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Dadras O, Diaz E. Perceived discrimination and its association with self-rated health, chronic pain, mental health, and utilization of health services among Syrian refugees in Norway: a cross-sectional study. Front Public Health 2024; 12:1264230. [PMID: 38406500 PMCID: PMC10884245 DOI: 10.3389/fpubh.2024.1264230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 01/22/2024] [Indexed: 02/27/2024] Open
Abstract
Background There is a scarcity of research on discriminatory experiences and their association with health outcomes among Syrian Refugees in Norway. Thus, this study aims to examine the relationship between perceived discrimination, self-rated health (SRH), chronic pain, poor mental health, and healthcare utilization among Syrian refugees resettled in Norway. Methods Cross-sectional data from the Integration for Health project were analyzed, including 154 Syrian refugees who resettled in Norway in 2018-19. Perceived discrimination, SRH, chronic pain, psychological distress, post-traumatic stress symptoms, and healthcare visits were assessed. Statistical analyses, including Poisson regression and multinomial logistic regression, were conducted. The significant statistical level was set at 0.05. Results Approximately 30% of participants reported experiencing discrimination, with no significant associations between sociodemographic factors and perceived discrimination. Perceived discrimination was significantly associated with psychological distress (adjusted PR: 2.07, 95%CI: 1.21-3.55), post-traumatic stress symptoms (adjusted PR: 11.54, 95%CI: 1.25-106.16), and 4 or more psychologist visits (adjusted OR: 12.60, 95%CI: 1.72-92.16). However, no significant associations were found between perceived discrimination and SRH; pain symptoms, or general healthcare utilization. Conclusion Experienced discrimination is highly prevalent and seems to be associated with mental health outcomes, but not clearly with SRH, pain, or general healthcare visits among Syrian refugees living in Norway. Efforts should focus on reducing discrimination, promoting social inclusion, and improving access to mental health services for refugees. Public awareness campaigns, anti-discrimination policies, and cultural training for healthcare professionals are recommended to address these issues and improve the well-being of Syrian refugees in Norway.
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Affiliation(s)
- Omid Dadras
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
| | - Esperanza Diaz
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
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Crankshaw TL, Freedman J, Mutambara VM, Rajah Y. "I still don't know how someone gets pregnant": determinants of poor reproductive health among young female refugees in South Africa. BMC Womens Health 2024; 24:10. [PMID: 38172790 PMCID: PMC10765558 DOI: 10.1186/s12905-023-02847-6] [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] [Accepted: 12/14/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Studies exploring the sexual and reproductive health (SRH) of refugee women have focused primarily on first generation refugees in humanitarian and crisis settings. There is a paucity of research exploring the reproductive health of girls and young women who are born to refugee parents in a host country or who have migrated with their parents at a very young age and who have since reached sexual maturity. We conducted a qualitative study which aimed to explore the reproductive health and rights' needs and challenges amongst young refugee women in South Africa. METHODS The study was carried out in the city of eThekwini (Durban) in South Africa in 2021 and 2022. A total of 35 semi-structured, in person interviews were conducted amongst young refugee women between the ages of 18 and 24 years living in the city centre. RESULTS Twenty-five participants were 17 years or younger on arriving in South Africa, one of whom was born in South Africa. Eleven of these women had experienced one or more pregnancies while living in South Africa and all of these women had experienced at least one unintended pregnancy. Participants had poor reproductive health knowledge of the role of menstruation and how conception occurs. Economic, social, and legal insecurities intersected in complex ways as determinants of poor reproductive health outcomes. Despite availability, contraceptive use was poor and linked to lack of knowledge, myths and unwanted side effects. There were negative economic and social impacts for young refugee women experiencing early pregnancies irrespective of whether they were intended or not. Being unable to conceive or experiencing an unintended pregnancy negatively impacted sexual relationships which were entered primarily for material support. Desire for confidentiality shaped lack of access to legal termination of pregnancy in the public health sector. CONCLUSION Participants experienced specific vulnerabilities resulting from their position as refugees despite length of stay in South Africa. It is important to better understand these specificities in the design of programmes and policies aimed at ensuring positive health outcomes for these young women. Peer education amongst refugee communities may be an important tool in the provision of culturally acceptable SRH education.
