Zhang Sirey, Obeng-Nyarkoh Peggy-Ita, Altomare Antonia, Zuckerman Richard
The Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
Department of Pediatrics, University of Utah Health, Salt Lake City, UT, USA.
Commun Med (Lond). 2025 Jun 10;5(1):225. doi: 10.1038/s43856-025-00879-7.
Immigrants and refugees with HIV in high-income countries face unique challenges navigating their diagnoses due to cultural, social, and structural barriers, which impact access and adherence to care. This project sought to improve care systems by gathering experiences from clients and care providers.
A focused ethnography was conducted using participant observation and standardized interviews with 18 clients and 4 clinic team members from three Dartmouth Health Ryan White-HIV clinics in New Hampshire, USA. Ten clients consented to recorded interviews, while 8 shared their stories informally. Interpretation services were provided as needed, and clients received compensation for participation. Data analysis involved associating codes with keywords to identify categories, from which themes were developed.
Client informants encompass a spectrum of documentation statuses and lengths of residence. Clinic team member informants include physicians, nurses, and care coordinators. Findings emphasize the benefits in care experience when power dynamics are mitigated within clinical settings-both between clients and clinicians and among care team members. Client informants express fears of stigma and ostracization within immigrant communities, describe challenges with healthcare access related to immigration status, and voice a general desire for the clinic team to engage more in family and community communication and advocacy.
This ethnographic study highlights the importance of redefining culturally competent care by moving beyond narrow associations with ethnoracial identity toward a multidimensional approach. This approach considers interpersonal interactions, hybridized identities, diasporic experiences, and structural inequities. By reframing cultural competence and implementing actionable strategies to address structural vulnerabilities, clinicians transform each healthcare interaction into an opportunity to deliver equity-oriented care and enhance the well-being of immigrant and refugees with HIV.
在高收入国家，感染艾滋病毒的移民和难民在应对其诊断时面临独特挑战，因为文化、社会和结构障碍会影响获得医疗服务及坚持治疗。本项目旨在通过收集客户和医疗服务提供者的经验来改善医疗系统。
采用聚焦人种志研究方法，对美国新罕布什尔州达特茅斯健康机构的三个瑞安·怀特艾滋病毒诊所的18名客户和4名诊所团队成员进行了参与观察和标准化访谈。10名客户同意进行录音访谈，8名客户则非正式地分享了他们的故事。根据需要提供口译服务，客户参与研究可获得报酬。数据分析包括将代码与关键词关联以识别类别，并据此形成主题。
客户信息提供者涵盖了不同的文件状态和居住时长。诊所团队成员信息提供者包括医生、护士和护理协调员。研究结果强调，在临床环境中减轻权力动态影响（包括客户与临床医生之间以及护理团队成员之间）对护理体验有益。客户信息提供者表达了对移民社区中耻辱感和排斥的恐惧，描述了与移民身份相关的医疗服务获取挑战，并普遍希望诊所团队更多地参与家庭和社区沟通及宣传工作。
这项人种志研究强调了重新定义具有文化胜任力的护理的重要性，即从与种族身份的狭隘关联转向多维方法。这种方法考虑人际互动、混合身份、散居经历和结构不平等。通过重新构建文化胜任力并实施可操作的策略来解决结构脆弱性问题，临床医生将每次医疗互动转化为提供公平导向护理并提升感染艾滋病毒的移民和难民福祉的机会。
