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

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.