HIV medication adherence in the migration and settlement journey: Experiences and perspectives of migrant women living with HIV.

Medication adherence is the cornerstone of HIV care and management and involves taking HIV medication as prescribed. Though barriers to adherence are well-documented, little research to date has examined the everyday experiences of medication adherence of people living with HIV. As migrant women living with HIV (mWLWH) are disproportionately impacted by HIV in Canada, it is pertinent to better understand their unique experiences of medication adherence. This study examined the processes by which mWLWH engage with medication adherence and how these processes are influenced by their socio-structural context throughout their migration and settlement experiences. In this interpretive description study, we draw on 1) semi-structured interviews with mWLWH (n = 10) and service providers (n = 14) as a primary data sources, and 2) document review as a secondary data source. Through reflexive thematic analysis, we constructed four themes: 1) The context of everyday and long-term work of medication adherence; 2) Demonstrating medication adherence to prove you are not a threat nor a burden; 3) Anticipating future barriers to medication adherence in Canada by stockpiling HIV medications; and 4) Managing medication adherence in the context of housing insecurity. Overall, we demonstrate how mWLWH manage their everyday experiences of medication adherence, while navigating the complexities of migration and settlement. Further, our findings demonstrate that HIV remains a complex health condition, where medication adherence is highly regulated and scrutinized.