Intersecting sexuality, gender, race

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Intersecting sexuality, gender, race
citizenship Mental Health issues faced by
immigrants and refugees living with HIV/AIDS

• Presented by Josephine P. Wong, RN, PhD (c)
• Toronto Public Health,
• Planning Policy Urban Issues
• With CAAT Research Team

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Committee for Accessible AIDS Treatment (CAAT)
Research Team

• Josephine P. Wong, PhD (c)
• Dr. Alan Li
• Y. B. Chen, MSW
• Pushpa Kanagaratnam, PhD (c)
• Susanda Yee, MA
• Dr. Kenneth Fung
• Anuradha Roy Sen, PhD

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A Preliminary Study onMigration, HIV/AIDS
Mental HealthWhat are the issues?
MIGRATION
HIV/AIDS
MENTAL HEALTH
PHYSICAL SPIRITUAL HEALTH
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Purpose of Study

• The purpose of this study was to gain a
  preliminary understanding of
• The mental health issues faced by immigrants,
  refugees and non-status persons living with
  HIV/AIDS (IR-PHAs) in the Greater Toronto Area
• Their experiences in accessing services related
  to mental health
• Research priorities based on their identified
  needs

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Method

• Literature Search
• A brief program scan
• 2 Focus Groups
• 10 PHAs from the 5 ethnospecific communities
  served by CAAT
• 10 service providers affiliated with primary
  care, hospice care, and ethnospecific community
  ASOs

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Framework of Analysis What determines our health?

• Social Environmental
• Income
• Housing
• Food/nutrition
• Education
• Employment
• Healthy child development
• Social inclusion
• Access to services
• Physical environment
• Social environment
• etc.

• Individual
• Biological
• Genetic factors
• Lifestyle
• Personal Practices

Our Health
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Key finding 1 Literature review -- knowledge
gaps

• Majority of HIV/AIDS research in N. American
  focus on gay white males.
• Research subpopulations are mostly defined by
  race or ethnicity categories and not citizenship
  or migration status
• Studies of PHAs with multiple marginalities are
  virtually non-existent.
• There is a lack of inclusive research in which
  the meanings of mental health, sexuality
  HIV/AIDS are studied within the social contexts
  of the marginalized groups.

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Key finding 2 Mental health services for
IR-PHA are uncoordinated or inaccessible

• A request for mental health assessment and
  counselling for a non-English speaking female
  immigrant PHA led to 7 redirections and
  subsequently the request was referred back to a
  community AIDS service organization
• There is a lack of access to culturally
  linguistically appropriate counseling service
  beyond HIV testing counselling.
• IR-PHAs are sometimes retraumatized by
  fragmented and uncoordinated services or abuse of
  power by some service providers.

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Physical Psychosocial Connections

• Bodys response to HIV HIV treatment
• Visible invisible impairment
• altered functioning

spirit
body
mind

• stigma
• social exclusion
• isolation
• alienation

• stress
• altered sense of self
• depression

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Physical mental Wellnessare intertwined

• I have memory loss, its like the brain is not
  working now I cannot even remember my childrens
  birthday.
• After immigration, you cannot find work you
  need to upgrade your education, but how can you
  do that when your head is not working as well as
  before?

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Physical mental wellness are affectedby social
reactions interactions

• It happened to me. It visual impairment has
  created a loss of independence for me I am now
  scared of going to places unless I am really
  familiar with them I need to rely on others but
  I dont want to have to explain my condition all
  the time
• One late evening, I was going down to the club to
  meet some friends. The guard saw me from afar
  and thought I was drunk and refused to let me in
  I have to show my sight impairment ID
  Regular incidents like this will lead to stress
  and isolation. When you stay home all the time
  with the four walls, sooner or later, your
  thinking will become negative

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Social, economic political connections
spirit
body

• Access to basic
• Determinants
• housing
• employment
• health care
• income, etc.

Citizenship status
Social inclusion
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For refugee non-status PHAs, the immigration
processes were the major source of stress

• When you have HIV, you feel that people wouldnt
  date you but dating is the last thing you worry
  about the immigration status comes first I
  cannot think about HIV treatment or anything else
  until I get my immigration papers

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Other stressors are related to stigma
discrimination

• People have stereotypes about refugees they
  think they are uneducated, ignorant and only want
  to take advantage of the system.
• Being an immigrant, you dont want to be on
  social assistance, but you cannot find work
  because your home qualification is not being
  recognized. Once you are HIV positive, the
  government labels you as disabled and says that
  you can get disability benefits so that makes
  you feel you are disabled and that impacts on
  your mental health.

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IR-PHAs experience a sense of deep loss
uncertainty about their life in Canada.

• HIV is a big problem in Africa and Asia having
  a landed immigrant status is a relief. Once
  youve arrived in Canada, you know there are
  medication and treatment. You can try to close
  the chapter of persecution at home country.
  But you now have a different kind of mental
  distress and needs.
• We live longer but what kind of life are we
  living?
• Housing is a big stress when you cannot find
  housing, what do you do? Do you go back to the
  shelter?

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Research priorities identifiedby participants

• What types of mental health services are
  available to IR-PHAs?
• What needs to be in place to increase
  accessibility and utilization?
• How to facilitate a better coordination of
  existing services?
• What do service providers know about the
  intersection of HIV/AIDS, mental health
  migration?

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The 4 Ps contributing to the Mental Health of
IR-PHAs
environmental
Predisposing Factors
Precipitating Factors
war
biological
migration
trauma
genetical/ congenital
HIV diagnosis
Mental Health
loss
PHYSICAL SPIRITUAL HEALTH
Perpetuating Factors
Protective Factors
access to adequate income housing, employment,
etc.
stress
decreased health status
coping ability
personal strengths
social exclusion
social inclusion
community support
inadequate income inadequate housing
access to HIV care
altered sense of self
social spiritual support
unemployment
Etc.
Etc.