A Qualitative Study of Systemic Barriers Encountered by HIV-Positive Immigrants in Spain

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Abstract
Background: Immigrants are disproportionally impacted by HIV infection in Europe and in Spain. Immigrants are also identified as a vulnerable population during economic crises. Various socioeconomic barriers hinder HIV-positive immigrants from accessing healthcare services in the host country. As a result of the 2008 financial crisis, Spain has implemented multiple austerity measures, one of which was the enactments of Royal Decree Law (RDL) 16/2012 and Royal Decree (RD) 1192/2012 which abolished universal healthcare coverage. In this context, this study examined systemic barriers encountered by the participants while accessing health care after the enactments of 2012 RDL and RD. The study also researched distress felt by the participants and their experiences as HIV-positive immigrants living in Spain. Methods: Participants were recruited through a nongovernmental organization (NGO) during routine visits at the their center. A total of 12 participants were interviewed to reach data saturation. Participants were HIV-positive immigrants living in Spain for 1 or more years, allowing for substantial experience with navigating the healthcare system. Thematic analysis was performed to identify common themes in participants’ experiences living as HIV-positive individuals in Spain and confronting systemic barriers to healthcare access. Results: Four primary themes were identified. Participants identified experiencing emotional or physical (eg, side effects of medication) distress in adapting to life as HIV-positive individuals. Participants also expressed experiencing discrimination while living as HIV-positive immigrants in Spain. The primary systemic barrier to accessing health care encountered by participants was the inability to fulfill the requirement of having proof of registration in an Autonomous Community for the required time period, thus not being able to apply for a public health insurance card and utilize free care services. Participants identified a positive impact of third party (NGO, social worker, friend/family member) guidance on their experience of applying for a public health insurance card.Conclusions: HIV-positive immigrants are underserved in Spain. They encounter systemic barriers while accessing healthcare services, and experience fear and/or discrimination. The study underscores the role of NGOs in helping HIV-positive immigrants navigate the healthcare system. More research is needed on comprehensive approaches to address healthcare needs of HIV-positive immigrants in Spain.

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