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Affiliation(s)
- Tamaryn L Crankshaw
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa.
| | - Jane Freedman
- Centre for Sociological and Political Research (CRESPPA), Université Paris 8, Paris, France
| | - Victoria M Mutambara
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
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Namata C, Hatzidimitriadou E. Strategies for improving access to primary care services for homeless immigrants in England: a Delphi study. Prim Health Care Res Dev 2023; 24:e70. [PMID: 38093561 PMCID: PMC10790723 DOI: 10.1017/s1463423623000646] [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: 06/27/2023] [Revised: 09/22/2023] [Accepted: 11/05/2023] [Indexed: 12/18/2023] Open
Abstract
AIM The aim of the study was to identify the most prioritized strategies in improving access to primary care services (PCS) for homeless immigrants. BACKGROUND The issue of improving access to PCS for homeless immigrants is a complex and multifaceted one, and yet there is limited research on the strategies aimed at improving these services. Hence, the need for more studies that directly engage homeless immigrants and service providers in understanding their barriers to accessing PCS and their preferences for improving access to these services. METHODS The study used a two round Delphi method to elicit the views of stakeholders. The Delphi process utilized a web-based questionnaire. The stakeholders included healthcare providers and voluntary sector providers. The first round had a total of 58 items belonging to 14 categories. The second round comprised a total of 25 items belonging to 12 categories which were preselected based on participants' ranking of their importance in the first round. Participants were required to rank the relative importance of all the items on a 5-point Likert scale. Data were analysed using the STATA-15 software package. FINDINGS A total of 12 stakeholders participated in both rounds of the Delphi survey. The top three strategies encompassed fighting against discrimination and prejudice, improving and promoting mental health services, and empowering homeless immigrants. These evidence-based strategies hold the potential to support the implementation of healthcare interventions aimed at improving access to PCS and healthcare outcomes for homeless immigrants. However, it is crucial to conduct further research that includes homeless immigrants in the Delphi study to gain insights into the strategies that are most important to them in enhancing access to PCS, as they are the primary target users. Such research will contribute to the development of comprehensive and effective interventions tailored to the specific needs of homeless.
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Affiliation(s)
- Carol Namata
- Faculty of Medicine, Health and Social Care, Canterbury Christ Church University, Canterbury, Kent, England
| | - Eleni Hatzidimitriadou
- Faculty of Medicine, Health and Social Care, Canterbury Christ Church University, Canterbury, Kent, England
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Rossoni I, Chollier M, Dudushi R, Ghigo J, Padovese V. A scoping review of sexual and reproductive health recommendations in the context of migration to Europe. J Eur Acad Dermatol Venereol 2023; 37:2450-2461. [PMID: 37591613 DOI: 10.1111/jdv.19428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 07/21/2023] [Indexed: 08/19/2023]
Abstract
In recent years, growing instability and conflict around the world have continued to fuel outward migration, including migration to the EU/EEA. Many migrants hail from countries and regions with a higher burden of STIs-including HIV-and are exposed to enhanced risks of sexual and gender-based violence leading to sexual health issues during their journeys. This scoping review aims to identify existing sexual health recommendations for non-European migrants in the EU/EEA and identify gaps in their implementation. Sexual health recommendations formulated in relation to the migrant population in peer- reviewed journals or by expert consensus, between 2010 and 2021, were included. A keyword search was used to retrieve relevant publications on PubMed, ScienceDirect, the Cochrane Library databases, WHO and ECDC websites. The search strategy employed was charted in a dedicated Prisma Chart. Overall, 180 publications were retrieved. Based on the abstract and after eliminating duplicates, 33 publications were included for full-text reading. The references of these publications were screened. In total, 19 publications met the inclusion criteria. Evidence-based sexual health recommendations target only newly arrived migrants and migrant children (at arrival and during stay in the country). Screening practices are mostly informed by the country of origin and related prevalence, which remains a limitation; challenges faced during migration should also be considered. Implementation and compliance with these recommendations remain uncertain, as sexual health is not funded and addressed in a uniform manner across Europe.
