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Adrian Parra C, Stuardo Ávila V, Contreras Hernández P, Quirland Lazo C, Bustos Ibarra C, Carrasco-Portiño M, Belmar Prieto J, Barrientos J, Lisboa Donoso C, Low Andrade K. Structural and intermediary determinants in sexual health care access in migrant populations: a scoping review. Public Health 2024; 227:54-62. [PMID: 38118243 DOI: 10.1016/j.puhe.2023.11.031] [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] [Received: 07/14/2023] [Revised: 10/27/2023] [Accepted: 11/15/2023] [Indexed: 12/22/2023]
Abstract
OBJECTIVES Addressing migrant population's sexual health needs is essential, given the high vulnerability of this population, especially during migratory trajectories and when accessing health care in destination countries. The aim of this scoping review is to identify and describe the structural and intermediary determinants and their dimensions, which negatively influence sexual healthcare access in migrant population in the world in the last 20 years. STUDY DESIGN Scoping review. METHODS The search strategy was carried out in the databases PubMed/MEDLINE, Web of Science, EMBASE, and CINAHL. The inclusion criteria were primary studies published in English or Spanish from 2000 to 2022, describing determinants or barriers to access to sexual health for international migrants, refugees, and asylum seekers. The construction of the results was based on the social determinants of health framework. RESULTS A total of 44 studies were included. Thirteen categories that negatively affect access to sexual health in migrants were identified-structural determinants: language and communication barriers, religious and cultural values, VIH stigma and discrimination, irregular migration status, financial constraints, racism and discrimination, gender inequalities, and lack of knowledge and awareness about sexuality and sexual health; and intermediary determinants: financial health coverage, privacy and confidentiality, health system navigation; health system and facilities, and psychosocial factors. CONCLUSION The most relevant dimensions identified as barriers to access to health services were "culture and societal values" and "health system". Identifying the determinants that affect migrants' access to sexual health is relevant for the formulation of public policies with sociocultural relevance and an intersectional and human rights approach.
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Affiliation(s)
- C Adrian Parra
- PhD in Biomedical Research Methodology and Public Health, Department of Pediatrics, Obstetrics and Gynaecology and Preventive Medicine and Public Health, Universitat Autònoma de Barcelona, Spain
| | - V Stuardo Ávila
- Institute of Public Health, Universidad Andrés Bello, Santiago de Chile, Chile.
| | | | - C Quirland Lazo
- PhD in Biomedical Research Methodology and Public Health, Department of Pediatrics, Obstetrics and Gynaecology and Preventive Medicine and Public Health, Universitat Autònoma de Barcelona, Spain; Health Technology Assessment Unit, Arturo López Pérez Foundation, Chile
| | - C Bustos Ibarra
- Department of Social Work, Faculty of Social Sciences, Universidad de Concepción, Concepción, Chile
| | - M Carrasco-Portiño
- Department of Obstetrics and of Childcare, Faculty of Medicine, Universidad de Concepción, Concepción, Chile
| | - J Belmar Prieto
- School of Public Health, Faculty of Medicine, University of Chile, Santiago, Chile
| | - J Barrientos
- Faculty of Psychology, Universidad Alberto Hurtado, Chile
| | - C Lisboa Donoso
- School of Dentistry, Faculty of Health Sciences, Universidad Autonoma de Chile, Chile
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Ha T, Shi H, Givens D, Nguyen T, Nguyen N. Factors impacting HIV testing among young sexually active women migrant workers in Vietnamese industrial zones. BMC Public Health 2023; 23:1938. [PMID: 37803339 PMCID: PMC10559500 DOI: 10.1186/s12889-023-16841-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/26/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND Young migrant workers living in low- and middle-income countries often experience barriers and inadequate access to HIV prevention and treatment services. This study examines the prevalence of HIV testing, associated factors, and reasons for obtaining and not obtaining HIV testing among young sexually active women migrant workers in an industrial zone in Hanoi, Vietnam. METHODS A cross-sectional study was conducted among 512 sexually active young women migrant workers (aged 18 to 29) working in the Thang Long industrial zone in Hanoi, Vietnam. Data was collected via a face-to-face interview from January 2020 to June 2021. Multivariable logistic regression analysis was used to explore factors associated with ever-testing for HIV among sexually active participants. RESULTS The study found a low level of HIV testing and high rates of unprotected sex. Among those who reported being sexually active, only 23.7% of participants (n = 126) reported having ever been tested for HIV. Among those who reported never having tested for HIV, 38.2% reported not using condoms during their most recent sexual encounter. Factors associated with engaging in HIV testing included being older (25-29 years), having greater knowledge about HIV, past use of sexual and reproductive health and HIV services, and familiarity with HIV testing locations. CONCLUSIONS Overall, a low level of HIV testing, high rates of unprotected sex, and low perceived risks regarding HIV among the study participants point to a need to implement targeted HIV interventions that can improve both safe sex practices and perceptions of and knowledge about risky sexual behaviors. Such interventions should use insights from this study to address factors facilitating HIV testing among industrial zones' women migrant workers.
