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Miranda MNS, Pimentel V, Graça J, Seabra SG, Sebastião CS, Diniz A, Faria D, Teófilo E, Roxo F, Maltez F, Germano I, Oliveira J, Ferreira J, Poças J, Mansinho K, Mendão L, Gonçalves MJ, Mouro M, Marques N, Pacheco P, Proença P, Tavares R, Correia de Abreu R, Serrão R, Faria T, O. Martins MR, Gomes P, Abecasis AB, Pingarilho M. Sociodemographic, Clinical, and Behavioral Factors Associated with Sexual Transmitted Infection among HIV-1 Positive Migrants in Portugal: Are There Differences between Sexes? Pathogens 2024; 13:598. [PMID: 39057824 PMCID: PMC11280352 DOI: 10.3390/pathogens13070598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 07/09/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024] Open
Abstract
INTRODUCTION Sexually transmitted infections (STIs) continue to occur at high levels. According to the WHO, each year there are an estimated 374 million new infections with syphilis, gonorrhea, chlamydia, and trichomoniasis. STIs are associated with an increased risk of acquiring HIV infection. Migrants are reportedly highly affected by STIs. OBJECTIVES This study aims to characterize factors associated with STIs in a population of HIV-positive migrants living in Portugal. METHODOLOGY This is a cross-sectional observational study of 265 newly diagnosed HIV-1 positive migrants, who were defined as individuals born outside Portugal. This group of people were part of the BESTHOPE study that was developed in 17 Portuguese hospitals between September 2014 and December 2019, and included information collected through sociodemographic and behavioral questionnaires filled in by the migrant patients, clinical questionnaires filled in by the clinicians and HIV-1 genomic sequences generated through resistance testing (Sanger sequencing). A multivariable statistical analysis was used to analyze the association between sociodemographic characteristics, sexual behaviors, HIV testing and sexual infections. RESULTS Most HIV-1 positive individuals included in the study were men (66.8%) and aged between 25 and 44 years old (59.9%). Men had a higher proportion of STIs when compared to women (40.4% vs. 14.0%) and the majority of men reported homosexual contacts (52.0%). Most men reported having had two or more occasional sexual partners in the previous year (88.8%) and 50.9% reported always using condoms with occasional partners, while 13.2% never used it. For regular partners, only 29.5% of the women reported using condoms, compared to 47.3% of men. Other risk behaviors for acquiring HIV, such as tattooing and performing invasive medical procedures, were more prevalent in men (38.0% and 46.2%, respectively), when compared to women (30.4% and 45.1% respectively) and 4.7% of men reported having already shared injectable materials, with no data for comparison in the case for women. Additionally, 23.9% of women reported having had a blood transfusion while only 10.3% of men reported having had this medical procedure. Meanwhile, 30.9% of the individuals reported having been diagnosed with some type of STI in the last 12 months. In addition, 43.3% of individuals that answered a question about hepatitis reported to be infected with hepatitis B, while 13.0% reported having hepatitis C infection. According to the multivariable analysis, the only transmission route was significantly associated with reports of previous STI infection: men who have sex with men (MSM) were 70% more likely to have been diagnosed with an STI in the past 12 months compared to the heterosexual route. CONCLUSION HIV-1 infected men were more likely to report previous STIs than women. On the other hand, most migrant women had a regular sexual partner and never or only sometimes used condoms. This somewhat discrepant findings suggest that gender inequalities may make women unable to negotiate safe sexual practices, resulting in increased susceptibility to infection. However, since migrant women report less STIs, we cannot exclude that these STIs may remain undiagnosed. The implementation of safer sex awareness campaigns for condom use and screening for STIs in women is crucial. On the other hand, health education campaigns for STI knowledge need to be implemented for both MSM and women and their partners.
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Affiliation(s)
- Mafalda N. S. Miranda
- Global Health and Tropical Medicine, GHTM, Associate Laboratory in Translation and Innovation towards Global Health, LA-REAL, Instituto de Higiene e Medicina Tropical, IHMT, Universidade NOVA de Lisboa, UNL, Rua da Junqueira 100, 1349-008 Lisbon, Portugal; (M.N.S.M.); (C.S.S.)
| | - Victor Pimentel
- Global Health and Tropical Medicine, GHTM, Associate Laboratory in Translation and Innovation towards Global Health, LA-REAL, Instituto de Higiene e Medicina Tropical, IHMT, Universidade NOVA de Lisboa, UNL, Rua da Junqueira 100, 1349-008 Lisbon, Portugal; (M.N.S.M.); (C.S.S.)
| | - Jacqueline Graça
- Global Health and Tropical Medicine, GHTM, Associate Laboratory in Translation and Innovation towards Global Health, LA-REAL, Instituto de Higiene e Medicina Tropical, IHMT, Universidade NOVA de Lisboa, UNL, Rua da Junqueira 100, 1349-008 Lisbon, Portugal; (M.N.S.M.); (C.S.S.)
| | - Sofia G. Seabra
- Global Health and Tropical Medicine, GHTM, Associate Laboratory in Translation and Innovation towards Global Health, LA-REAL, Instituto de Higiene e Medicina Tropical, IHMT, Universidade NOVA de Lisboa, UNL, Rua da Junqueira 100, 1349-008 Lisbon, Portugal; (M.N.S.M.); (C.S.S.)
| | - Cruz S. Sebastião
- Global Health and Tropical Medicine, GHTM, Associate Laboratory in Translation and Innovation towards Global Health, LA-REAL, Instituto de Higiene e Medicina Tropical, IHMT, Universidade NOVA de Lisboa, UNL, Rua da Junqueira 100, 1349-008 Lisbon, Portugal; (M.N.S.M.); (C.S.S.)