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Affiliation(s)
- I Rossoni
- Van Vollenhoven Institute for Law, Governance and Society, Leiden University, Leiden, The Netherlands
| | - M Chollier
- CRIR-AVS PACA, APHM, Marseille, France
- UNESCO Chair for Sexual Health and Human Rights, Paris, France
| | - R Dudushi
- Faculty of Social Sciences, University of Tirana, Tirana, Albania
| | - J Ghigo
- Department of Obstetrics and Gynecology, Mater Dei Hospital, Msida, Malta
| | - V Padovese
- Genitourinary Clinic, Department of Dermatology and Venereology, Mater Dei Hospital, Msida, Malta
- International Foundation for Dermatology, Migrant Health Dermatology Working Group, London, UK
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Panchenko S, Mayaud P, Baranyi Nicholls S, López González C, Ordáz KM, Baird M, Gabster A. " You are the first person to ask me how I'm doing sexually": sexual and reproductive health needs and sexual behaviours among migrant people in transit through Panama. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 5:1157622. [PMID: 37502614 PMCID: PMC10370347 DOI: 10.3389/frph.2023.1157622] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 06/26/2023] [Indexed: 07/29/2023] Open
Abstract
Background Unprecedented numbers of migrant people transiting through the Darién Gap at the Panama-Colombia border were recorded in 2021 and 2022. Data on sexual and reproductive health (SRH) needs and service provision among migrant people in transit is generally extremely sparse. This study aimed to collect personal accounts of sexual behaviours and SRH needs and access to services among migrant people in transit through Panama. Methods We conducted a rapid-assessment qualitative study using semi-structured interviews during June-July 2022. Participants were migrant people in transit at three locations across Panama: (i) at the Migrant Reception Station (MRS) in Darién province at the Panama-Colombia border, (ii) in the city of David near the Costa Rica-Panama border, and (iii) at the Costa Rica-Panama border. Migrant peoples (>18 years) were invited to participate using purposive sampling. Results Overall, 26 adult migrant people (16 men, 10 women) across the three sites participated in the study. We identified three overarching themes from the interviews: (1) increased need for SRH service provision, (2) experiences of sex, relationships, and transactional sex, and (3) vulnerability to exploitation and sexual violence. All accounts reported that no formal SRH care was present during the journey through the Gap and described as inconsistent at the MRS in Darién. Provision of gynaecological or genital examinations, laboratory testing for urinary tract or STI, and prenatal care were mentioned to be the most pressing needs. Participants reported a change in their sexual behaviour while travelling, whether a decline in sexual libido or preference towards short-term partners. Most female participants recounted constantly fearing sexual violence during the journey through the Gap and several respondents reported witnessing incidents of sexual and other forms of violence. Conclusion There are significant unmet needs regarding SRH care during the journey of migrant people transiting through the Darién Gap, at the MRS in the Darién province, and across Panama. Provision of antenatal care, rapid testing for HIV/STI, condom distribution, and care for victims of sexual violence would significantly reduce adverse SRH outcomes and improve the well-being of migrant people, even when in transit.
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Affiliation(s)
- Sofya Panchenko
- Faculty of Infectious & Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Instituto Conmemorativo Gorgas de Estudios de la Salud, Panama City, Panama
| | - Philippe Mayaud
- Faculty of Infectious & Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | | | - Madeline Baird
- Faculty of Infectious & Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Faculty of Anthropology, Univeristy of Connecticut, Storrs, CT, United States
| | - Amanda Gabster
- Instituto Conmemorativo Gorgas de Estudios de la Salud, Panama City, Panama
- National Research System of Panamá (SNI), Panamá, Panamá
- Center of Population Sciences for Health Equity, College of Nursing, Florida State University, Tallahassee, FL, United States
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Tirado V, Ekström AM, Orsini N, Hanson C, Strömdahl S. Knowledge of the abortion law and key legal issues of sexual and reproductive health and rights among recently arrived migrants in Sweden: a cross-sectional survey. BMC Public Health 2023; 23:551. [PMID: 36959645 PMCID: PMC10035217 DOI: 10.1186/s12889-023-15399-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 03/07/2023] [Indexed: 03/25/2023] Open
Abstract
Background Sexual and reproductive health and rights (SRHR), including access and information on the laws and policies related to abortion, varies considerably between countries. Migrants may have limited knowledge of SRHR and related resources in their new country. This study investigates migrants’ knowledge of the right to safe and legal abortion and other associated factors including the recent law on sexual consent, the legal age for sexual consent and age to marry in Sweden. Methods We conducted a cross-sectional study from 2018 to 2019 among recent migrants attending high schools or Swedish language schools. Descriptive statistics were computed on the knowledge of the Swedish abortion law and other legal aspects. Univariable and multivariable logistic regression analyses were conducted to assess if migrants’ socio-demographic characteristics were associated with knowledge (i.e. correct/incorrect) of the Swedish abortion law and other key SRHR-related legal issues. Results Of the total 6,263 participants, 3,557 (57%) responded about whether it is legal to have an induced abortion in Sweden, and of these, 2,632 (74%) answered incorrectly. While more than half (61%) of the respondents knew the sexual consent law, nearly half (48%) did not know that sexual consent is also required for married couples. About 90% correctly responded that it is illegal to have sex with a minor (under the age of 15) and were aware of the legal age (18 years) to marry in Sweden. Incorrect knowledge of the Swedish abortion law was associated with being religious (adjusted odds ratio (AOR), 2.12; 95% confidence interval (CI), 1.42–3.15), not having previous sexual health education (AOR, 1.68; 95% CI, 1.38–2.05), coming from a country with predominantly restrictive abortion laws (AOR, 1.46; 95% CI, 1.16–1.84), low level of education (AOR, 1.29; 95% CI, 1.04–1.61) and having a temporary residence permit (AOR, 1.27; 95% CI, 1.02–1.57). Conclusion We found a substantial lack of knowledge among migrants of reproductive age in Sweden regarding important laws and policies of SRHR, particularly the right to abortion. SRHR-related programmes and comprehensive sexual health education for recently arrived migrants could include components to increase knowledge of legal and safe abortions and other laws concerning SRHR. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-023-15399-z.