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Affiliation(s)
- Toan Ha
- Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Hui Shi
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - David Givens
- Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Trang Nguyen
- Institute of Social and Medical Studies, Hanoi, Vietnam
| | - Nam Nguyen
- Institute of Social and Medical Studies, Hanoi, Vietnam
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Vujcich D, Reid A, Brown G, Durham J, Guy R, Hartley L, Mao L, Mullens AB, Roberts M, Lobo R. HIV-Related Knowledge and Practices among Asian and African Migrants Living in Australia: Results from a Cross-Sectional Survey and Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4347. [PMID: 36901357 PMCID: PMC10002009 DOI: 10.3390/ijerph20054347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 02/24/2023] [Accepted: 02/25/2023] [Indexed: 06/18/2023]
Abstract
Australian HIV notification rates are higher for people born in Northeast Asia, Southeast Asia and sub-Saharan Africa compared to Australian-born people. The Migrant Blood-Borne Virus and Sexual Health Survey represents the first attempt to build the national evidence base regarding HIV knowledge, risk behaviors and testing among migrants in Australia. To inform survey development, preliminary qualitative research was conducted with a convenience sample of n = 23 migrants. A survey was developed with reference to the qualitative data and existing survey instruments. Non-probability sampling of adults born in Northeast Asia, Southeast Asia and sub-Saharan Africa was undertaken (n = 1489), and descriptive and bivariate analyses of data were conducted. Knowledge of pre-exposure prophylaxis was low (15.59%), and condom use at last sexual encounter was reported by 56.63% of respondents engaging in casual sex, and 51.80% of respondents reported multiple sexual partners. Less than one-third (31.33%) of respondents reported testing for any sexually transmitted infection or blood-borne virus in the previous two years and, of these, less than half (45.95%) tested for HIV. Confusion surrounding HIV testing practices was reported. These findings identify policy interventions and service improvements critically needed to reduce widening disparities regarding HIV in Australia.
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Affiliation(s)
- Daniel Vujcich
- School of Population Health, Curtin University, Bentley, WA 6102, Australia
| | - Alison Reid
- School of Population Health, Curtin University, Bentley, WA 6102, Australia
| | - Graham Brown
- Centre for Social Impact, UNSW, Sydney, NSW 2052, Australia
| | - Jo Durham
- Centre for Healthcare Transformation, Australian Centre for Health Services Innovation, School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, QLD 4059, Australia
| | - Rebecca Guy
- Kirby Institute, UNSW, Sydney, NSW 2052, Australia
| | - Lisa Hartley
- Centre for Human Rights Education, Curtin University, Bentley, WA 6102, Australia
| | - Limin Mao
- Centre for Social Research in Health, UNSW, Sydney, NSW 2052, Australia
| | - Amy B. Mullens
- School of Psychology & Wellbeing, Centre for Health Research, Institute for Resilient Regions, University of Southern Qld, Ipswich, QLD 4305, Australia
| | - Meagan Roberts
- School of Population Health, Curtin University, Bentley, WA 6102, Australia
| | - Roanna Lobo
- School of Population Health, Curtin University, Bentley, WA 6102, Australia
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Maheen H, Chalmers K, Khaw S, McMichael C. Sexual and reproductive health service utilisation of adolescents and young people from migrant and refugee backgrounds in high-income settings: a qualitative evidence synthesis (QES). Sex Health 2021; 18:283-293. [PMID: 34412768 DOI: 10.1071/sh20112] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 06/01/2021] [Indexed: 11/23/2022]
Abstract
Young people with migrant or refugee backgrounds from low- and middle-income countries settle in high-income countries and tend to underutilise sexual and reproductive health (SRH) services. This review aimed to explore perceptions and experiences of SRH services and the factors that shape their use among migrant youth. It focuses on qualitative studies that examine SRH service use among young migrants living in high-income countries. Seven peer-review databases and web-based grey literature were searched using pre-determined search criteria. The review includes 16 articles that met the inclusion criteria. The qualitative evidence synthesis (QES) method was used to synthesise findings. Thematic analysis resulted in five main themes and 11 sub-themes. Findings suggest that despite diversity of countries of origin and host countries, there were considerable similarities in their perceptions of and experiences with SRH services. Some young migrants reported experiences of discrimination by service providers. Cost of care was a deterrent to SRH service use in countries without universal healthcare coverage. Lack of information about SRH services, concerns about confidentiality, community stigma around sexually transmitted infections and premarital sex were key barriers to SRH service use. Health systems should integrate flexible service delivery options to address access barriers of SRH service use in young migrants. Engagement with parents and communities can help to destigmatise sexual health problems, including STIs. Host countries need to equip young migrants with the knowledge required to make informed SRH decisions and access relevant SRH services and resources.