| | - António Diniz
- Unidade Imunodeficiência, Hospital Pulido Valente—Unidade Local de Saúde Santa Maria, 1769-001 Lisbon, Portugal
| | - Domitília Faria
- Serviço de Medicina 3, Hospital de Portimão—Unidade Local de Saúde Algarve, 8500-338 Portimão, Portugal
| | - Eugénio Teófilo
- Serviço de Medicina 2.3, Hospital de Santo António dos Capuchos, Centro Hospitalar de Lisboa Central—Unidade Local de Saúde de São José, 1169-050 Lisbon, Portugal
| | - Fausto Roxo
- Unidade de Doenças Infecciosas, Hospital de Santarém—Unidade Local de Saúde Lezíria, 2005-177 Santarém, Portugal
| | - Fernando Maltez
- Serviço de Doenças Infeciosas, Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa Central—Unidade Local de Saúde São José, 1069-166 Lisbon, Portugal
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, 1649-026 Lisbon, Portugal
| | - Isabel Germano
- Serviço de Medicina 1.4, Hospital de São José, Centro Hospitalar Universitário de Lisboa Central—Unidade Local de Saúde São José, 1150-199 Lisbon, Portugal
| | - Joaquim Oliveira
- Serviço de Prevenção e Controlo de Infeções e de Resistências aos Antimicrobianos—Unidade Local de Saúde de Coimbra, 3004-561 Coimbra, Portugal
| | - José Ferreira
- Serviço de Medicina 2, Hospital de Faro—Unidade Local de Saúde Algarve, 8000-386 Faro, Portugal
| | - José Poças
- Serviço de Infeciologia, Centro Hospitalar de Setúbal—Unidade Local de Saúde Arrábida, 22910-446 Setúbal, Portugal
| | - Kamal Mansinho
- Serviço de Doenças Infeciosas, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, 1349-019 Lisbon, Portugal
| | - Luís Mendão
- Grupo de Ativistas em Tratamentos (GAT), 1000-228 Lisbon, Portugal
| | | | - Margarida Mouro
- Serviço de Infeciologia, Hospital de Aveiro, Centro Hospitalar Baixo Vouga, 3810-164 Aveiro, Portugal
| | - Nuno Marques
- Serviço de Infeciologia, Hospital Garcia da Orta, 2805-267 Almada, Portugal
| | - Patrícia Pacheco
- Serviço de Infeciologia, Hospital Dr. Fernando da Fonseca, 2720-276 Amadora, Portugal
| | - Paula Proença
- Serviço de Infeciologia, Hospital de Faro—Unidade Local de Saúde Algarve, 8000-386 Faro, Portugal
| | - Raquel Tavares
- Serviço de Infeciologia, Hospital Beatriz Ângelo, 2674-514 Loures, Portugal
| | - Ricardo Correia de Abreu
- Serviço de Doenças Infeciosas, Hospital Pedro Hispano—Unidade de Local de Saúde de Matosinhos, 4464-513 Matosinhos, Portugal
| | - Rosário Serrão
- Serviço de Doenças Infeciosas, Unidade Local de Saúde de São João, 4202-451 Porto, Portugal
| | - Telo Faria
- Hospital José Joaquim Fernandes—Unidade Local de Saúde do Baixo Alentejo, 7801-849 Beja, Portugal
| | | | - M. Rosário O. Martins
- Global Health and Tropical Medicine, GHTM, Associate Laboratory in Translation and Innovation towards Global Health, LA-REAL, Instituto de Higiene e Medicina Tropical, IHMT, Universidade NOVA de Lisboa, UNL, Rua da Junqueira 100, 1349-008 Lisbon, Portugal; (M.N.S.M.); (C.S.S.)
| | - Perpétua Gomes
- Laboratório de Biologia Molecular (LMCBM, SPC, ULSLO-HEM), 1349-019 Lisbon, Portugal
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Caparica, Portugal
| | - Ana B. Abecasis
- Global Health and Tropical Medicine, GHTM, Associate Laboratory in Translation and Innovation towards Global Health, LA-REAL, Instituto de Higiene e Medicina Tropical, IHMT, Universidade NOVA de Lisboa, UNL, Rua da Junqueira 100, 1349-008 Lisbon, Portugal; (M.N.S.M.); (C.S.S.)
| | - Marta Pingarilho
- Global Health and Tropical Medicine, GHTM, Associate Laboratory in Translation and Innovation towards Global Health, LA-REAL, Instituto de Higiene e Medicina Tropical, IHMT, Universidade NOVA de Lisboa, UNL, Rua da Junqueira 100, 1349-008 Lisbon, Portugal; (M.N.S.M.); (C.S.S.)
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Shobowale O, Schmidt AJ, Meireles P, Rojas Castro D, Detandt S, Stutterheim SE, Weatherburn P, Jonas KJ. Determinants of HIV Testing Among Migrant Men Who Have Sex With Men from Sub-Saharan Africa and Other Regions Residing in 10 European Countries. AIDS Behav 2024; 28:488-506. [PMID: 38326669 PMCID: PMC10876736 DOI: 10.1007/s10461-023-04239-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 02/09/2024]
Abstract
Migrant men who have sex with men (mMSM) from sub-Saharan Africa (SSA) and other regions outside Europe are highly vulnerable to HIV. However, research on the determinants of HIV testing among mMSM from SSA, and how these differ across the categories of mMSM living in Europe, is limited. Using data from the European MSM Internet Survey (EMIS-2017), we assessed HIV testing prevalence and recency in mMSM from SSA and other mMSM residing in ten European countries, as well as the determinants of HIV testing across different mMSM categories with logistic regression analyses. Ever-testing for HIV was slightly higher in mMSM from SSA (83%) compared to other mMSM categories (75-80%), except for mMSM from Latin America and Caribbean region (84%). Overall, 20% of mMSM had never tested. In multivariable analysis, higher age (adjusted odds ratio [AOR] 1.05, 95% confidence interval [CI] 1.01-1.10), higher HIV knowledge (AOR 1.45, 95%-CI 1.11-1.90), and residence in smaller settlements (AOR 0.45, 95%-CI 0.21-0.96) were significantly associated with ever testing for HIV in mMSM from SSA. Comparing mMSM from SSA to mMSM from other regions, we found varying significant similarities (higher age, residence in smaller settlements and HIV knowledge) and differences (lower educational attainment, not identifying as gay, being a student, and limited disclosure of homosexual attraction) in the determinants of ever-testing for HIV. Community-specific interventions addressing identified sociodemographic and behavioral determinants to increase HIV testing uptake in the different mMSM categories and better data for further research are warranted.
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Affiliation(s)
- Oladipupo Shobowale
- Department of Work and Social Psychology, Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, The Netherlands.
| | - Axel J Schmidt
- London School of Hygiene & Tropical Medicine (LSHTM), Sigma Research, London, UK
| | - Paula Meireles
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | | | - Sandrine Detandt
- Faculty of Psychology, Observatoire du Sida et des Sexualités Research Center, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Sarah E Stutterheim
- Department of Health Promotion, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Peter Weatherburn
- London School of Hygiene & Tropical Medicine (LSHTM), Sigma Research, London, UK
| | - Kai J Jonas
- Department of Work and Social Psychology, Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, The Netherlands
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Araújo TMED, Lulendo E, Brito Magalhães RDL, Valle ARMDC, Borges PDTM, Almeida PD, Almeida MG, Oliveira LBD, Mendes IAC, Sousa AFLD. Sexual exposure to HIV in Angolan men who have sex with men immigrants: A cross-sectional study in Portugal and Brazil. Int J STD AIDS 2023; 34:876-883. [PMID: 37350448 DOI: 10.1177/09564624231185810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
BACKGROUND In different contexts, international migrants are vulnerable to health disparities that increase the risk of HIV/AIDS exposure and continue to bear a significant burden of new virus infections in developed and developing countries. In this study, we sought to examine sexual practices and factors linked to HIV exposure among a sample of Angolan men who have sex with men (MSM) immigrants. METHODS The study was conducted in two Portuguese-speaking countries, Brazil and Portugal, and involved 250 Angolan MSM immigrants between September 2020 and February 2021, using sampling methods to constitute the sample and the HIV Incidence Risk Index (HIRI) to define virus exposure risk. Odds ratio (OR) and adjusted odds ratio (aOR) were used to calculate the chances of higher HIRI index in the sample. RESULTS Our results showed that 76.8% of participants presented a high HIRI index, influenced by the practice of chemsex (aOR: 4.26), having a known/repeated partner (aOR: 4.59), and engaging in passive sex without a condom in the last 30 days (aOR: 1.29) or 6 months (aOR: 1.98). CONCLUSIONS It is crucial to focus on this vulnerable population and implement sexual health policies that integrate combined HIV prevention measures aimed at immigrant MSM.