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Affiliation(s)
- Veronika Tirado
- grid.4714.60000 0004 1937 0626Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Anna Mia Ekström
- grid.4714.60000 0004 1937 0626Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- grid.416648.90000 0000 8986 2221Department of Infectious Diseases, Venhälsan, Södersjukhuset, Stockholm, Sweden
| | - Nicola Orsini
- grid.4714.60000 0004 1937 0626Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Claudia Hanson
- grid.4714.60000 0004 1937 0626Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- grid.8991.90000 0004 0425 469XLondon School of Hygiene and Tropical Medicine, London, UK
| | - Susanne Strömdahl
- grid.4714.60000 0004 1937 0626Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- grid.8993.b0000 0004 1936 9457Department of Medical Sciences, Infectious Medicine, Uppsala University, Uppsala, Sweden
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Blukacz A, Carreño Calderon A, Obach A, Cabieses B, Peroncini J, Oliva A. Perceptions of Health Needs among Venezuelan Women Crossing the Border in Northern Chile during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15175. [PMID: 36429892 PMCID: PMC9690325 DOI: 10.3390/ijerph192215175] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 11/12/2022] [Accepted: 11/15/2022] [Indexed: 06/16/2023]
Abstract
In parallel to the COVID-19 pandemic, Chile has experienced a significant influx of international migrants, many of whom are Venezuelan women who have entered the country through unauthorized crossing points. In this context, gender and migration intersect as the social determinants of health, leading to their experiencing a range of adverse events. This poses important challenges in terms of short- and long-term health outcomes, the social determinants of health, and access to healthcare. This study aims at describing Venezuelan women's perceptions of their health needs as they migrate to Chile via an unauthorized crossing point, with a focus on adverse events throughout the migration cycle, self-reported health needs, and responses. A qualitative case study was carried out with 22 participants in the Antofagasta region of Chile, including Venezuelan migrant women, healthcare professionals, and social workers from the public healthcare system, stakeholders from non-governmental and international organizations, and local government officials. The semi-structured, individual interviews were analyzed thematically. The results show that Venezuelan women face a range of adverse events throughout the migration cycle. The perceived health needs that are reported are sometimes linked to these adverse events or existed prior to migration and were exacerbated throughout the migratory cycle. Addressing these physical and mental health needs is essential for short- and long-term individual and public health; however, despite substantial efforts to ameliorate the situation, persisting gaps in access to care are reported.