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Affiliation(s)
- Humaira Maheen
- Centre for Health Equity, School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton, Vic. 3053, Australia; and Corresponding author.
| | - Kate Chalmers
- Centre for Health Equity, School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton, Vic. 3053, Australia
| | - Sarah Khaw
- Centre for Health Equity, School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton, Vic. 3053, Australia
| | - Celia McMichael
- School of Geography Faculty of Science, University of Melbourne, 203 Bouverie Street, Carlton, Vic. 3053, Australia
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Ziersch A, Walsh M, Baak M, Rowley G, Oudih E, Mwanri L. "It is not an acceptable disease": A qualitative study of HIV-related stigma and discrimination and impacts on health and wellbeing for people from ethnically diverse backgrounds in Australia. BMC Public Health 2021; 21:779. [PMID: 33892683 PMCID: PMC8063420 DOI: 10.1186/s12889-021-10679-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 03/22/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND People from ethnically diverse backgrounds living with HIV are susceptible to adverse health and wellbeing outcomes, particularly as a consequence of HIV-related stigma and discrimination (HSD), though relatively little is known about experiences in Australia. METHODS This paper reports on HSD in ethnically diverse communities in South Australia and impacts on health and wellbeing. Interviews and focus groups were conducted with 10 individuals living with HIV from ethnically diverse backgrounds, 14 ethnically diverse community leaders, and 50 service providers. Data were analysed thematically. RESULTS Findings indicated that HIV is a highly stigmatised condition in ethnically diverse communities due to fear of moral judgment and social isolation, and was experienced at the intersections of gender, sexual orientation, religion, culture, and immigration status. Experiences of HSD were damaging to health and wellbeing through non-disclosure, reduced social support, delayed testing, service access barriers, impacts on treatment adherence, and directly to mental health. CONCLUSIONS Actions addressing the impacts of HSD on people from ethnically diverse backgrounds are crucial.
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Affiliation(s)
- Anna Ziersch
- College of Medicine and Public Health, Flinders University, Adelaide, Australia.
| | - Moira Walsh
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Melanie Baak
- School of Education, University of South Australia, Adelaide, Australia
| | - Georgia Rowley
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Enaam Oudih
- Relationships Australia South Australia, Adelaide, Australia
| | - Lillian Mwanri
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
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Blondell SJ, Debattista J, Griffin MP, Durham J. Conceptualising, measuring, and addressing HIV-related stigma: Towards reducing disparities in HIV testing and HIV-related outcomes among migrants of HIV unknown or negative status in high-income countries. Health Promot J Austr 2020; 32:433-436. [PMID: 32619076 DOI: 10.1002/hpja.383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 06/29/2020] [Indexed: 11/07/2022] Open
Affiliation(s)
- Sarah J Blondell
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
| | - Joseph Debattista
- Metro North Public Health Unit, Metro North Hospital & Health Service, Brisbane, QLD, Australia
| | - Mark P Griffin
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
- Insight Research Services Associated, Brisbane, QLD, Australia
| | - Jo Durham
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
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Adedimeji A, Shi Q, Haddad L, Holman S, Edmonds A, Weber K, Kassaye S, Karim R, Bolivar H, Reid M, Kempf M, Golub E, Hoover DR, Anastos K. Women from afar: an observational study of demographic characteristics and mortality among foreign-born women living with HIV in the Women's Interagency HIV Study (WIHS) in the United States 1994-2016. J Int AIDS Soc 2020; 23:e25486. [PMID: 32437092 PMCID: PMC7241263 DOI: 10.1002/jia2.25486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 03/06/2020] [Accepted: 03/13/2020] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Foreign-born persons comprise ~13% of the US population. Immigrants, especially women, often face a complex set of social and structural factors that negatively impact health outcomes including greater risk of HIV infection. We described socio-demographic, clinical and immunological characteristics and AIDs and non-AIDS death among foreign-born women living with HIV (FBWLWH) participating in the US Women's Interagency HIV Study (WIHS) in the US from 1994 to 2016. We hypothesized that FBW will experience higher AIDS-related mortality compared to US-born women (USBW). METHODS The WIHS is a multicenter prospective observational cohort study of mostly women living with HIV (WLWH). The primary exposure in this analysis, which focused on 3626 WLWH, was self-reported country of birth collapsed into foreign-born and US born. We assessed the association of birthplace with categorized demographic, clinical and immunological characteristics, and AIDS/non-AIDS mortality of WLWH, using chi-squared tests. Proportional hazard models examined the association of birthplace with time from enrolment to AIDS and non-AIDS death. RESULTS Of the 628 FBW, 13% were born in Africa, 29% in the Caribbean and 49% in Latin America. We observed significant differences by HIV status in socio-demographic, clinical and immunological characteristics and mortality. For both AIDS and non-AIDS caused deaths FBW WLWH had lower rates of death. Adjusting for year of study enrolment and other demographic/clinical characteristics mitigated FBW's statistical survival advantage in AIDS deaths Relative Hazard (RH = 0.91 p = 0.53), but did not substantively change the survival advantage in non-AIDS deaths RH = 0.33, p < 0.0001). CONCLUSION Foreign-born WLWH exhibited demographic, clinical and immunological characteristics that are significantly different compared with women born in the US or US territory. After adjusting for these characteristics, the FB WLWH had a significantly lower hazard of non-AIDS but not AIDS mortality compared to women born in the US or a US territory. These findings of non-increased mortality can help inform models of care to optimize treatment outcomes among FBWLWH in the United States.
