Social and Structural Barriers to Primary Care Access Among Women Living With HIV in Metro Vancouver, Canada: A Longitudinal Cohort Study.
Kathleen N Deering, Louise Chong, Putu Duff and 7 others
PMID 33989244WHAT IT FOUND
Women living with HIV who were immigrants, transgender, suicidal, or experiencing violence had higher odds of being unable to access primary care.
Using HIV-specific services was linked to better access. Public funding did not remove these barriers.
Key findings
01Being a transgender woman, an immigrant, contemplating or attempting suicide, or experiencing physical/sexual violence were associated with increased odds of being unable to access primary care.
02Using HIV-specific health or support services was associated with lower odds of being unable to access primary care.
03At baseline, 15.5% of participants reported needing primary health care and being unable to access it in the previous 6 months.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The cohort had a high proportion of participants with histories of marginalization (unstable housing, drug use), so results may not apply to women living with HIV without these experiences. All variables except viral load were self-reported, which risks underreporting due to social desirability or stigma. The study could not determine causality; it identified associations between social factors and access barriers. Power may have been limited for detecting smaller effects due to the 3.5-year follow-up period rather than the planned 5 years.
Declared interests
The authors report no real or perceived vested interests related to this article.
The easy way to misread this
Do not assume that publicly funded healthcare systems eliminate access barriers. This study found that despite universal coverage in British Columbia, women with specific social vulnerabilities still faced significant obstacles to getting primary care.