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Affiliation(s)
- Alice Blukacz
- Programa de Estudios Sociales en Salud, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago 7610658, Chile
| | - Alejandra Carreño Calderon
- Programa de Estudios Sociales en Salud, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago 7610658, Chile
| | - Alexandra Obach
- Programa de Estudios Sociales en Salud, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago 7610658, Chile
| | - Báltica Cabieses
- Programa de Estudios Sociales en Salud, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago 7610658, Chile
- Department of Health Sciences, University of York, York YO10 5DD, UK
| | - Jeniffer Peroncini
- Subsistema Chile Crece Contigo, Subsecretaria de la Niñez, Ministerio de Desarrollo Social y Familia, Santiago 8320000, Chile
| | - Alejandra Oliva
- Programa de Estudios Sociales en Salud, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago 7610658, Chile
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Gray C, Crawford G, Maycock B, Lobo R. Exploring the Intersections of Migration, Gender, and Sexual Health with Indonesian Women in Perth, Western Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13707. [PMID: 36294283 PMCID: PMC9603176 DOI: 10.3390/ijerph192013707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/14/2022] [Accepted: 10/20/2022] [Indexed: 06/16/2023]
Abstract
This paper explores the intersections of migration, gender, and sexual health with Indonesian women living in Perth, Western Australia. The study was part of a larger participatory action research project to co-design an intervention to increase HIV testing in migrant Indonesian women. Unstructured interviews were conducted with adult Indonesian women (n = 10) on their experiences of migration and sexual health. Zimmerman's migration phases (pre-departure and travel, destination, and return) provided a framework to conceptualize women's migration journeys. We found that women's migration journeys were shaped by gender, with male-led migration often reinforcing gender norms. Structural and sociocultural factors (including visa status) influenced women's sense of belonging while living in Australia, such as help-seeking behaviour and engagement in sexual relationships. Intersecting factors of gender, culture, and the migration process should be considered when designing public health interventions to improve women's sexual health, in particular migration policies and procedures.
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Affiliation(s)
- Corie Gray
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Bentley 6102, Australia
| | - Gemma Crawford
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Bentley 6102, Australia
| | - Bruce Maycock
- College of Medicine & Health, University of Exeter, Exeter EX4 4PY, UK
| | - Roanna Lobo
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Bentley 6102, Australia
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Svensson P, Asamoah BO, Agardh A. Facilitating an encounter with a new sexuality discourse: the role of civic communicators in building sexual health literacy among newly arrived migrants. CULTURE, HEALTH & SEXUALITY 2022; 24:1303-1318. [PMID: 34288831 DOI: 10.1080/13691058.2021.1946156] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 06/17/2021] [Indexed: 06/13/2023]
Abstract
Language and different sexual health discourses constitute barriers to the uptake of information on sexual and reproductive health and rights among migrants. Challenges remain with regards to the design and implementation of culturally appropriate programmes and interventions. This study explored the role of civic communicators in increasing access to sexual health information among migrants resettling in Sweden. Twenty in-depth interviews were conducted and analysed using qualitative content analysis. Findings illustrate the potential role of civic communicators in identifying sexual health needs, deconstructing misinformation and providing a space for reflective dialogue. Training in adult pedagogy, leadership, cultural competence and subject knowledge, and allocating sufficient time to cover themes that are culturally different, sensitive and politicised, are essential for good quality implementation and promoting rights-based sexual health.
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Affiliation(s)
- Pia Svensson
- Division of Social Medicine and Global Health, Department of Clinical sciences, Lund University, Malmö, Sweden
| | - Benedict Oppong Asamoah
- Division of Social Medicine and Global Health, Department of Clinical sciences, Lund University, Malmö, Sweden
| | - Anette Agardh
- Division of Social Medicine and Global Health, Department of Clinical sciences, Lund University, Malmö, Sweden
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Arora AK, Engler K, Lessard D, Kronfli N, Rodriguez-Cruz A, Huerta E, Lemire B, Routy JP, Wittmer R, Cox J, de Pokomandy A, Del Balso L, Klein M, Sebastiani G, Vedel I, Quesnel-Vallée A, Lebouché B. 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; 12:1497. [PMID: 36143282 PMCID: PMC9503330 DOI: 10.3390/jpm12091497] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [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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Affiliation(s)
- Anish K. Arora
- Department of Family Medicine, Faculty of Medicine & Health Sciences, McGill University, Montréal, QC H3S 1Z1, Canada
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, QC H4A 3S5, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montréal, QC H4A 3S5, Canada
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research (CIHR/SPOR) Mentorship Chair in Innovative Clinical Trials in HIV Care, Montréal, QC H4A 3S5, Canada
| | - Kim Engler
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, QC H4A 3S5, Canada
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research (CIHR/SPOR) Mentorship Chair in Innovative Clinical Trials in HIV Care, Montréal, QC H4A 3S5, Canada
| | - David Lessard
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, QC H4A 3S5, Canada
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research (CIHR/SPOR) Mentorship Chair in Innovative Clinical Trials in HIV Care, Montréal, QC H4A 3S5, Canada