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Affiliation(s)
- Adebola Adedimeji
- Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxNYUSA
| | - Qiuhu Shi
- Department of Epidemiology and Community HealthSchool of Health Sciences and PracticeNew York Medical CollegeValhallaNYUSA
| | - Lisa Haddad
- Department of Gynecology and ObstetricsEmory University School of MedicineAtlantaGAUSA
| | - Susan Holman
- State University of New YorkDownstate Medical CenterBrooklynNYUSA
| | - Andrew Edmonds
- Department of EpidemiologyThe University of North Carolina at Chapel HillNCUSA
| | | | - Seble Kassaye
- Department of Infectious DiseasesGeorgetown UniversityWashingtonDCUSA
| | - Roksana Karim
- Division of Disease Prevention, Policy and Global HealthKeck School of MedicineUniversity of Southern CaliforniaLos AngelesCAUSA
| | | | - Michael Reid
- Institute of Global Health SciencesDivision of HIV, Infectious Disease and Global MedicineUniversity of California at San FranciscoCAUSA
| | - Mirjam‐Colette Kempf
- Schools of Nursing, Public Health and MedicineUniversity of Alabama at BirminghamBirminghamALUSA
| | - Elizabeth Golub
- Department of EpidemiologyJohns Hopkins UniversityBaltimoreMDUSA
| | | | - Kathryn Anastos
- Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxNYUSA
- Department of MedicineMontefiore Medical CenterBronxNYUSA
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Hall BJ, Yang X, Huang L, Yi G, Chan EWW, Tucker JD, Latkin CA. Barriers and Facilitators of Rapid HIV and Syphilis Testing Uptake Among Filipino Transnational Migrants in China. AIDS Behav 2020; 24:418-427. [PMID: 30840160 DOI: 10.1007/s10461-019-02449-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Transnational migrant workers are known to be at high risk for HIV/STIs. This study estimated the point prevalence of HIV/syphilis and examined correlates of HIV/syphilis testing uptake among female migrant domestic workers in Macao, China. Data was obtained from 1363 female Filipino domestic workers who were offered free rapid HIV and syphilis testing. A mixed methods analysis was undertaken to examine correlates of testing and themes about reasons for not testing. Among 1164 women tested, there were no cases of HIV/syphilis observed and 199 (14.6%) refused HIV/syphilis testing. Greater social integration (aOR 1.12; 95% CI 1.02-1.24), having more than one sexual partner (aOR 1.65; 95% CI 1.02-2.65), and longer working hours on the testing day (aOR 0.97; 95% CI 0.94-1.00), were associated with testing uptake. Among those who tested, the majority (> 70%) had never tested before, suggesting the need to improve testing outreach. Qualitative themes about reasons for not testing included low perceived need and insufficient time. Individual and structural testing barriers should be reduced to optimize HIV/STI testing in migrant populations.