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Svensson P, Agardh A, Zdravkovic S, Asamoah BO. Investigating pathways for predisposing, enabling and need factors in predicting the use of STI/HIV-testing services among Syrian and Iraqi migrants in Scania, Sweden - a cross-sectional study with directed acyclic graphs for modelling pathways to testing. BMC Public Health 2022; 22:2177. [PMID: 36434617 PMCID: PMC9700979 DOI: 10.1186/s12889-022-14615-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 11/14/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Some groups of migrants have increased vulnerability to Sexually Transmitted Infections (STI) and Human Immunodeficiency Virus (HIV) transmission partly due to a lower uptake of disease preventive activities targeting the general population in receiving country. Limited access to economic and social resources and poor language skills may exacerbate exposure to sexual risks and utilization of health services. AIM To explore general and migrant specific predictors for STI/HIV-testing among Syrian and Iraqi migrants in Sweden and to investigate potential pathways that link predisposing, enabling and need- factors to STI/HIV-testing. METHOD Cross-sectional study design based on a migration specific framework for health care utilization. Directed acyclic graphs (DAGs) were used to model assumptions about factors associated with the uptake of STI/HIV-testing services. Bi-variable and multivariable logistic regression analyses assessed individual predictors while adjusting for covariates. The magnitude of the indirect effect of mediating variables were estimated with bootstrap analyses and a method for decomposing the total effect. RESULT The pathways between younger age, unmarried, and self-identifying as bi- or homosexual and testing were mainly indirect, mediated by experiences of sexual coercion and other risk behaviours. One third of the indirect mediating effect of the pathway between higher education and testing could be attributed to Swedish language skills. CONCLUSION Utilization of STI/HIV-testing services among Syrian and Iraqi migrants seemed to be motivated by sexual risk exposure and risk awareness. Interventions should focus on language-adapted information about available screening services and where to go for advice on sexual wellbeing and sexual rights. Such activities should be implemented within an integration promoting framework, addressing structures that increase STI/HIV risk exposure, specifically targeting vulnerable subgroups of migrants.
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Affiliation(s)
- Pia Svensson
- grid.4514.40000 0001 0930 2361Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Anette Agardh
- grid.4514.40000 0001 0930 2361Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Slobodan Zdravkovic
- grid.32995.340000 0000 9961 9487Department of Care Science, Faculty of Health and Society and Malmö Institute for Studies of Migration Diversity and Welfare (MIM), Malmö University, Malmö, Sweden
| | - Benedict Oppong Asamoah
- grid.4514.40000 0001 0930 2361Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden
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Experiences of Migrant People Living with HIV in a Multidisciplinary HIV Care Setting with Rapid B/F/TAF Initiation and Cost-Covered Treatment: The ‘ASAP’ Study. J Pers Med 2022; 12:jpm12091497. [PMID: 36143282 PMCID: PMC9503330 DOI: 10.3390/jpm12091497] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 09/02/2022] [Accepted: 09/09/2022] [Indexed: 11/21/2022] Open
Abstract
This study aimed to explore the experiences of migrant people living with HIV (MLWH) enrolled in a Montreal-based multidisciplinary HIV care clinic with rapid antiretroviral treatment (ART) initiation and cost-covered ART. Between February 2020 and March 2022, 32 interviews were conducted with 16 MLWH at three time-points (16 after 1 week of ART initiation, 8 after 24 weeks, 8 after 48 weeks). Interviews were analyzed via the Framework Method. Thirty categories were identified, capturing experiences across the HIV care cascade. At diagnosis, most MLWH described “initially experiencing distress”. At linkage, almost all MLWH discussed “navigating the health system with difficulty”. At treatment initiation, almost all MLWH expressed “being satisfied with treatment”, particularly due to a lack of side effects. Regarding care retention, all MLWH noted “facing psychosocial or health-related challenges beyond HIV”. Regarding ART adherence, most MLWH expressed “being satisfied with treatment” with emphasis on their taking control of HIV. At viral suppression, MLWH mentioned “finding more peace of mind since becoming undetectable”. Regarding their perceived health-related quality of life, most MLWH indicated “being helped by a supportive social network”. Efficient, humanizing, and holistic approaches to care in a multidisciplinary setting, coupled with rapid and free ART initiation, seemed to help alleviate patients’ concerns, address their bio-psycho-social challenges, encourage their initial and sustained engagement with HIV care and treatment, and ultimately contribute to positive experiences.
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Arora AK, Ortiz-Paredes D, Engler K, Lessard D, Mate KK, Rodriguez-Cruz A, Kronfli N, Vedel I, Cox J, Quesnel-Vallée A, Lebouché B. Barriers and Facilitators Affecting the HIV Care Cascade for Migrant People Living with HIV in Organization for Economic Co-Operation and Development Countries: A Systematic Mixed Studies Review. AIDS Patient Care STDS 2021; 35:288-307. [PMID: 34375137 PMCID: PMC8380795 DOI: 10.1089/apc.2021.0079] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Migrants in countries affiliated with the Organization for Economic Co-operation and Development (OECD) have a higher risk of acquiring HIV, experience delayed HIV diagnosis, and have variable levels of engagement with HIV care and treatment when compared to native-born populations. A systematic mixed studies review was conducted to generate a multilevel understanding of the barriers and facilitators affecting HIV Care Cascade steps for migrant people living with HIV (MLWH) in OECD countries. Medline, Embase, Scopus, CINAHL, and the Cochrane Library were searched on March 25, 2020. Screening, critical appraisal, and analysis were conducted independently by two authors. We used qualitative content analysis and the five-level Socio-Ecological Model (i.e., individual, interpersonal, organizational, community, and policy) to categorize barriers and facilitators. Fifty-nine studies from 17 OECD countries were included. MLWH faced similar barriers and facilitators regardless of their host country, ethnic and geographic origins, or legal status. Most barriers and facilitators were associated with the individual and organizational levels and centered around retention in HIV care and treatment. Adapting clinical environments to better address MLWH's competing needs via multidisciplinary models would address retention issues across OECD countries.
