{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T02:36:04Z","timestamp":1790044564901,"version":"4.0.1"},"reference-count":39,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,1,15]],"date-time":"2025-01-15T00:00:00Z","timestamp":1736899200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Office of Research Services, MacEwan University"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>The human immunodeficiency virus (HIV) pandemic is a global public health and social justice issue. HIV continues to disproportionately affect marginalized populations, including immigrants and refugees living with HIV (IRLHIV). This study investigated and captured the experiences of IRLHIV using the social determinants of health framework. This study examined the intersecting factors affecting the health and well-being of IRLHIV in Alberta, Canada, prior to and during the COVID-19 pandemic. Concurrent mixed methods were used. Employing an online survey (n = 124) and photovoice methodology (n = 13), the researchers identified five salient themes: experiences of racism and discrimination, challenges accessing nutrition, healthcare, and affordable housing, and precarious employment situations. The findings underscored the amplification of pre-existing inequities during the COVID-19 pandemic, intensifying the discrimination and stigma faced by IRLHIV due to both their health status and immigration background. These findings highlight the urgent need for targeted, evidence-based interventions to address the social determinants of health that adversely affect IRLHIV. The researchers recommend further participatory research action into health disparities for IRLHIV to create responsive and culturally safe services for IRLHIV.<\/jats:p>","DOI":"10.3390\/ijerph22010114","type":"journal-article","created":{"date-parts":[[2025,1,16]],"date-time":"2025-01-16T04:55:19Z","timestamp":1737003319000},"page":"114","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Challenges and Resiliency: Social Determinants of Health, COVID-19, and the Disproportionate Impact on Immigrants and Refugees Living with HIV"],"prefix":"10.3390","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-4557-3610","authenticated-orcid":false,"given":"Natasha","family":"Marriette","sequence":"first","affiliation":[{"name":"School of Social Work and Human Services, University of the Fraser Valley, Abbotsford, BC V2S 7M8, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rita","family":"Dhungel","sequence":"additional","affiliation":[{"name":"School of Social Work and Human Services, University of the Fraser Valley, Abbotsford, BC V2S 7M8, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8712-6831","authenticated-orcid":false,"given":"Karun","family":"Karki","sequence":"additional","affiliation":[{"name":"School of Social Work, University of British Columbia, Vancouver, BC V6T 1Z2, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose","family":"Tovillo","sequence":"additional","affiliation":[{"name":"Faculty of Nursing, MacEwan University, Edmonton, AB T5J 4S2, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,15]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2023, April 19). HIV and AIDS. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/hiv-aids."},{"key":"ref_2","unstructured":"UNAIDS (2024, June 30). Global HIV & AIDS Statistics\u2014Fact Sheet. Available online: https:\/\/www.unaids.org\/sites\/default\/files\/media_asset\/UNAIDS_FactSheet_en.pdf."},{"key":"ref_3","unstructured":"Government of Canada (2024, June 30). HIV in Canada, Surveillance Report to December 31, 2022, Available online: https:\/\/www.canada.ca\/en\/public-health\/services\/publications\/diseases-conditions\/hiv-canada-surveillance-report-december-31-2022.html#st12."},{"key":"ref_4","unstructured":"Government of Canada (2024, July 05). Reducing the Health Impact of Sexually Transmitted Borne Infections in Canada by 2030: A Pan-Canadian STBBI Framework for Action, Available online: https:\/\/www.canada.ca\/en\/public-health\/services\/infectious-diseases\/sexual-health-sexually-transmitted-infections\/reports-publications\/sexually-transmitted-blood-borne-infections-action-framework.html#a1.0."},{"key":"ref_5","unstructured":"Government of Canada (2024, May 05). HIV and AIDS: Symptoms and Treatment, Available online: https:\/\/www.canada.ca\/en\/public-health\/services\/diseases\/hiv-aids.html#a4."},{"key":"ref_6","unstructured":"Public Health Agency of Canada (2024, March 12). HIV in Canada: 2022 Surveillance Highlights, Available online: https:\/\/www.canada.ca\/content\/dam\/phac-aspc\/documents\/services\/publications\/diseases-conditions\/hiv-2022-surveillance-highlights\/hiv-2022-surveillance-highlights.pdf."