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HIV outcomes among migrants from low-income and middle-income countries living in high-income countries: a review of recent evidence. Curr Opin Infect Dis 2019; 31:25-32. [PMID: 29095720 DOI: 10.1097/qco.0000000000000415] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Migrants living in high-income countries are disproportionately affected by HIV infection and frequently have characteristics associated with poor HIV clinical outcomes. HIV epidemiology among migrants is influenced by changes in migration patterns and variations in transmission risk behaviors. Here we review the recently published literature on known HIV outcomes among migrants from low-income and middle-income countries living in high-income countries. RECENT FINDINGS High proportions of migrants acquire HIV after migration, and this group frequently presents to care late. Once established in care, migrants are often more likely to experience worse HIV treatment outcomes compared with native populations. Multiple individual and structural factors influence HIV diagnosis and treatment outcomes among migrants, including disruption of social networks, increased sexual risk behaviors, communication barriers, limited access to care, and stigma. Few studies have examined interventions targeted at improving HIV outcomes among migrants. SUMMARY Stigma and limited access to care appear to be primary drivers of poor HIV outcomes among migrants in high-income countries. Addressing these disparities is limited by difficulties in identifying and monitoring this population as well as a lack of evidence regarding appropriate interventions for migrants living with HIV. Improving outcomes for this group requires interventions that are specifically targeted at this marginalized and growing population.
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What Works? Prevention and Control of Sexually Transmitted Infections and Blood-Borne Viruses in Migrants from Sub-Saharan Africa, Northeast Asia and Southeast Asia Living in High-Income Countries: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16071287. [PMID: 30974851 PMCID: PMC6480002 DOI: 10.3390/ijerph16071287] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 04/03/2019] [Accepted: 04/05/2019] [Indexed: 01/05/2023]
Abstract
Migration is a significant risk factor for the acquisition of human immunodeficiency virus (HIV), hepatitis B virus (HBV) and other sexually transmitted infections (STIs). An increasing proportion of these infections in high-income countries, such as Australia, are among migrants moving from low and middle-income countries with a high prevalence of HIV, HBV and other STIs. This systematic review explored the prevention and control of HIV, HBV and other STIs in migrants (>18 years) from Southeast Asia, Northeast Asia and sub-Saharan Africa living in high-income countries with universal health care. This systematic review followed PRISMA guidelines and was registered with PROSPERO. Six academic databases were searched for articles published between 2002 and 2018. Sixteen peer-reviewed articles met the inclusion criteria, consisting of fourteen quantitative and two qualitative studies conducted in Australia, the Netherlands, Canada, Spain, Italy, and Germany. Three levels of interventions were identified: individual, community and structural interventions. Most studies addressed factors at an individual level; interventions were most commonly outreach testing for HIV, HBV and other STIs. Few studies addressed structural factors or demonstrated comprehensive evaluation of interventions. Limited population-specific findings could be determined. To prevent further transmission of HIV, HBV and other STIs, comprehensive public health approaches must consider the complex interactions between migration, health care system determinants, and broader socioeconomic and sociocultural factors.
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Gray C, Lobo R, Narciso L, Oudih E, Gunaratnam P, Thorpe R, Crawford G. Why I Can't, Won't or Don't Test for HIV: Insights from Australian Migrants Born in Sub-Saharan Africa, Southeast Asia and Northeast Asia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E1034. [PMID: 30901957 PMCID: PMC6466030 DOI: 10.3390/ijerph16061034] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 03/10/2019] [Accepted: 03/15/2019] [Indexed: 12/18/2022]
Abstract
People born in sub-Saharan Africa and Southeast Asia are overrepresented in HIV notifications in Australia. Just under half of all notifications among people from sub-Saharan Africa and Southeast Asia are diagnosed late. Increased HIV testing among these communities is necessary to ensure early diagnosis, better care and reduce likelihood of HIV onward transmission. Recently, Australia has made new HIV testing methods available: rapid HIV testing and self-testing kits. We conducted 11 focus groups with 77 participants with people from sub-Saharan Africa, Southeast Asia and Northeast Asia in four jurisdictions in Australia. Focus groups discussed barriers to HIV testing and the acceptability of new testing methods. Barriers to HIV testing included: cost and eligibility of health services, low visibility of HIV in Australia, HIV-related stigma, and missed opportunities by general practitioners (GPs) for early diagnosis of HIV and linkage into care. Participants had low levels of knowledge on where to test for HIV and the different methods available. Diverse opportunities for testing were considered important. Interventions to increase HIV testing rates among sub-Saharan African, Southeast Asia and Northeast Asian migrants in Australia need to be multi-strategic and aimed at individual, community and policy levels. New methods of HIV testing, including rapid HIV testing and self-testing, present an opportunity to engage with migrants outside of traditional health care settings.
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Affiliation(s)
- Corie Gray
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Kent Street, Bentley, WA 6102, Australia.
| | - Roanna Lobo
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Kent Street, Bentley, WA 6102, Australia.
| | - Lea Narciso
- Communicable Disease Control Branch, Public Health and Clinical Systems, Department for Health and Wellbeing, Government of South Australia, Adelaide, SA 5000, Australia.
| | - Enaam Oudih
- PEACE Multicultural Services, Relationships Australia South Australia, Adelaide, SA 5000, Australia.
| | - Praveena Gunaratnam
- The Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia.
| | - Rachel Thorpe
- Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, VIC 3086, Australia.
| | - Gemma Crawford
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Kent Street, Bentley, WA 6102, Australia.