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Affiliation(s)
- Anish K. Arora
- Department of Family Medicine, Faculty of Medicine & Health Sciences, McGill University, Montréal, Canada
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montréal, Canada
- Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV Care, Canadian Institutes of Health Research, Montréal, Canada
| | - David Ortiz-Paredes
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montréal, Canada
| | - Kim Engler
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montréal, Canada
- Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV Care, Canadian Institutes of Health Research, Montréal, Canada
| | - David Lessard
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montréal, Canada
- Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV Care, Canadian Institutes of Health Research, Montréal, Canada
| | - Kedar K.V. Mate
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montréal, Canada
- Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV Care, Canadian Institutes of Health Research, Montréal, Canada
| | - Adriana Rodriguez-Cruz
- Department of Family Medicine, Faculty of Medicine & Health Sciences, McGill University, Montréal, Canada
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montréal, Canada
- Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV Care, Canadian Institutes of Health Research, Montréal, Canada
| | - Nadine Kronfli
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Canada
- Chronic Viral Illness Service, Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montréal, Canada
| | - Isabelle Vedel
- Department of Family Medicine, Faculty of Medicine & Health Sciences, McGill University, Montréal, Canada
| | - Joseph Cox
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Canada
- Chronic Viral Illness Service, Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montréal, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine & Health Sciences, McGill University, Montréal, Canada
| | - Amélie Quesnel-Vallée
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine & Health Sciences, McGill University, Montréal, Canada
- Department of Sociology, Faculty of Arts, McGill University, Montréal, Canada
| | - Bertrand Lebouché
- Department of Family Medicine, Faculty of Medicine & Health Sciences, McGill University, Montréal, Canada
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montréal, Canada
- Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV Care, Canadian Institutes of Health Research, Montréal, Canada
- Chronic Viral Illness Service, Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montréal, Canada
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Roura M, Dias S, LeMaster JW, MacFarlane A. Participatory health research with migrants: Opportunities, challenges, and way forwards. Health Expect 2021; 24:188-197. [PMID: 33528082 PMCID: PMC8077110 DOI: 10.1111/hex.13201] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 12/21/2020] [Accepted: 12/31/2020] [Indexed: 12/15/2022] Open
Abstract
CONTEXT Migration is one of the most politically pressing issues of the 21st century but migrant health remains an under-researched area. The International Collaboration for Participatory Health Research (ICPHR) working group on migration developed this position statement to address opportunities and challenges in relation to migrant health. It aims to contribute to a shift from a deficit model that sees migrants as passively affected by policies to their reconceptualization as citizens who are engaged in the co-creation of solutions. METHODS This paper examines the opportunities and challenges posed by the use of PHR with migrants. It draws on a broad literature to provide examples of successful PHR with migrants and highlights critical issues for consideration. FINDINGS Successful initiatives illustrate the value of engaging migrants in the definition of the research agenda, the design and implementation of health interventions, the identification of health-protective factors and the operationalization and validation of indicators to monitor progress. Within increasingly super diverse contexts, fragmented community landscapes that are not necessarily constructed along ethnicity traits, inadequate structures of representation, local tensions and operational barriers can hamper meaningful PHR with migrants. CONCLUSION For each research context, it is essential to gauge the 'optimal' level and type of participation that is more likely to leverage migrants' empowerment. The development of Monitoring and Evaluation tools and methodological strategies to manage inter-stakeholder discrepancies and knowledge translation gaps are steps in this direction. PATIENT OR PUBLIC CONTRIBUTION This paper draws from contributions of migrant populations and other stakeholders to policymaking.
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Affiliation(s)
- Maria Roura
- School of Public HealthUniversity College CorkCorkIreland
| | - Sonia Dias
- NOVA National School of Public Health, Public Health Research CenterUniversidade NOVA de Lisboa & Comprehensive Health Research Center (CHRC)LisboaPortugal
| | | | - Anne MacFarlane
- School of Medicine LimerickLimerickIreland
- Health Research InstituteUniversity of LimerickLimerickIreland
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Arora A, Quesnel-Vallee A, Lessard D, Mate K, Rodriguez-Cruz A, Kronfli N, Engler K, Vedel I, Lebouché B. Barriers and facilitators associated with steps of the HIV care cascade for migrants in OECD countries: a systematic mixed studies review protocol. BMJ Open 2020; 10:e040646. [PMID: 33158835 PMCID: PMC7651739 DOI: 10.1136/bmjopen-2020-040646] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION In 2019, the United Nations signalled a substantial rise in the number of international migrants, up to 272 million globally, about half of which move to only 10 countries, including 8 member nations of the Organization for Economic Co-operation and Development (OECD). Migrants in OECD countries are often at higher risk for acquiring HIV and have a higher frequency of delayed HIV diagnosis. The barriers and facilitators that migrant people living with HIV (PLWH) in OECD countries face in relation to HIV care are insufficiently understood. The five-step HIV Care Cascade Continuum (HCCC) is an effective model to identify gaps, barriers and facilitators associated with HIV care. The purpose of this study is to generate a comprehensive, multilevel understanding of barriers and facilitators regarding the five steps of the HCCC model in OECD countries by migration status. METHODS AND ANALYSIS A systematic mixed studies review using a data-based convergent design will be conducted. Medline, Embase, Scopus, CINAHL and the Cochrane Library will be searched on 25 March 2020. Screening and critical appraisal will be conducted independently by the first author. Authors 3-5 will act as second reviewers, each independently conducting 33% of the screening and appraisal. Quantitative data will be transformed to qualitative data and be synthesised using thematic analysis. The Mixed Methods Appraisal Tool will be used for quality assessment. An advisory committee, composed of four migrant PLWH, will be involved in screening and appraising 5% of articles to build knowledge and experience with systematic reviews. They will also be involved in analysis and dissemination. ETHICS AND DISSEMINATION Ethics approval was obtained from the McGill University Health Centre (15-188-MUHC, 2016-1697, eReviews 4688). Publications arising from this study will be open-access. PROSPERO REGISTRATION NUMBER CRD42020172122.
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Affiliation(s)
- Anish Arora
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
- Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials, Canadian Institutes of Health Research, Montréal, Québec, Canada
| | - Amelie Quesnel-Vallee
- Department of Sociology, Faculty of Arts, McGill University, Montréal, Québec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
| | - David Lessard
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
- Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials, Canadian Institutes of Health Research, Montréal, Québec, Canada
| | - Kedar Mate
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
- Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials, Canadian Institutes of Health Research, Montréal, Québec, Canada
| | - Adriana Rodriguez-Cruz
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
- Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials, Canadian Institutes of Health Research, Montréal, Québec, Canada
| | - Nadine Kronfli
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
- Department of Medicine, Chronic Viral Illness Service, Division of Infectious Diseases, McGill University Health Centre, Montréal, Québec, Canada
| | - Kim Engler
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
- Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials, Canadian Institutes of Health Research, Montréal, Québec, Canada
| | - Isabelle Vedel
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
| | - Bertrand Lebouché
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
- Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials, Canadian Institutes of Health Research, Montréal, Québec, Canada
- Department of Medicine, Chronic Viral Illness Service, Division of Infectious Diseases, McGill University Health Centre, Montréal, Québec, Canada
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Dias S, Gama A, Abrantes P, Gomes I, Fonseca M, Reigado V, Simões D, Carreiras E, Mora C, Pinto Ferreira A, Akpogheneta O, Martins MO. Patterns of Sexual Risk Behavior, HIV Infection, and Use of Health Services Among Sub-Saharan African Migrants in Portugal. JOURNAL OF SEX RESEARCH 2020; 57:906-913. [PMID: 31002270 DOI: 10.1080/00224499.2019.1601154] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This study identified patterns of sexual risk behavior among a sub-Saharan African migrant (SAM) population in Portugal and examined its associations with human immunodeficiency virus (HIV) prevalence, sociodemographics, use of sexual health services, and HIV testing. A cross-sectional biobehavioral survey was conducted with a venue-based sample of 790 SAMs. Data were collected using questionnaires and rapid HIV tests. Cluster analysis identified five subgroups with differing levels of HIV infection (2.5% to 11.3%). In Cluster 1, most participants reported sexual abstinence over the past year and the remaining used condoms consistently; this cluster had the highest HIV prevalence (11.3%). In Cluster 2, most reported one sexual partner and all reported unprotected sex; all HIV-positive participants in this cluster were unaware of their HIV-positive status. In Clusters 3 and 4, most had four or more partners, yet all used condoms. In Cluster 3, 56.5% reported both regular and occasional partners. In Cluster 4, 74% had only occasional partners; all engaged in commercial sex. In Cluster 5, all reported four or more partners and condomless sex. In all subgroups we found low rates of HIV testing and high unawareness of HIV serostatus. Targeted prevention interventions are needed to reduce unprotected sexual relations and undiagnosed infection, as well as improve linkage to sexual health services.