| | - Nadine Kronfli
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, QC H4A 3S5, Canada
- Department of Medicine, Chronic Viral Illness Service, Division of Infectious Diseases, McGill University Health Centre, Montréal, QC H4A 3J1, Canada
| | - Adriana Rodriguez-Cruz
- Department of Family Medicine, Faculty of Medicine & Health Sciences, McGill University, Montréal, QC H3S 1Z1, Canada
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, QC H4A 3S5, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montréal, QC H4A 3S5, Canada
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research (CIHR/SPOR) Mentorship Chair in Innovative Clinical Trials in HIV Care, Montréal, QC H4A 3S5, Canada
| | - Edmundo Huerta
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, QC H4A 3S5, Canada
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research (CIHR/SPOR) Mentorship Chair in Innovative Clinical Trials in HIV Care, Montréal, QC H4A 3S5, Canada
| | - Benoit Lemire
- Pharmacy Department, McGill University Health Centre, Montréal, QC H4A 3J1, Canada
| | - Jean-Pierre Routy
- Department of Medicine, Chronic Viral Illness Service, Division of Infectious Diseases, McGill University Health Centre, Montréal, QC H4A 3J1, Canada
| | - René Wittmer
- Department of Family Medicine and Emergency Medicine, Université de Montréal, Montréal, QC H3C 3J7, Canada
| | - Joseph Cox
- Department of Medicine, Chronic Viral Illness Service, Division of Infectious Diseases, McGill University Health Centre, Montréal, QC H4A 3J1, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine & Health Sciences, McGill University, Montréal, QC H3A 1A2, Canada
| | - Alexandra de Pokomandy
- Department of Family Medicine, Faculty of Medicine & Health Sciences, McGill University, Montréal, QC H3S 1Z1, Canada
- Department of Medicine, Chronic Viral Illness Service, Division of Infectious Diseases, McGill University Health Centre, Montréal, QC H4A 3J1, Canada
| | - Lina Del Balso
- Department of Medicine, Chronic Viral Illness Service, Division of Infectious Diseases, McGill University Health Centre, Montréal, QC H4A 3J1, Canada
| | - Marina Klein
- Department of Medicine, Chronic Viral Illness Service, Division of Infectious Diseases, McGill University Health Centre, Montréal, QC H4A 3J1, Canada
| | - Giada Sebastiani
- Department of Medicine, Chronic Viral Illness Service, Division of Infectious Diseases, McGill University Health Centre, Montréal, QC H4A 3J1, Canada
| | - Isabelle Vedel
- Department of Family Medicine, Faculty of Medicine & Health Sciences, McGill University, Montréal, QC H3S 1Z1, Canada
| | - Amélie Quesnel-Vallée
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine & Health Sciences, McGill University, Montréal, QC H3A 1A2, Canada
- Department of Sociology, Faculty of Arts, McGill University, Montréal, QC H3A 0G5, Canada
| | - ASAP Migrant Advisory Committee
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, QC H4A 3S5, Canada
- Department of Medicine, Chronic Viral Illness Service, Division of Infectious Diseases, McGill University Health Centre, Montréal, QC H4A 3J1, Canada
| | - Bertrand Lebouché
- Department of Family Medicine, Faculty of Medicine & Health Sciences, McGill University, Montréal, QC H3S 1Z1, Canada
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, QC H4A 3S5, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montréal, QC H4A 3S5, Canada
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research (CIHR/SPOR) Mentorship Chair in Innovative Clinical Trials in HIV Care, Montréal, QC H4A 3S5, Canada
- Department of Medicine, Chronic Viral Illness Service, Division of Infectious Diseases, McGill University Health Centre, Montréal, QC H4A 3J1, Canada
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11
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Amroussia N, Holmström C, Ouis P. Migrants in Swedish sexual and reproductive health and rights related policies: a critical discourse analysis. Int J Equity Health 2022; 21:125. [PMID: 36064412 PMCID: PMC9446749 DOI: 10.1186/s12939-022-01727-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 08/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous research has shown that migrants in Sweden are disadvantaged in terms of sexual and reproductive health and rights (SRHR). SRHR policies might play a crucial role in shaping migrants' SRHR outcomes. The purpose of the study was to critically examine: a) how migrants were represented in the discourses embedded within Swedish SRHR-related policies, and b) how migrants' SRHR-related issues were framed and addressed within these discourses. METHODS Critical discourse analysis (CDA) was used to analyze a total of 54 policy documents. Following Jäger's approach to CDA, discourse strands and entanglements between different discourse strands were examined. RESULTS Our findings consisted of three discourse strands: 1) "Emphasizing vulnerability", 2) "Constructing otherness", and 3) "Prioritizing the structural level or the individual level?". Migrants' representation in Swedish SRHR-related policies is often associated with the concept of vulnerability, a concept that can hold negative connotations such as reinforcing social control, stigma, and disempowerment. Alongside the discourse of vulnerability, the discourse of otherness appears when framing migrants' SRHR in relation to what is defined as honor-related violence and oppression. Furthermore, migrant SRHR issues are occasionally conceptualized as structural issues, as suggested by the human rights-based approach embraced by Swedish SRHR-related policies. Relevant structural factors, namely migration laws and regulations, are omitted when addressing, for example, human trafficking and HIV/AIDS. CONCLUSIONS We conclude that the dominant discourses favor depictions of migrants as vulnerable and as the Other. Moreover, despite the prevailing human rights-based discourse, structural factors are not always considered when framing and addressing migrants' SRHR issues. This paper calls for a critical analysis of the concept of vulnerability in relation to migrants' SRHR. It also highlights the importance of avoiding othering and paying attention to the structural factors when addressing migrants' SRHR.