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12
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Della Bona M, Crawford G, Nimmo L, Leavy JE. What does 'Keep Watch' mean to migrant parents? Examining differences in supervision, cardiopulmonary resuscitation training and water familiarisation. Int J Public Health 2019; 64:755-762. [PMID: 30603940 DOI: 10.1007/s00038-018-1197-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 11/13/2018] [Accepted: 12/19/2018] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Drowning is a public health challenge. Children of migrants may be at increased risk as parents may be unaware of local water safety issues. This study explores differences between Australian-born and migrant parents in Western Australia for: (1) swimming ability; (2) supervision; (3) water familiarisation; and (4) cardiopulmonary resuscitation (CPR) training. METHODS A cross-sectional survey of parents and carers of children aged under 5 years residing in WA (n = 1506) captured demographics, knowledge of appropriate supervision, water safety knowledge and skills. Logistic regression was conducted. RESULTS Migrants were significantly less likely to identify adequate supervision (p = 0.004); have participated in child water familiarisation programmes (p = 0.000); or perceived themselves as able swimmers (p = 0.000). Significantly less migrants had also undertaken CPR training (p = 0.000). CONCLUSIONS Findings add to the small but growing body of literature highlighting the importance of tailored drowning prevention strategies for migrants in countries such as Australia with a strong aquatic culture.
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Affiliation(s)
- Malena Della Bona
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia.
| | - Gemma Crawford
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia
| | - Lauren Nimmo
- Health Promotion and Research, Royal Life Saving Society Western Australia Inc, PO Box 28, Floreat, WA, 6014, Australia
| | - Justine E Leavy
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia
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13
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Rade DA, Crawford G, Lobo R, Gray C, Brown G. Sexual Health Help-Seeking Behavior among Migrants from Sub-Saharan Africa and South East Asia living in High Income Countries: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E1311. [PMID: 29932158 PMCID: PMC6069090 DOI: 10.3390/ijerph15071311] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 06/18/2018] [Accepted: 06/18/2018] [Indexed: 12/30/2022]
Abstract
The number of migrants has increased globally. This phenomenon has contributed to increasing health problems amongst migrants in high-income countries, including vulnerability for HIV acquisition and other sexual health issues. Adaptation processes in destination countries can present difficulties for migrants to seek help from and gain access to health services. This study examined migrants’ from sub-Saharan Africa (SSA) and South East Asia (SEA) sexual health help-seeking behavior in high-income countries with universal health coverage. The systematic review followed PRISMA guidelines and was registered with PROSPERO. Several databases were searched from 2000 to 2017. Of 2824 studies, 15 met the inclusion criteria. These consisted of 12 qualitative and three quantitative studies conducted in Australia, Spain, the United Kingdom, Belgium, Scotland, Ireland, and Sweden. Migrants experienced a range of difficulties accessing health services, specifically those related to sexual health, in high-income countries. Few studies described sources of sexual health help-seeking or facilitators to help-seeking. Barriers to access were numerous, including: stigma, direct and indirect costs, difficulty navigating health systems in destination countries and lack of cultural competency within health services. More culturally secure health services, increased health service literacy and policy support to mitigate costs, will improve health service access for migrants from SSA and SEA. Addressing the structural drivers for stigma and discrimination remains an ongoing and critical challenge.
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Affiliation(s)
- Donna Angelina Rade
- School of Public Health, Curtin University, Kent Street, Bentley, WA 6102, Australia.
| | - Gemma Crawford
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Kent Street, Bentley, WA 6102, Australia.
| | - Roanna Lobo
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Kent Street, Bentley, WA 6102, Australia.
| | - Corie Gray
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Kent Street, Bentley, WA 6102, Australia.
| | - Graham Brown
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Kent Street, Bentley, WA 6102, Australia.
- Australian Research Centre in Sex, Health and Society School of Psychology and Public Health, La Trobe University, Bundoora, VIC 3086, Australia.