},{"key":"ref_7","unstructured":"(2024, July 05). HIV.gov. Who Is at Risk for HIV?, Available online: https:\/\/www.hiv.gov\/hiv-basics\/overview\/about-hiv-and-aids\/who-is-at-risk-for-hiv\/."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"100088","DOI":"10.1016\/j.jmh.2022.100088","article-title":"\u201cI die silently inside\u201d. Qualitative findings from a study of people living with HIV who migrate to and settle in Canada","volume":"5","author":"Maposa","year":"2022","journal-title":"J. Migr. Health"},{"key":"ref_9","unstructured":"Dhungel, R., Lorenzetti, L., Lorenzetti, D.L., Karki, K.K., Thomas, S., McGuinness, C., Suedfeld, K., and Bell, C. (2023). Gender-Based Violence Against Immigrant and Refugee Women Living with HIV\/Risk in Canada: A Systematic Review Final Report."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"304","DOI":"10.14745\/ccdr.v45i12a01","article-title":"HIV in Canada-surveillance report, 2018","volume":"45","author":"Haddad","year":"2019","journal-title":"Can. Commun. Dis. Rep."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"132","DOI":"10.3126\/mef.v13i01.56070","article-title":"Vulnerable to Precarity: COVID-19 and the Experience of Difference by Newcomers, Immigrants, and Migrant Workers in Canada","volume":"13","author":"Karki","year":"2023","journal-title":"Molung Educ. Front."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1353\/hpu.2015.0049","article-title":"Improving access to mental health services for racialized immigrants, refugees, and non-status people living with HIV\/AIDS","volume":"26","author":"Chen","year":"2015","journal-title":"J. Health Care Poor Underserved"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"38","DOI":"10.24095\/hpcdp.40.2.02","article-title":"Original mixed methods research\u2014Mandatory HIV screening, migration and HIV stigma in Canada: Exploring the experiences of sub-Saharan African immigrants living with HIV in western Canada","volume":"40","author":"Patten","year":"2020","journal-title":"Health Promot. Chronic Dis. Prev. Can."},{"key":"ref_14","unstructured":"Public Health Agency of Canada (2024, March 12). CPHO Sunday Edition: The Impact of COVID-19 on Racialized Communities, Available online: https:\/\/www.canada.ca\/en\/public-health\/news\/2021\/02\/cpho-sunday-edition-the-impact-of-covid-19-on-racialized-communities.html."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1387","DOI":"10.1016\/0140-6736(91)93068-K","article-title":"Health inequalities among British civil servants: The Whitehall II study","volume":"337","author":"Marmot","year":"1991","journal-title":"Lancet"},{"key":"ref_16","unstructured":"Wilkinson, R., Marmot, M., and World Health Organization. Regional Office for Europe (2024, March 12). The Solid Facts: Social Determinants of Health. Copenhagen: WHO Regional Office for Europe. Available online: https:\/\/apps.who.int\/iris\/handle\/10665\/108082."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1099","DOI":"10.1016\/S0140-6736(05)71146-6","article-title":"Social determinants of health inequalities","volume":"19","author":"Marmot","year":"2005","journal-title":"Lancet"},{"key":"ref_18","unstructured":"Raphael, D., Bryant, T., Mikkonen, J., and Raphael, A. (2020). Social determinants of health. The Canadian Facts, York University School of Health Policy and Management. [2nd ed.]. Available online: https:\/\/thecanadianfacts.org\/The_Canadian_Facts-2nd_ed.pdf."},{"key":"ref_19","unstructured":"World Health Organization (WHO) (2024, March 14). A Conceptual Framework for Action on the Social Determinants of Health. Available online: https:\/\/iris.who.int\/bitstream\/handle\/10665\/44489\/9789241500852_eng.pdf?sequence=1."},{"key":"ref_20","unstructured":"Creswell, J.W., and Clark, V.L. (2018). Designing and Conducting Mixed Methods Research, SAGE. [3rd ed.]."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1111\/j.1442-2018.2010.00541.x","article-title":"Recruiting hard-to-reach united states population sub-groups via adaptations of snowball sampling strategy","volume":"12","author":"Sadler","year":"2010","journal-title":"Nurs. Health Sci."},{"key":"ref_22","unstructured":"Atkinson, R., and Flint, J. (2024, July 08). Accessing Hidden and Hard-to-Reach Populations: Snowball Research Strategies. Social Research Update, (33). Available online: https:\/\/sru.soc.surrey.ac.uk\/SRU33.PDF."},{"key":"ref_23","unstructured":"Palibroda, B., Krieg, B., Murdock, L., and Havelock, J. (2024, July 08). A Practical Guide to Photovoice: Sharing Pictures, Telling Stories and Changing Communities. Available online: https:\/\/www.communitythroughcare.net\/s\/a-practical-guide-pdf20.pdf."