Barriers to and facilitators of accessing HIV services for street-involved youth in Canada and Kenya
Abstract Introduction UNICEF estimates that there are as many as 100 million street-involved youth (SIY) globally. Marginalized conditions put SIY at higher risk of HIV and adverse outcomes once HIV-positive. The objective of this analysis was to describe barriers and facilitators of accessing HIV p...
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| Format: | Article |
| Language: | English |
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BMC
2022-10-01
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| Series: | BMC Public Health |
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| Online Access: | https://doi.org/10.1186/s12889-022-14290-7 |
| _version_ | 1798030069190361088 |
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| author | Momina Khan Katie MacEntee Reuben Kiptui Amy Van Berkum Abe Oudshoorn David O Ayuku Edith Apondi Edward Ou Jin Lee Alex Abramovich Sue-Ann MacDonald Paula Braitstein |
| author_facet | Momina Khan Katie MacEntee Reuben Kiptui Amy Van Berkum Abe Oudshoorn David O Ayuku Edith Apondi Edward Ou Jin Lee Alex Abramovich Sue-Ann MacDonald Paula Braitstein |
| author_sort | Momina Khan |
| collection | DOAJ |
| description | Abstract Introduction UNICEF estimates that there are as many as 100 million street-involved youth (SIY) globally. Marginalized conditions put SIY at higher risk of HIV and adverse outcomes once HIV-positive. The objective of this analysis was to describe barriers and facilitators of accessing HIV prevention, testing, and treatment services as Phase I of an implementation study evaluating the use of peer navigators to increase access to HIV services. Methods Semi-structured interviews, focus group discussions (FGD), and theatre testing were conducted with individuals who identify as SIY, health care providers, and community stakeholders living in Canada (Toronto, Montreal, London) and Kenya (Eldoret, Huruma, Kitale). Data were analyzed using a directed content approach, guided by the socio-ecological model (SEM). Results Across the six sites were 195 participants: 64 SIY, 42 healthcare providers, and 97 community-based stakeholders. Barriers were identified at the societal (e.g. intersectional stigma and discrimination), public policy (e.g., inadequate access to basic needs, legal documentation, lack of health insurance, and limited community-based funding), institutional (e.g. lack of inclusive education and training, inadequate HIV educational outreach, and restrictive service provision), interpersonal (e.g., ineffective communication from healthcare providers), and intrapersonal levels (e.g. lack of trust and associated fear, low perception for healthcare, and lack of self-esteem). These contributed to limited HIV services utilization among SIY. Conversely, numerous facilitators were also identified at the public policy (e.g. affordable HIV services and treatment), institutional (e.g. available and accessible HIV prevention tools, HIV education and awareness programs, and holistic models of care), interpersonal level (e.g., systems navigation support, peer support, and personal relationships), and intrapersonal levels (e.g. self-efficacy) as positively supporting SIY access to HIV services. Conclusion Intersectional stigma was a critical barrier in all sites, and policies and programs that foster welcoming environments for youth from diverse backgrounds and living circumstances may be better able to respond to the HIV service needs of this high risk population. Social support and navigation services were reported to facilitate access to HIV services in all sites. |
| first_indexed | 2024-04-11T19:34:18Z |
| format | Article |
| id | doaj.art-9550875d9a434960ab4a9bed5a977858 |
| institution | Directory Open Access Journal |
| issn | 1471-2458 |
| language | English |
| last_indexed | 2024-04-11T19:34:18Z |
| publishDate | 2022-10-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Public Health |