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Gray C, Crawford G, Reid A, Lobo R. HIV knowledge and use of health services among people from South-East Asia and sub-Saharan Africa living in Western Australia. Health Promot J Austr 2018; 29:274-281. [PMID: 29687507 DOI: 10.1002/hpja.168] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 04/16/2018] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND HIV notifications among people born in sub-Saharan Africa and South-East Asia have increased in Australia in the last decade. People born in these regions have the highest rates of HIV diagnosis by region of birth and are overrepresented in late or advanced presentation of HIV infection. METHODS This study developed and tested a questionnaire for reliability through test-retest. A cross-sectional survey using intercept and online recruitment of HIV knowledge and use of health services was then undertaken among people born in sub-Saharan Africa and South-East Asia, who had arrived in Australia less than 10 years ago and were living in Western Australia (n = 209). Results were reported on by gender and length of time in Australia. RESULTS Participants had a reasonable knowledge of HIV transmission, but held a number of incorrect beliefs. Two-thirds (65%) of participants reported a barrier to accessing health services in Australia. Just over a third (34%) of participants had ever tested for HIV, despite indicating that they believed HIV testing was important. CONCLUSIONS This project indicates a very low rate of HIV testing among this priority population. Further action is required to improve early diagnosis of HIV and reduce onward transmission of HIV infection within these communities. SO WHAT?: We need targeted interventions that extend beyond knowledge to increase HIV testing rates among this population.
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Affiliation(s)
- Corie Gray
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Bentley, WA, Australia
| | - Gemma Crawford
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Bentley, WA, Australia
| | - Alison Reid
- School of Public Health, Curtin University, Bentley, WA, Australia
| | - Roanna Lobo
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Bentley, WA, Australia
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15
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Mullens AB, Kelly J, Debattista J, Phillips TM, Gu Z, Siggins F. Exploring HIV risks, testing and prevention among sub-Saharan African community members in Australia. Int J Equity Health 2018; 17:62. [PMID: 29784050 PMCID: PMC5963033 DOI: 10.1186/s12939-018-0772-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 05/03/2018] [Indexed: 12/20/2022] Open
Abstract
Background Significant health disparities persist regarding new and late Human Immunodeficiency Virus (HIV) diagnoses among sub-Saharan African (SSA) communities in Australia. Personal/cultural beliefs and practices influence HIV (risk, prevention, testing) within Australia and during visits to home countries. Method A community forum was conducted involving 23 male and female adult African community workers, members and leaders, and health workers; facilitated by cultural workers and an experienced clinician/researcher. The forum comprised small/large group discussions regarding HIV risk/prevention (responses transcribed verbatim; utilising thematic analysis). Results Stigma, denial, social norms, tradition and culture permeated perceptions/beliefs regarding HIV testing, prevention and transmission among African Australians, particularly regarding return travel to home countries. Conclusions International travel as a risk factor for HIV acquisition requires further examination, as does the role of the doctor in HIV testing and Pre-exposure Prophylaxis (PrEP). Further assessment of PrEP as an appropriate/feasible intervention is needed, with careful attention regarding negative community perceptions and potential impacts.
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Affiliation(s)
- Amy B Mullens
- School of Psychology and Counselling, Institute for Resilient Regions, University of Southern Queensland, Ipswich Campus, 11 Salisbury Road, Ipswich, Qld 4305, Australia.
| | - Jennifer Kelly
- School of Health and Wellbeing, University of Southern Queensland, Ipswich Campus, 11 Salisbury Road, Ipswich, Qld 4305, Australia
| | - Joseph Debattista
- Queensland Health, Metro North Public Health Unit, Bryden Street, Windsor, Qld 4030, Australia
| | - Tania M Phillips
- School of Psychology and Counselling, Institute for Resilient Regions, University of Southern Queensland, Ipswich Campus, 11 Salisbury Road, Ipswich, Qld 4305, Australia
| | - Zhihong Gu
- Ethnic Communities Council of Queensland, PO Box 5916, West End, Qld 4101, Australia
| | - Fungisai Siggins
- Kalpa purru Wirranjarlki, Anyinginyi Health Aboriginal Corporation, 1 Irvine Street, PO Box 40, Tennant Creek, NT, 0861, Australia
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Guiguet M, Dionou S, Volant J, Samba MC, Benammar N, Chauvin P, Simon A. Men from Sub-Saharan Africa Living in Worker Hostels in France: A Hidden Population with Poor Access to HIV Testing. J Immigr Minor Health 2018; 19:991-994. [PMID: 26979169 DOI: 10.1007/s10903-016-0385-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Delayed presentation to care among HIV-infected individuals continued to be frequent in France. Migrants are at high risk for late presentation. This cross-sectional study investigated barriers to HIV testing in the specific population of men from sub-Saharan Africa living in four migrant worker hostels in Paris, France. Factors associated with never having been tested for HIV were examined using logistic regression. In all, 550 men participated, coming mainly from Mali and Senegal, with 31 % having lived in France for less than 5 years, and 25 % without any health insurance. Only 37 % have ever been tested for HIV. Not having health insurance was the main risk factor for never-testing [adjusted odds ratio (aOR) 2.4; 95 % confidence interval (CI) 1.4-4.0]. Despite free and anonymous HIV testing available at dedicated public screening centers, 63 % of men living in migrant worker hostels had never been tested for HIV.