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Affiliation(s)
- Sónia Dias
- Escola Nacional de Saúde Pública, Centro de Investigação em Saúde Pública , Universidade NOVA de Lisboa
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL
| | - Ana Gama
- Escola Nacional de Saúde Pública, Centro de Investigação em Saúde Pública , Universidade NOVA de Lisboa
| | - Patrícia Abrantes
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL
| | - Isabel Gomes
- Center for Mathematics and Applications, Faculty of Sciences and Technology, Nova University of Lisbon
| | - Miguel Fonseca
- Center for Mathematics and Applications, Faculty of Sciences and Technology, Nova University of Lisbon
| | - Vera Reigado
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL
| | | | - Emília Carreiras
- AJPAS - Associação de Intervenção Comunitária, Desenvolvimento Social e de Saúde
| | - Cristina Mora
- AJPAS - Associação de Intervenção Comunitária, Desenvolvimento Social e de Saúde
| | | | - Onome Akpogheneta
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL
| | - Maria O Martins
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL
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10
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Vujcich D, Wangda S, Roberts M, Lobo R, Maycock B, Kulappu Thanthirige C, Reid A. Modes of administering sexual health and blood-borne virus surveys in migrant populations: A scoping review. PLoS One 2020; 15:e0236821. [PMID: 32745106 PMCID: PMC7398552 DOI: 10.1371/journal.pone.0236821] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 07/14/2020] [Indexed: 12/21/2022] Open
Abstract
There has been a growing number of sexual health and blood-borne virus (SHBBV) surveys specifically administered to migrant populations. The purpose of this scoping review is to collate available information about how SHBBV surveys have been administered in migrant populations and the effect that mode of administration has on data quality, reliability and other practical considerations, e.g. response rates (RR) and social desirability bias. A methodological framework for scoping reviews was applied. SHBBV survey studies administered to international migrants published since 2000 were included if they contained some description of mode of administration. Ninety one studies were identified for inclusion from Embase, Medline, Web of Science, Google Scholar and supplementary grey literature. 'Interview only' was the most common mode of administration (n = 48), predominately comprising face-to-face interviews. Thirty six studies reported data from 'self-completed' surveys only, with pen-and-paper being most common (n = 17). Few studies (n = 7) combined interview and self-completed methods of survey administration. Sixty one studies did not report (or only partially reported) RR or the data necessary to calculate RR. Of the studies that reported RR, most were missing other key information including method of recruitment, consent procedures and whether incentives were offered. Strengths and limitations of all administration modes are summarised. Guidelines to inform future SHBBV survey research in migrant populations are presented.
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Affiliation(s)
- Daniel Vujcich
- School of Public Health, Curtin University, Perth, Australia
- * E-mail:
| | | | - Meagan Roberts
- School of Public Health, Curtin University, Perth, Australia
| | - Roanna Lobo
- School of Public Health, Curtin University, Perth, Australia
| | - Bruce Maycock
- College of Medicine & Health, University of Exeter, Exeter, United Kingdom
| | | | - Alison Reid
- School of Public Health, Curtin University, Perth, Australia
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11
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Dias S, Gama A, Loos J, Roxo L, Simões D, Nöstlinger C. The role of mobility in sexual risk behaviour and HIV acquisition among sub-Saharan African migrants residing in two European cities. PLoS One 2020; 15:e0228584. [PMID: 32023309 PMCID: PMC7001961 DOI: 10.1371/journal.pone.0228584] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 01/18/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Migrants from high endemic countries accounted for 18% of newly diagnosed HIV infections in Europe in 2017. Knowledge on the link between HIV risk and post-migration travels and their impact on HIV acquisition is scarce, but critical to inform prevention. This study aims to explore risky sexual behaviour and HIV-acquisition among sub-Saharan African migrants, and to assess post-migration mobility as a determinant of sexual risk behaviour. METHODS Data from two cross-sectional bio-behavioural surveys to assess HIV-prevalence conducted in Lisbon and Antwerp were analysed to explore migration-related characteristics, travel patterns, and sexual risk taking in the host country and abroad. Bi- and multivariate associations were estimated through adjusted odds ratios and 95% confidence intervals; multivariable logistic regression determined factors associated with condomless sexual intercourse. RESULTS Among N = 1508 participants above 18 years (58% males), 68% travelled post-migration (49.2% reported intercourse abroad). The overall proportion of condomless sex at last sexual intercourse was high (68.1%). The odds of condomless sex in the host country was five times higher when the last sexual intercourse abroad was also condomless [OR:5.32; 95%CI:2.98-9.25]. About half of the travellers reported concurrency, i.e. a regular partner in the host country while having other sexual partners abroad. Almost three percent of the participants reported being HIV+, but 5% had a reactive HIV test-result, with similar proportions among travellers and non-travellers. Also, among the n = 75 participants with reactive HIV test-results, condomless sex occurred (n = 40) and was associated with mobility. CONCLUSIONS Sub-Saharan African migrants are mobile and engage in sexual risk behaviours in the countries of residence and while travelling, increasing risk of post-migration HIV-acquisition. A transnational perspective on HIV prevention and sexual health promotion is needed for effectively reducing migrants' HIV risk related to their mobility.