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Affiliation(s)
- Nada Amroussia
- Centre for Sexology and Sexuality Studies (CSS), Faculty of Health and Society (HS), Nordenskiöldsgatan 1, 211 19, Malmö, Sweden. .,Department of Women's and Children's health, Uppsala University, Uppsala, Sweden.
| | - Charlotta Holmström
- Centre for Sexology and Sexuality Studies (CSS), Faculty of Health and Society (HS), Nordenskiöldsgatan 1, 211 19, Malmö, Sweden
| | - Pernilla Ouis
- Centre for Sexology and Sexuality Studies (CSS), Faculty of Health and Society (HS), Nordenskiöldsgatan 1, 211 19, Malmö, Sweden.,School of Health and Welfare, Halmstad University, Halmstad, Sweden
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12
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Tirado V, Engberg S, Holmblad IS, Strömdahl S, Ekström AM, Hurtig AK. "One-time interventions, it doesn't lead to much" - healthcare provider views to improving sexual and reproductive health services for young migrants in Sweden. BMC Health Serv Res 2022; 22:668. [PMID: 35585585 PMCID: PMC9115984 DOI: 10.1186/s12913-022-07945-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 04/11/2022] [Indexed: 11/14/2022] Open
Abstract
Background Sexual and reproductive health and rights (SRHR) is an important aspect for young people. In Sweden, young migrants often encounter barriers to accessing and using sexual and reproductive health (SRH) services, despite that these services are free of charge for young people (ages 15–25). Healthcare providers’ views and best practices are of great importance for improving the utilisation of existing SRH services, particularly for young people. This study aims to understand healthcare providers’ experiences and perspectives on barriers to SRHR among young migrants and their suggestions for strategies to improve the provision of SRH services to this group. Methods Midwives, counsellors and nurses with at least five years of professional experience within SRHR were reached through a purposeful sample at primary care clinics, specialised clinics and youth-friendly clinics, which provide SRH services to migrant youths in Stockholm. Twelve interviews were conducted from May 2018 to February 2020. Qualitative content analysis was performed. Results The analysis identified one theme: Improving the fragmentation in the SRH services, and four sub-themes: 1. Being unaware of SRHR; 2. Creating trust and responsive interactions; 3. Communicating in the same language; and 4. Collaborating to build bridges. The barriers included distrust in the healthcare system, socio-cultural norms surrounding SRHR, incomplete translations, and a need for long-lasting collaboration with SRH services and other range of services for migrants. The strategies for improvement as suggested by participants included involving existing cultural groups and organisations to enable trust, consistent and dependable interpreters, a streamline of SRH services with other healthcare staff and health facilities, and collaborations with homes designated for young migrants and language schools for a direct linkage to service providers. Conclusions Findings indicate that there are fragmentations in SRH services, and these include lack of knowledge about SRHR among migrant youth, language and communication barriers, and a lack of structure needed to build dependable services that go beyond one-time interventions. While initiatives and strategies from healthcare providers for improvement of SRH services exist, the implementation of some strategies may also require involving the regional and national decision-makers and multi-stakeholders like communities, civil society and young migrants themselves.
