🟠 Moderate Evidence
Immigrants living with or at risk of HIV face significant psychological and structural barriers to accessing care, according to qualitative research published in the Journal of Migration and Health in 2026. The study, led by Marc Shi and colleagues, identifies immigration-related stress—termed “migratory grief”—as a key factor complicating HIV treatment engagement and prevention efforts among immigrant communities.
Key takeaways
- Immigration-related stress creates psychological barriers to HIV care engagement among immigrant populations
- Structural barriers including housing instability, employment precarity, and healthcare access gaps compound clinical challenges
- Community-engaged research design prioritised lived experience of immigrants, revealing gaps in current service models
- Study suggests need for migration-informed HIV programmes that address both clinical and social determinants
Study at a Glance
| Source | Journal of Migration and Health |
| Study type | Qualitative community-engaged study |
| Population | Immigrants living with or at risk of HIV |
| Design | In-depth interviews and focus groups |
| Year | 2026 |
Barriers to HIV Care Among Immigrants: Multi-level Framework
Categories of barriers identified in qualitative analysis, Journal of Migration and Health (2026)
Source: Shi et al., Journal of Migration and Health, 2026 | Georgian Medical Journal News
Migratory grief as a clinical barrier
The research team, including Marc Shi, Jordy Rojas Antigua, Lesly Diaz Chacha, Nat Orihuela, Chanelle M. Diaz, and Viraj V. Patel, conducted community-engaged qualitative interviews and focus groups with immigrants living with or at risk of HIV. Their analysis identified “migratory grief”—the psychological distress accompanying separation from home, loss of social networks, and acculturation challenges—as a significant yet underrecognised factor affecting engagement with HIV treatment and prevention services.
This grief manifests as depression, anxiety, and social isolation that compounds the clinical demands of HIV management. Participants described how acculturative stress and loss of family connection interfered with medication adherence, healthcare attendance, and disclosure of HIV status within their communities. The Journal of Migration and Health publication emphasises that standard HIV care models typically address clinical outcomes without accounting for these migration-specific psychological dimensions.
Structural barriers compound clinical complexity
Beyond psychological factors, the study reveals how housing instability, employment precarity, and food insecurity create interconnected barriers to sustained HIV care. Participants reported that irregular employment and housing instability disrupted appointments, made medication storage difficult, and limited access to consistent healthcare providers. Immigration status uncertainty added another layer, with some participants avoiding healthcare facilities due to fear of deportation or legal consequences.
According to the research published in the Journal of Migration and Health, these structural barriers are not merely background factors—they are active drivers of HIV treatment failure and missed prevention opportunities. Researchers noted that interventions addressing only biomedical aspects of HIV (antiretroviral therapy, viral load suppression) without addressing housing, employment, and legal status leave critical gaps in care. This aligns with existing literature on migration and health equity, which demonstrates that social determinants directly affect clinical outcomes.
Implications for HIV programme redesign
The community-engaged methodology—which centred immigrant voices in identifying barriers—highlights a critical gap in current HIV service delivery. Researchers found that immigrants themselves identified specific, actionable interventions: translation services, culturally informed mental health support, legal aid partnerships, and employment assistance integrated into HIV clinics. These solutions emerged directly from participant experience rather than from clinical assumptions.
The study suggests that effective HIV programmes serving immigrant populations must operate at multiple levels simultaneously. This includes integrating mental health screening for migratory grief, establishing housing and employment support pathways, ensuring legal confidentiality protections, and training clinicians in migration-informed care. The authors argue that siloed service delivery—where HIV care is separate from housing, mental health, and legal support—perpetuates treatment failure among populations already experiencing cumulative structural disadvantage.
Immigration-related stress, conceptualised as “migratory grief,” directly interferes with HIV treatment engagement and prevention uptake, yet remains largely unaddressed in standard care models.
— Marc Shi and colleagues, Journal of Migration and Health (2026)
What this means
Frequently asked questions
What is “migratory grief” and why does it matter for HIV care?
Migratory grief refers to the psychological distress experienced by immigrants due to separation from home, loss of social networks, and acculturation stress. According to the study published in the Journal of Migration and Health, this grief directly interferes with medication adherence, appointment attendance, and disease disclosure. Current HIV care models do not systematically address this dimension, leaving immigrant patients at higher risk of treatment failure.
How do structural barriers (housing, employment) affect HIV outcomes?
Research by Shi and colleagues found that housing instability prevents consistent medication storage and refrigeration, employment precarity disrupts clinic attendance, and food insecurity reduces medication tolerability. These are not simply background disadvantages—they are active mediators of treatment failure. Standard biomedical HIV interventions cannot compensate for unaddressed structural barriers.
What changes are needed in HIV service delivery for immigrant populations?
The study recommends integration of mental health screening for migratory grief, housing and employment support, legal aid partnerships, culturally informed care, and interpreter services directly into HIV clinics. Rather than referring patients separately to multiple agencies, integrated models ensure that all dimensions of wellbeing are addressed together, improving engagement and clinical outcomes.
Future research should test whether integrated, migration-informed HIV programmes actually improve treatment outcomes and viral suppression compared to standard models. Community-engaged implementation science paired with quantitative outcome tracking would provide evidence to guide resource allocation and scale successful interventions across diverse immigrant populations globally.
Source: Migratory grief and structural barriers to care: a community-engaged qualitative study of immigration-related stress among immigrants living with or at risk of HIV, Journal of Migration and Health, 2026
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Medically reviewed by Prof. Giorgi Pkhakadze, MD, MPH, PhD. Spotted an error? Contact the editorial team.