},{"key":"ref_24","unstructured":"Dhungel, R. (2019, March 05). Anti-Oppressive Practice in Anti-Trafficking Intervention in Nepal. Social Dialogue, 20. Available online: https:\/\/socialdialogue.online\/sd20\/09_article.html."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1089\/jwh.1999.8.185","article-title":"Photovoice: A participatory action research strategy applied to women\u2019s health","volume":"8","author":"Wang","year":"1999","journal-title":"J. Women\u2019s Health"},{"key":"ref_26","first-page":"560","article-title":"Photovoice ethics: Perspectives from Flint Photovoice","volume":"28","author":"Wang","year":"2001","journal-title":"Health Educ. Behav. Off. Publ. Soc. Public Health Educ."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1080\/2159676X.2019.1628806","article-title":"Reflecting on reflexive thematic analysis","volume":"11","author":"Braun","year":"2019","journal-title":"Qual. Res. Sport Exerc. Health"},{"key":"ref_28","unstructured":"Canadian Race Relations Foundation (2024, March 14). Glossary of Terms. Available online: https:\/\/crrf-fcrr.ca\/glossary-of-terms\/."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1186\/s12939-022-01792-4","article-title":"Structural violence and the uncertainty of viral undetectability for African, Caribbean and black people living with HIV in Canada: An institutional ethnography","volume":"22","author":"Odhiambo","year":"2023","journal-title":"Int. J. Equity Health"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1108\/IJMHSC-07-2013-0026","article-title":"An exploratory study on the mental health of immigrants, refugees and non-status people living with HIV in Toronto","volume":"9","author":"Wong","year":"2013","journal-title":"Int. J. Migr. Health Soc. Care"},{"key":"ref_31","unstructured":"World Health Organization (2024, July 05). Primary Health Care. Available online: https:\/\/www.who.int\/health-topics\/primary-health-care#tab=tab_1."},{"key":"ref_32","unstructured":"Government of Canada (2024, July 05). About Canada\u2019s Health Care System, Available online: https:\/\/www.canada.ca\/en\/health-canada\/services\/canada-health-care-system.html#a1."},{"key":"ref_33","unstructured":"Alberta Health Services (2024, October 24). About AHS. Available online: https:\/\/www.albertahealthservices.ca\/about\/about.aspx."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"768","DOI":"10.1016\/j.jana.2016.07.003","article-title":"Stigma experiences in marginalized people living with HIV seeking health services and resources in Canada","volume":"27","author":"Donnelly","year":"2016","journal-title":"J. Assoc. Nurses AIDS Care"},{"key":"ref_35","unstructured":"Edmonton Chamber of Voluntary Organizations (2024, October 24). The Housing Stories of Newcomers in Edmonton: A Snapshot of the Lived Experience. Available online: https:\/\/ecvo.ca\/wp-content\/uploads\/2021\/05\/The-Housing-Stories-of-Newcomers-in-EdmontonFINAL.pdf."},{"key":"ref_36","unstructured":"Government of Canada (2024, October 24). Canada Emergency Response Benefit, Available online: https:\/\/www.canada.ca\/en\/services\/benefits\/ei\/cerb-application.html."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1108\/IJHRH-08-2022-0091","article-title":"Stigma, discrimination and HIV or AIDS: An empirical investigation of Asian immigrants and refugees in Canada","volume":"17","author":"Ullah","year":"2024","journal-title":"Int. J. Hum. Rights Healthc."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Beichler, H., Kutalek, R., and Dorner, T.E. (2023). People living with HIV and AIDS: Experiences towards antiretroviral therapy, paradigm changes, coping, stigma, and Discrimination\u2014A grounded theory study. Int. J. Environ. Res. Public Health, 20.","DOI":"10.3390\/ijerph20043000"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1080\/13557858.2016.1246518","article-title":"Are immigrants healthier than native-born Canadians? A systematic review of the healthy immigrant effect in Canada","volume":"22","author":"Vang","year":"2017","journal-title":"Ethn. Health"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/22\/1\/114\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T10:29:29Z","timestamp":1759919369000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/22\/1\/114"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,15]]},"references-count":39,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,1]]}},"alternative-id":["ijerph22010114"],"URL":"https:\/\/doi.org\/10.3390\/ijerph22010114","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,15]]}}}