| spelling | doaj.art-9550875d9a434960ab4a9bed5a9778582022-12-22T04:06:54ZengBMCBMC Public Health1471-24582022-10-0122111310.1186/s12889-022-14290-7Barriers to and facilitators of accessing HIV services for street-involved youth in Canada and KenyaMomina Khan0Katie MacEntee1Reuben Kiptui2Amy Van Berkum3Abe Oudshoorn4David O Ayuku5Edith Apondi6Edward Ou Jin Lee7Alex Abramovich8Sue-Ann MacDonald9Paula Braitstein10Division of Social and Behavioral Sciences, Dalla Lana School of Public Health, University of TorontoDivision of Epidemiology, Dalla Lana School of Public Health, University of TorontoAcademic Model Providing Access to Healthcare (AMPATH)Arthur Labatt Family School of Nursing, Western UniversityArthur Labatt Family School of Nursing, Western UniversityDepartment of Mental Health and Behavioral Sciences, School of Medicine, College of Health Sciences, Moi UniversityAcademic Model Providing Access to Healthcare (AMPATH)École de Travail Social, Université de MontréalDivision of Social and Behavioral Sciences, Dalla Lana School of Public Health, University of TorontoÉcole de Travail Social, Université de MontréalDivision of Epidemiology, Dalla Lana School of Public Health, University of TorontoAbstract Introduction UNICEF estimates that there are as many as 100 million street-involved youth (SIY) globally. Marginalized conditions put SIY at higher risk of HIV and adverse outcomes once HIV-positive. The objective of this analysis was to describe barriers and facilitators of accessing HIV prevention, testing, and treatment services as Phase I of an implementation study evaluating the use of peer navigators to increase access to HIV services. Methods Semi-structured interviews, focus group discussions (FGD), and theatre testing were conducted with individuals who identify as SIY, health care providers, and community stakeholders living in Canada (Toronto, Montreal, London) and Kenya (Eldoret, Huruma, Kitale). Data were analyzed using a directed content approach, guided by the socio-ecological model (SEM). Results Across the six sites were 195 participants: 64 SIY, 42 healthcare providers, and 97 community-based stakeholders. Barriers were identified at the societal (e.g. intersectional stigma and discrimination), public policy (e.g., inadequate access to basic needs, legal documentation, lack of health insurance, and limited community-based funding), institutional (e.g. lack of inclusive education and training, inadequate HIV educational outreach, and restrictive service provision), interpersonal (e.g., ineffective communication from healthcare providers), and intrapersonal levels (e.g. lack of trust and associated fear, low perception for healthcare, and lack of self-esteem). These contributed to limited HIV services utilization among SIY. Conversely, numerous facilitators were also identified at the public policy (e.g. affordable HIV services and treatment), institutional (e.g. available and accessible HIV prevention tools, HIV education and awareness programs, and holistic models of care), interpersonal level (e.g., systems navigation support, peer support, and personal relationships), and intrapersonal levels (e.g. self-efficacy) as positively supporting SIY access to HIV services. Conclusion Intersectional stigma was a critical barrier in all sites, and policies and programs that foster welcoming environments for youth from diverse backgrounds and living circumstances may be better able to respond to the HIV service needs of this high risk population. Social support and navigation services were reported to facilitate access to HIV services in all sites.https://doi.org/10.1186/s12889-022-14290-7Street youthHomelessnessHIVAccess to careKenyaCanada |
| spellingShingle | Momina Khan Katie MacEntee Reuben Kiptui Amy Van Berkum Abe Oudshoorn David O Ayuku Edith Apondi Edward Ou Jin Lee Alex Abramovich Sue-Ann MacDonald Paula Braitstein Barriers to and facilitators of accessing HIV services for street-involved youth in Canada and Kenya BMC Public Health Street youth Homelessness HIV Access to care Kenya Canada |
| title | Barriers to and facilitators of accessing HIV services for street-involved youth in Canada and Kenya |
| title_full | Barriers to and facilitators of accessing HIV services for street-involved youth in Canada and Kenya |
| title_fullStr | Barriers to and facilitators of accessing HIV services for street-involved youth in Canada and Kenya |
| title_full_unstemmed | Barriers to and facilitators of accessing HIV services for street-involved youth in Canada and Kenya |
| title_short | Barriers to and facilitators of accessing HIV services for street-involved youth in Canada and Kenya |
| title_sort | barriers to and facilitators of accessing hiv services for street involved youth in canada and kenya |
| topic | Street youth Homelessness HIV Access to care Kenya Canada |
| url | https://doi.org/10.1186/s12889-022-14290-7 |
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