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Affiliation(s)
- M Guiguet
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Pierre Louis Institute of Epidemiology and Public Health, (IPLESP UMRS 1136), 75013, Paris, France.
| | - S Dionou
- CDAG-Department of Internal Medicine and Clinical Immunology, AP-HP, Hôpital Pitié Salpêtrière, 75013, Paris, France.,COREVIH Ile-de-France Centre, 75013, Paris, France
| | - J Volant
- Fédération SOS Hépatite, 75020, Paris, France
| | - M C Samba
- CDAG-Department of Internal Medicine and Clinical Immunology, AP-HP, Hôpital Pitié Salpêtrière, 75013, Paris, France
| | - N Benammar
- CDAG-Department of Internal Medicine and Clinical Immunology, AP-HP, Hôpital Pitié Salpêtrière, 75013, Paris, France
| | - P Chauvin
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Pierre Louis Institute of Epidemiology and Public Health, (IPLESP UMRS 1136), 75013, Paris, France
| | - A Simon
- CDAG-Department of Internal Medicine and Clinical Immunology, AP-HP, Hôpital Pitié Salpêtrière, 75013, Paris, France
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Loos J, Manirankunda L, Platteau T, Albers L, Fransen K, Vermoesen T, Namanya F, Nöstlinger C. Acceptability of a Community-Based Outreach HIV-Testing Intervention Using Oral Fluid Collection Devices and Web-Based HIV Test Result Collection Among Sub-Saharan African Migrants: A Mixed-Method Study. JMIR Public Health Surveill 2016; 2:e33. [PMID: 27493067 PMCID: PMC4990717 DOI: 10.2196/publichealth.5519] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 05/11/2016] [Accepted: 06/17/2016] [Indexed: 12/03/2022] Open
Abstract
Background Late human immunodeficiency virus (HIV) diagnosis is common among sub-Saharan African migrants. To address their barriers to HIV testing uptake and improve timely HIV diagnoses and linkage to care, the outreach HIV testing intervention, “swab2know,” was developed. It combined a community-based approach with innovative testing methods: oral fluid self-sampling and the choice between Web-based HIV test result collections using a secured website or post-test counseling at a sexual health clinic. The sessions included an informational speech delivered by a physician of sub-Saharan African origin and testimonies by community members living with HIV. Objectives The objectives of this study were to evaluate the intervention’s acceptability among sub-Saharan African migrants and its potential to reach subgroups at higher risk for HIV infection and to identify facilitators and barriers for HIV testing uptake. Methods This mixed-method study combined qualitative (participant observations and informal interviews with testers and nontesters) and quantitative data (paper–pencil survey, laboratory data, and result collection files). Data were analyzed using a content analytical approach for qualitative and univariate analysis for quantitative data. Results A total of 10 testing sessions were organized in sub-Saharan African migrant community venues in the city of Antwerp, Belgium, between December 2012 and June 2013. Overall, 18.2% of all people present (N=780) underwent HIV testing; 29.8% of them tested for HIV for the first time, 22.3% did not have a general practitioner, and 21.5% reported 2 or more sexual partners (last 3 months). Overall, 56.3% of participants chose to collect their HIV test results via the protected website. In total, 78.9% collected their results. The qualitative analysis of 137 participant observation field notes showed that personal needs and Internet literacy determined the choice of result collection method. Generally, the oral fluid collection devices were well accepted mainly because sub-Saharan African migrants dislike blood taking. For some participants, the method raised concerns about HIV transmission via saliva. The combination of information sessions, testimonies, and oral fluid collection devices was perceived as effectively reducing thresholds to participation. Acceptability of the intervention differed between individual participants and settings. Acceptance was higher among women, in churches and settings where community leaders were engaged in HIV awareness raising. Higher preventive outcomes were observed in settings with lower acceptance. The presence of the intervention team visualized the magnitude of the HIV epidemic to the public and promoted HIV testing uptake at large, for example, those who declined indicated they would take up testing later. Conclusions When accompanied by tailored provision of information, outreach HIV testing interventions adopting a community-based approach and innovative methods such as Web-based result collection and oral fluid collection devices are acceptable and reduce thresholds for HIV testing uptake. The swab2know intervention was able to reach sub-Saharan African migrants at risk of HIV infection, and with limited access to regular HIV testing. Among nontesters, the intervention contributed to awareness raising and therefore has a place in a multipronged HIV test promotion strategy.
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Affiliation(s)
- Jasna Loos
- HIV and Sexual Health Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
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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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