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Structural violence and the uncertainty of viral undetectability for African, Caribbean and Black people living with HIV in Canada: an institutional ethnography.
- Source :
- International Journal for Equity in Health; 2/17/2023, Vol. 22 Issue 1, p1-19, 19p
- Publication Year :
- 2023
-
Abstract
- Biomedical advances in healthcare and antiretroviral treatment or therapy (ART) have transformed HIV/AIDS from a death sentence to a manageable chronic disease. Studies demonstrate that people living with HIV who adhere to antiretroviral therapy can achieve viral suppression or undetectability, which is fundamental for optimizing health outcomes, decreasing HIV-related mortality and morbidity, and preventing HIV transmission. African, Caribbean, and Black (ACB) communities in Canada remain structurally disadvantaged and bear a disproportionate burden of HIV despite biomedical advancements in HIV treatment and prevention. This institutional ethnography orients to the concept of 'structural violence' to illuminate how inequities shape the daily experiences of ACB people living with HIV across the HIV care cascade. We conducted textual analysis and in-depth interviews with ACB people living with HIV (n = 20) and health professionals including healthcare providers, social workers, frontline workers, and health policy actors (n = 15). Study findings produce a cumulative understanding that biomedical HIV discourses and practices ignore structural violence embedded in Canada's social fabric, including legislation, policies and institutional practices that produce inequities and shape the social world of Black communities. Findings show that inequities in structural and social determinants of health such as food insecurity, financial and housing instability, homelessness, precarious immigration status, stigma, racial discrimination, anti-Black racism, criminalization of HIV non-disclosure, health systems barriers and privacy concerns intersect to constrain engagement and retention in HIV healthcare and ART adherence, contributing to the uncertainty of achieving and maintaining undetectability and violating their right to health. Biomedical discourses and practices, and inequities reduce Black people to a stigmatized, pathologized, and impoverished detectable viral underclass. Black people perceived as nonadherent to ART and maintain detectable viral loads are considered "bad" patients while privileged individuals who achieve undetectability are considered "good" patients. An effective response to ending HIV/AIDS requires implementing policies and institutional practices that address inequities in structural and social determinants of health among ACB people. [ABSTRACT FROM AUTHOR]
- Subjects :
- DIAGNOSIS of HIV infections
VIOLENCE prevention
AFRICANS
HIV-positive persons
HIV infections
ANTI-HIV agents
SOCIAL determinants of health
BLACK people
SOCIAL workers
VIRAL load
RESEARCH methodology
INTERVIEWING
SOCIAL justice
HIGHLY active antiretroviral therapy
BLACK Caribbean people
ETHNOLOGY research
INFORMED consent (Medical law)
CARIBBEAN people
PSYCHOSOCIAL factors
DRUGS
RESEARCH funding
ETHNOLOGY
ETHNIC groups
PATIENT compliance
DATA analysis software
EMPLOYEE retention
Subjects
Details
- Language :
- English
- ISSN :
- 14759276
- Volume :
- 22
- Issue :
- 1
- Database :
- Complementary Index
- Journal :
- International Journal for Equity in Health
- Publication Type :
- Academic Journal
- Accession number :
- 161960331
- Full Text :
- https://doi.org/10.1186/s12939-022-01792-4