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Affiliation(s)
- Sónia Dias
- NOVA National School of Public Health, Public Health Research Centre & Global Health and Tropical Medicine, Universidade NOVA de Lisboa, Lisboa, Portugal
- Comprehensive Health Research Centre (CHRC), Lisboa, Portugal
- * E-mail:
| | - Ana Gama
- NOVA National School of Public Health, Public Health Research Centre & Global Health and Tropical Medicine, Universidade NOVA de Lisboa, Lisboa, Portugal
- Comprehensive Health Research Centre (CHRC), Lisboa, Portugal
| | - Jasna Loos
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Luis Roxo
- NOVA National School of Public Health, Public Health Research Centre & Global Health and Tropical Medicine, Universidade NOVA de Lisboa, Lisboa, Portugal
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12
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Pottie K, Lotfi T, Kilzar L, Howeiss P, Rizk N, Akl EA, Dias S, Biggs BA, Christensen R, Rahman P, Magwood O, Tran A, Rowbotham N, Pharris A, Noori T, Pareek M, Morton R. The Effectiveness and Cost-Effectiveness of Screening for HIV in Migrants in the EU/EEA: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15081700. [PMID: 30096905 PMCID: PMC6121945 DOI: 10.3390/ijerph15081700] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 07/19/2018] [Accepted: 08/01/2018] [Indexed: 01/08/2023]
Abstract
Migrants, defined as individuals who move from their country of origin to another, account for 40% of newly-diagnosed cases of human immunodeficiency virus (HIV) in the European Union/European Economic Area (EU/EEA). Populations at high risk for HIV include migrants, from countries or living in neighbourhoods where HIV is prevalent, and those participating in high risk behaviour. These migrants are at risk of low CD4 counts at diagnosis, increased morbidity, mortality, and onward transmission. The aim of this systematic review is to evaluate the effectiveness and cost-effectiveness of HIV testing strategies in migrant populations and to estimate their effect on testing uptake, mortality, and resource requirements. Following a systematic overview, we included four systematic reviews on the effectiveness of strategies in non-migrant populations and inferred their effect on migrant populations, as well as eight individual studies on cost-effectiveness/resource requirements. We assessed the certainty of our results using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. The systematic reviews reported that HIV tests are highly accurate (rapid test >90% sensitivity, Western blot and ELISA >99% sensitivity). A meta-analysis showed that rapid testing approaches improve the access and uptake of testing (risk ratio = 2.95, 95% CI: 1.69 to 5.16), and were associated with a lower incidence of HIV in the middle-aged women subgroup among marginalised populations at a high risk of HIV exposure and HIV related stigma. Economic evidence on rapid counselling and testing identified strategic advantages with rapid tests. In conclusion, community-based rapid testing programmes may have the potential to improve uptake of HIV testing among migrant populations across a range of EU/EEA settings.
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Affiliation(s)
- Kevin Pottie
- Bruyère Research Institute, 85 Primrose Ave, Annex E, Ottawa, ON K1R 7G5, Canada.
- Departments of Family Medicine & Epidemiology and Community Medicine, University of Ottawa, Ottawa, ON K1N 6N5, Canada.
| | - Tamara Lotfi
- Faculty of Health Sciences, American University of Beirut, Beirut 1107 2020, Lebanon.
- AUB GRADE Center, Clinical Research Institute, American University of Beirut, Beirut 1107 2020, Lebanon.
| | - Lama Kilzar
- Faculty of Health Sciences, American University of Beirut, Beirut 1107 2020, Lebanon.
| | - Pamela Howeiss
- Department of Internal Medicine, American University of Beirut, Beirut 1107 2020, Lebanon.
| | - Nesrine Rizk
- Department of Internal Medicine, American University of Beirut, Beirut 1107 2020, Lebanon.
| | - Elie A Akl
- Faculty of Health Sciences, American University of Beirut, Beirut 1107 2020, Lebanon.
- AUB GRADE Center, Clinical Research Institute, American University of Beirut, Beirut 1107 2020, Lebanon.
- Department of Internal Medicine, American University of Beirut, Beirut 1107 2020, Lebanon.
| | - Sonia Dias
- National School of Public Health, Centro de Investigação em Saúde Pública & GHTM/IHMT, Universidade Nova de Lisboa, 2825-149 Caparica, Portugal.
| | - Beverly-Ann Biggs
- Department of Medicine/RMH at the Doherty Institute, The University of Melbourne Vic Australia, Parkville 3010, Australia.
| | - Robin Christensen
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, 2000 Frederiksberg, Denmark.
- Department of Rheumatology, Odense University Hospital, 5000 Odense, Denmark.
| | - Prinon Rahman
- Bruyère Research Institute, 85 Primrose Ave, Annex E, Ottawa, ON K1R 7G5, Canada.
| | - Olivia Magwood
- Bruyère Research Institute, 85 Primrose Ave, Annex E, Ottawa, ON K1R 7G5, Canada.
| | - Anh Tran
- NHMRC Clinical Trials Centre, The University of Sydney, Campbell 2006, Australia.
| | - Nick Rowbotham
- NHMRC Clinical Trials Centre, The University of Sydney, Campbell 2006, Australia.
| | - Anastasia Pharris
- European Centre for Disease Prevention and Control, 16973 Solna, Sweden.
| | - Teymur Noori
- European Centre for Disease Prevention and Control, 16973 Solna, Sweden.
| | - Manish Pareek
- Department of Infection, Immunity and Inflammation, University of Leicester, Leicester LE1 7RH, UK.
| | - Rachael Morton
- NHMRC Clinical Trials Centre, The University of Sydney, Campbell 2006, Australia.
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Dias S, Gama A, Pingarilho M, Simões D, Mendão L. Health Services Use and HIV Prevalence Among Migrant and National Female Sex Workers in Portugal: Are We Providing the Services Needed? AIDS Behav 2017; 21:2316-2321. [PMID: 27475942 DOI: 10.1007/s10461-016-1511-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This cross-sectional bio-behavioral survey conducted with 853 female sex workers (FSW) aimed to examine differences in use of HIV health services, testing and prevalence among migrant and national FSW. A quarter of undocumented FSW had never used National Health Service (NHS) and 15 % never tested for HIV, significantly more than nationals (p < 0.001 and p = 0.024, respectively). HIV infection was self-reported by 11.9 % of nationals, 1.8 % of documented and 0.8 % of undocumented migrants (p < 0.001). The HIV rapid test was reactive in 13.6 % of undocumented, 8.0 % of nationals and 2.3 % of documented. A higher proportion of migrants were unaware of their positive serostatus compared to nationals. Ever had HIV testing was less likely among undocumented, who never used the NHS and who didn't know where to go if suspected being HIV-infected. Promoting early diagnosis with linkage to care among migrant FSW should be supported, while developing health services better tailored to their needs.
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Barriers and Facilitators to HIV Testing in Migrants in High-Income Countries: A Systematic Review. AIDS Behav 2015; 19:2012-24. [PMID: 26025193 DOI: 10.1007/s10461-015-1095-x] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Migrants, particularly from low- and middle-income countries, are at a heightened risk of adverse HIV outcomes. HIV testing may improve these outcomes. We reviewed and synthesised studies into migrants and HIV testing (outcome variable), published between January 1997 and April 2014. Papers using quantitative, qualitative and mixed methods designs, and samples with adult (≥18 years) migrants from low- and middle-income countries in high-income countries were included in the paper. Of 3155 papers retrieved, 31 met the inclusion criteria and are included in the review. A large number of barriers and facilitators to HIV testing were identified across the individual, social and structural levels. A number of study design and methodological issues, however, inhibited a comprehensive synthesis. There is no doubt that addressing HIV testing in migrants in high-income countries is complex; however, it has important implications for individual, community and population health, and a strong, empirically based response is warranted.
