The Rapid Assessment, Response, and Evaluation (RARE) portion of the CSAD Project in the Twin Cities (Minneapolis-St. Paul, Minnesota) was designed to identify barriers to care faced by African refugees and immigrants. Data were collected from cultural experts and African people living with HIV (PLWH) who were out of care, who had newly entered care, or who were in and out of care. Findings from RARE can be categorized into five main themes: HIV/AIDS within the African context, experiences of African PLWH, unfamiliarity with HIV and support services that facilitate access to care, cultural and religious dilemmas in seeking or remaining in care, and accessing African PLWH and getting them into care. Most of the issues identified were manifestations of stigma, gender, religion and/or faith, as well as the two main underlying cross-cutting themes of knowledge and fear. The top barriers to care included fatalistic views about HIV, fear of isolation, fear of deportation, lack of knowledge of the care system and HIV-related services, and employment issues.

Stigma HIV Religion Religious leaders Cultural experts African PLWH African refugees and immigrants

HIV Infections refugee Interpersonal Relations Human immunodeficiency virus infection human social isolation Refugees health service social support Cultural Competency Minnesota African American religion ethnology Health Services Needs and Demand human relation Urban Health Services interview cultural competence United States Humans Interviews as Topic Emigrants and Immigrants Article migration African Americans Health Services Accessibility health care delivery