PhD defence Oladipupo Oluwaseun Shobowale

Keywords: HIV/AIDS, HIV testing, Care pathway, African migrants

"Determinants of HIV Testing and Care Pathways among African Migrants in the Netherlands"

African migrants in Europe, including the Netherlands, are disproportionately affected by HIV, and late diagnoses remain a public health challenge. This research explored barriers and facilitators to healthcare access, HIV testing, HIV self-testing, and linkage to HIV care (LtHC) among African migrants in the Netherlands. Participants frequently reported financial challenges, such as unfamiliar insurance policies and unexpected costs (Eigen Risico), as well as negative perceptions of the Dutch healthcare system and experiences of provider-related (enacted) stigma. For those living with HIV, LtHC was often hindered by disclosure concerns. Migration-related precarity (racial hierarchies, socioeconomic marginalization, and legal status) and bureaucratic delays in Dutch healthcare and asylum systems served as intersecting barriers to both general healthcare access and LtHC. Community-based care connection support was consistently crucial in helping African migrants (with and without HIV) navigate these barriers, particularly undocumented migrants and asylum seekers. For HIV testing, low risk perception and multilevel stigma (individual, interpersonal, and community levels), including intersectional stigma related to race, sexuality, and gender, were primary barriers. However, when implemented consistently and effectively, community-level interventions such as outreach testing, partnerships, and collaboration can facilitate HIV testing. Finally, African migrants valued HIV self-testing (HIVST) for the privacy and autonomy it offered, but cost, procedural complexity, and poor awareness, visibility, and integration with existing health services limited uptake. Collectively, these research findings point to a clear and urgent need for systemic reforms and community-driven, integrated interventions tailored to African migrant communities.

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