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Massari V, Lapostolle A, Grupposo MC, Dray-Spira R, Costagliola D, Chauvin P. Which adults in the Paris metropolitan area have never been tested for HIV? A 2010 multilevel, cross-sectional, population-based study. BMC Infect Dis 2015. [PMID: 26198690 PMCID: PMC4509770 DOI: 10.1186/s12879-015-1006-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Despite the widespread offer of free HIV testing in France, the proportion of people who have never been tested remains high. The objective of this study was to identify, in men and women separately, the various factors independently associated with no lifetime HIV testing. METHODS We used multilevel logistic regression models on data from the SIRS cohort, which included 3006 French-speaking adults as a representative sample of the adult population in the Paris metropolitan area in 2010. The lifetime absence of any HIV testing was studied in relation to individual demographic and socioeconomic factors, psychosocial characteristics, sexual biographies, HIV prevention behaviors, attitudes towards people living with HIV/AIDS (PLWHA), and certain neighborhood characteristics. RESULTS In 2010, in the Paris area, men were less likely to have been tested for HIV at least once during their lifetime than women. In multivariate analysis, in both sexes, never having been tested was significantly associated with an age younger or older than the middle-age group (30-44 years), a low education level, a low self-perception of HIV risk, not knowing any PLWHA, a low lifetime number of couple relationships, and the absence of any history of STIs. In women, other associated factors were not having a child < 20 years of age, not having additional health insurance, having had no or only one sexual partner in the previous 5 years, living in a cohabiting couple or having no relationship at the time of the survey, and a feeling of belonging to a community. Men with specific health insurance for low-income individuals were less likely to have never been tested, and those with a high stigma score towards PLWHA were more likely to be never-testers. Our study also found neighborhood differences in the likelihood of men never having been tested, which was, at least partially, explained by the neighborhood proportion of immigrants. In contrast, in women, no contextual variable was significantly associated with never-testing for HIV after adjustment for individual characteristics. CONCLUSIONS Studies such as this one can help target people who have never been tested in the context of recommendations for universal HIV screening in primary care.
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Affiliation(s)
- Véronique Massari
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis Institute d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Department of Social Epidemiology, F-75012, Paris, France.
| | - Annabelle Lapostolle
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis Institute d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Department of Social Epidemiology, F-75012, Paris, France.
| | - Marie-Catherine Grupposo
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis Institute d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Department of Social Epidemiology, F-75012, Paris, France.
| | - Rosemary Dray-Spira
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis Institute d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Department of Social Epidemiology, F-75012, Paris, France.
| | - Dominique Costagliola
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis Institute d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Department of HIV Clinical Research, F-75013, Paris, France.
| | - Pierre Chauvin
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis Institute d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Department of Social Epidemiology, F-75012, Paris, France.
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Dias S, Gama A, Fuertes R, Mendão L, Barros H. Risk-taking behaviours and HIV infection among sex workers in Portugal: results from a cross-sectional survey. Sex Transm Infect 2014; 91:346-52. [PMID: 25512671 DOI: 10.1136/sextrans-2014-051697] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 11/25/2014] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Sex workers (SW) are key populations at an increased risk of HIV infection. This study aimed to characterise risk-taking behaviours and assess HIV prevalence among SW in Portugal. METHODS A cross-sectional survey was conducted with 1040 SW using a participatory research approach. SW were recruited in sex-work locations and community-based organisation offices. Data were collected through a questionnaire with trained interviewers. An HIV rapid test was performed in 213 respondents. RESULTS Reported HIV prevalence was 8%: 17.6% of man-to-woman transgenders, 7.4% of women and 5% of men. Of SW reportedly living with HIV, 52.2% reported ever injecting drug use. Inconsistent condom use with clients in the last month was higher among male SW (26.5%) and with non-paying partners in the last year was higher among women (71.3%). Among reported HIV-positive SW, the proportions of inconsistent condom use were high. In multivariate regression analysis, reported HIV infection remained significantly higher among transgenders (OR 6.4; 95% CI 1.7 to 24.3), those older (OR 5.1; 95% CI 1.3 to 21.1), working outdoors (OR 5.4; 95% CI 1.9 to 15.6), having ever used psychoactive substances (OR 4.1; 95% CI 2.2 to 7.7) and earning ≤€1000 per month (OR 2.6; 95% CI 1.2 to 5.9). Of those who had an HIV rapid test, 8.9% were reactive; 73.7% were unaware of their seropositivity. CONCLUSIONS The HIV infection burden in SW is high. Efforts to promote HIV testing must be sustained in order to reduce undiagnosed infection. The diverse risk profiles of SW must be addressed in targeted HIV interventions. Prevention interventions should be systematically implemented within most-at-risk subgroups of SW.
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Affiliation(s)
- Sónia Dias
- Instituto de Higiene e Medicina Tropical & CMDT, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Ana Gama
- Instituto de Higiene e Medicina Tropical & CMDT, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Ricardo Fuertes
- GAT-Grupo Português de Activistas sobre o Tratamento de VIH/Sida Pedro Santos, Lisboa, Portugal
| | - Luís Mendão
- GAT-Grupo Português de Activistas sobre o Tratamento de VIH/Sida Pedro Santos, Lisboa, Portugal
| | - Henrique Barros
- Institute of Public Health of University of Porto, University of Porto Medical School, Porto, Portugal
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Woodward A, Howard N, Wolffers I. Health and access to care for undocumented migrants living in the European Union: a scoping review. Health Policy Plan 2014; 29:818-30. [PMID: 23955607 PMCID: PMC4186209 DOI: 10.1093/heapol/czt061] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2013] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Literature on health and access to care of undocumented migrants in the European Union (EU) is limited and heterogeneous in focus and quality. Authors conducted a scoping review to identify the extent, nature and distribution of existing primary research (1990-2012), thus clarifying what is known, key gaps, and potential next steps. METHODS Authors used Arksey and O'Malley's six-stage scoping framework, with Levac, Colquhoun and O'Brien's revisions, to review identified sources. Findings were summarized thematically: (i) physical, mental and social health issues, (ii) access and barriers to care, (iii) vulnerable groups and (iv) policy and rights. RESULTS Fifty-four sources were included of 598 identified, with 93% (50/54) published during 2005-2012. EU member states from Eastern Europe were under-represented, particularly in single-country studies. Most study designs (52%) were qualitative. Sampling descriptions were generally poor, and sampling purposeful, with only four studies using any randomization. Demographic descriptions were far from uniform and only two studies focused on undocumented children and youth. Most (80%) included findings on health-care access, with obstacles reported at primary, secondary and tertiary levels. Major access barriers included fear, lack of awareness of rights, socioeconomics. Mental disorders appeared widespread, while obstetric needs and injuries were key reasons for seeking care. Pregnant women, children and detainees appeared most vulnerable. While EU policy supports health-care access for undocumented migrants, practices remain haphazard, with studies reporting differing interpretation and implementation of rights at regional, institutional and individual levels. CONCLUSIONS This scoping review is an initial attempt to describe available primary evidence on health and access to care for undocumented migrants in the European Union. It underlines the need for more and better-quality research, increased co-operation between gatekeepers, providers, researchers and policy makers, and reduced ambiguities in health-care rights and obligations for undocumented migrants.
