now that HIV testing is no longer mandatory for immigration barriers to HIV testing must be addressed. This study was conducted to identify barriers to HIV testing in black immigrants and compare them to barriers in US born black individuals. Methodology: A validated Barriers to HIV Testing Scale was self-administered by 1061 black participants (18-64 years, 57% foreign-born, 51% women) living in Massachusetts in 2010. Scale items captured several sub-domains influencing testing. Composite scores were compared between immigrants and non-immigrants using ANCOVA. A binary response variable was used in logistic regression to determine predictors of barriers. Results: The mean barriers score was higher for immigrants (78.7 vs 74.1 for US-born, p<0.0001). In univariate analysis, less well educated, lower income, non-English speaking immigrants who have lived in the US for a shorter period of time were more likely to have higher barriers to testing. Annual income below $20,000 was associated with approximately 7-fold increase in the odds for greater barriers in immigrants. In adjusted multivariable analysis only low education levels and shorter duration in the US remained significant. For US born individuals, lower educational attainment was the only factor that predicted testing barriers. Conclusion: Black immigrants face more barriers to HIV testing than US born black individuals. These barriers are driven primarily by education level and duration of time in the US. Interventions should be developed to address these barriers, particularly in new arrivals to the US.

Learning Areas:

Diversity and culture
Implementation of health education strategies, interventions and programs
Protection of the public in relation to communicable diseases including prevention or control
Public health or related public policy

Learning Objectives:
Identify barriers to HIV testing in black immigrants and compare them to barriers in US born black individuals. Describe the impact these barriers to HIV testing may have on HIV testing rates in immigrant populations now that HIV testing is no longer mandatory due to the lifting of the HIV Travel Ban.

Keyword(s): HIV/AIDS, Immigrants

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the principal or co-principal investigator of several federally funded grants focusing on access to HIV services, care and treatment both domestically and internationally. This study was funded through a grant awarded by the Centers for AIDS Research at Harvard University. My scientific interests include racial and ethnic disparities in access to HIV care and related services, particularly those designed for women and immigrant populations.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.