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Affiliation(s)
- Aniek Woodward
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, Tavistock Place, London, WC1H 9SH, UK, King's International Development Institute and King's Centre for Global Health, King's College London, London, WC2R 2LS, UK and Vrije Universiteit Medical Centre, Amsterdam, 1007 MB, the Netherlands Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, Tavistock Place, London, WC1H 9SH, UK, King's International Development Institute and King's Centre for Global Health, King's College London, London, WC2R 2LS, UK and Vrije Universiteit Medical Centre, Amsterdam, 1007 MB, the Netherlands
| | - Natasha Howard
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, Tavistock Place, London, WC1H 9SH, UK, King's International Development Institute and King's Centre for Global Health, King's College London, London, WC2R 2LS, UK and Vrije Universiteit Medical Centre, Amsterdam, 1007 MB, the Netherlands
| | - Ivan Wolffers
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, Tavistock Place, London, WC1H 9SH, UK, King's International Development Institute and King's Centre for Global Health, King's College London, London, WC2R 2LS, UK and Vrije Universiteit Medical Centre, Amsterdam, 1007 MB, the Netherlands
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Fernández-Balbuena S, Belza MJ, Urdaneta E, Esteso R, Rosales-Statkus ME, de la Fuente L. Serving the underserved: an HIV testing program for populations reluctant to attend conventional settings. Int J Public Health 2014; 60:121-6. [PMID: 25224831 DOI: 10.1007/s00038-014-0606-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 07/18/2014] [Accepted: 09/08/2014] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES We assess the contribution of a rapid-HIV testing program run by Médicos del Mundo and oriented to vulnerable populations reluctant to attend conventional settings. METHODS We compare the program outcomes with a network of 20 HIV/STI clinics (EPIVIH) and the Spanish National Surveillance System (SNHSS). RESULTS 33.3% of the new diagnoses were women (8.6% EPIVIH and 17.7% SNHSS). Transsexuals were 6.9% (1.9% EPIVIH), female sex workers 23.6% (2.0% EPIVIH) and 19.4% Sub-Saharan Africans (3.8% EPIVIH and 7.8% SNHSS). HIV prevalence in men was slightly higher than in the EPIVIH and almost twice among women. CONCLUSIONS This program is contributing substantially to the promotion of HIV diagnosis in female sex workers, sub-Saharan Africans and transsexuals, which are less present at clinical settings.
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Affiliation(s)
- Sonia Fernández-Balbuena
- National Epidemiology Centre, Carlos III Health Institute C/Sinesio Delgado 6, 28029, Madrid, Spain,
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Fernández-Balbuena S, de la Fuente L, Hoyos J, Rosales-Statkus ME, Barrio G, Belza MJ. Highly visible street-based HIV rapid testing: is it an attractive option for a previously untested population? A cross-sectional study. Sex Transm Infect 2013; 90:112-8. [PMID: 24234073 DOI: 10.1136/sextrans-2013-051234] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Given the shortage of community-based HIV testing initiatives in resource-rich countries not targeting most-at-risk populations, we aimed to evaluate whether a highly visible mobile programme promoting and offering rapid HIV testing in the street can attract persons at risk for infection who have never been tested. METHODS Between 2008 and 2011, the programme served 7552 persons in various Spanish cities who answered a brief questionnaire while awaiting their results. The factors associated with being tested for the first time were analysed using two logistic regression models, one for men who have sex with men (MSM) and the other for only heterosexual men (MSW) and women. RESULTS 3517 participants (47%) were first-time testers (24% of MSM, 56% of MSW and 60% of women). Among them, 22 undiagnosed HIV infections were detected with a global prevalence of 0.6% and 3.1% in MSM. Undergoing a first HIV test was independently associated with age <30, being from Spain or another developed country, lack of university education, having fewer partners, having had unprotected sex with casual partners and not having been diagnosed with a sexually transmitted infection. In heterosexuals, also with never injected drugs, and in MSM, with not being involved in the gay community. Among those tested for the first time, 22% had never thought of being tested and 62% decided to be tested when they passed by and noticed the programme, regardless of their previous intentions. CONCLUSIONS This community programme attracted a substantial number of persons previously untested and particularly hard to reach, such as those with low education and MSM who were least involved in the gay community. Programme visibility was a decisive factor for almost two of every three persons who had never been tested.
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Never tested for HIV in Latin-American migrants and Spaniards: prevalence and perceived barriers. J Int AIDS Soc 2013; 16:18560. [PMID: 23663441 PMCID: PMC3651516 DOI: 10.7448/ias.16.1.18560] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 03/11/2013] [Accepted: 04/12/2013] [Indexed: 11/08/2022] Open
Abstract
Introduction Increasing the uptake of HIV testing and decreasing the number of undiagnosed people is a priority for HIV prevention. Understanding the barriers that hinder people from testing is vital, particularly when working with especially vulnerable populations like migrants. Most data available on migrants are based on African migrants in the UK, while barriers to HIV testing in Latin-American migrants living in Europe remain unexplored. Still, they account for a quarter of new diagnosis in Spain and suffer higher rates of delayed diagnosis. Methods Between May 2008 and March 2011, a mobile unit offered free rapid HIV tests in different Spanish cities. We compared the prevalence of no previous testing, adjusting for potential confounders by two multivariate logistic models, and described differences in perceived barriers to testing in Latin-American migrants living in Spain versus Spaniards. Participants included men who have sex with men (MSM), men who have sex exclusively with women (MSW), and women. Results Of the 5920 individuals who got tested and answered a self-administered questionnaire, 36.5% were MSM (20.4% previously untested), 28.9% were MSW (49% previously untested) and 34.6% were women (53% previously untested). Almost one quarter were Latin-American, of whom 30% had never been tested versus 45% of untested Spaniards. After adjusting for potential confounders, Spaniards were more likely to report no previous testing than Latin-Americans among women and MSW all together (Odds Ratio (OR)=2.0; 95% Confidence Interval (CI): 1.7–2.4) and among MSM (OR=1.6; 95% CI: 1.2–2.0). Among the 2455 who had never undergone an HIV test before, main barriers to testing were low perceived risk (54% Spaniards vs. 47% Latin-American) and concerns arising from the loss of anonymity (19.5% vs. 16.9%). Fear of rejection or discrimination and fear of legal problems were a barrier for <2%. Conclusions Latin-American migrants living in Spain were more likely to get tested than Spaniards. Regardless of nationality, low perceived risk was the main barrier to testing whereas fear of stigma or discrimination and fear of legal problems were merely incidental. However, new Spanish austerity policies regarding healthcare for migrants in response to the economic crisis may reverse this situation.
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Associations of Education Level and Bone Density Tests among Cognitively Intact Elderly White Women in Managed Medicare. Curr Gerontol Geriatr Res 2012; 2012:179150. [PMID: 23056041 PMCID: PMC3463901 DOI: 10.1155/2012/179150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Accepted: 08/08/2012] [Indexed: 11/17/2022] Open
Abstract
Objectives. To examine associations between having bone density tests and level of education among white elderly women in managed Medicare. Method. Data from the ninth through twelfth cohort (2006-2009) of the Medicare Health Outcome Survey (HOS) of managed Medicare plans were analyzed; 239331 white elderly women were included. Respondents were grouped by education level and the percentages of respondents who had lifetime bone density testing done among each group were analyzed. Results. 62.7% of respondents with less than a high school education reported previously taking a bone density test. This was lower than the 73.8% for respondents who completed high school and the 81.0% for respondents with more than a high school education. When potential confounding factors such as age, body mass index, marital status, smoking history, year of HOS survey, and region were factored in, the odds ratios of having a bone density test when compared to respondents with less than a high school education were 1.61 and 2.39, respectively, for those with just a high school education and more than a high school education (P < 0.001). Conclusion. Higher education was independently associated with greater use of bone density test in these elderly white women.
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