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Affiliation(s)
- Veronika Tirado
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
| | - Siri Engberg
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Susanne Strömdahl
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Department of Medical Sciences, Infectious Medicine, Uppsala University, Uppsala, Sweden
| | - Anna Mia Ekström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Department of Infectious Diseases, Venhälsan, Södersjukhuset, Stockholm, Sweden
| | - Anna Karin Hurtig
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
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13
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Chawhanda C, Levin J, Ibisomi L. Factors associated with sexual and reproductive health service utilisation in high migration communities in six Southern African countries. BMC Public Health 2022; 22:876. [PMID: 35501749 PMCID: PMC9063360 DOI: 10.1186/s12889-022-13308-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 04/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Migration among women has significant health consequences on their access to and utilisation of health services, particularly sexual and reproductive health services. Despite the large quantity of research on migrant health, there is a paucity of research on the factors associated with utilization of modern methods of contraception, intimate partner violence services and sexual and reproductive health (SRH) referral services among non-migrants, internal and international migrant women. Consequently, understanding the factors associated with utilisation of SRH services among women in Southern Africa motivates this study. METHODS The study uses secondary data from a cross sectional survey conducted in 2018. Logistic regression models were fitted to investigate the factors associated with utilisation of sexual and reproductive health services among 2070 women aged 15-49 years in high migrant communities in six Southern African countries. RESULTS Factors found to be associated with current non-use of modern contraceptive methods were country, employment status, educational level, comprehensive knowledge about SRH, comprehensive knowledge about HIV, desire for another child, partner's age and partner's educational level. Regarding utilisation of SRH services, important factors were ever denied access to a public healthcare facility, country, marital status and comprehensive knowledge about HIV. Factors associated with utilising IPV services were migration status, age and attitude towards wife beating. CONCLUSION The findings highlight that migration status is associated with utilisation of IPV services. Comprehensive knowledge about SRH and partner characteristic variables were associated with current non-use of modern contraceptive methods. There is a need for SRH programs that can disseminate accurate information about SRH and encourage male involvement in SRH related issues. In addition, the SRH programs should target all women regardless of their migration status, age, educational level and marital status.
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Affiliation(s)
- Christine Chawhanda
- School of Public Health, University of Witwatersrand, Johannesburg, South Africa.
| | - Jonathan Levin
- School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Latifat Ibisomi
- School of Public Health, University of Witwatersrand, Johannesburg, South Africa
- Nigerian Institute of Medical Research, Lagos, Nigeria
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14
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Çelikkanat Ş, Güngörmüş Z. A Qualitative Study on the Knowledge and Opinions of Syrian Women regarding Family Planning. SOCIAL WORK IN PUBLIC HEALTH 2022; 37:274-286. [PMID: 34847823 DOI: 10.1080/19371918.2021.2000917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Whatever the reason, migration has negative effects on individuals in terms of their physical, social and psychological aspects. Syria has witnessed a significant level of migration since 2011. The study was conducted with refugee women who attended the Adana Gülpınar Family Health Center between the dates of May 15 and April 15, 2019-2020. The samples of the study were the women who applied to the Adana Gülpınar Family Health Center. 30 individuals, determined using the purposeful sampling method, were included in the study. Refugee women cannot make personal decisions regarding the family planning for reasons such as pressure from their spouses, cultural pressure, and the inferior status of women. For this reason, they lack the necessary information regarding the family planning, and they are unable to access the family planning solutions.
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Affiliation(s)
- Şirin Çelikkanat
- Department of Nursing, Gaziantep Islam Science and Technology University of Health Sciences, Türkiye, Gaziantep
| | - Zeynep Güngörmüş
- Department of Nursing, Gaziantep Islam Science and Technology University of Health Sciences, Türkiye, Gaziantep
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15
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De Schrijver L, Fomenko E, Krahé B, Roelens K, Vander Beken T, Keygnaert I. Minority Identity, Othering-Based Stress, and Sexual Violence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:4221. [PMID: 35409901 PMCID: PMC8998422 DOI: 10.3390/ijerph19074221] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/15/2022] [Accepted: 03/18/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Some (minority) groups (MGs) are more vulnerable to sexual violence (SV) exposure than others. Othering-based stress (OBS) may mediate the relationship between minority identification and SV. This study aims to assess the prevalence of SV in different MGs to explore the relationship between minority identification and SV, to investigate whether belonging to multiple MGs moderates this relationship, and to explore OBS SV moderation for different MGs. METHOD Through an online survey administered to a nationally representative sample in Belgium, data was collected from 4632 persons, of whom 21.01% self-identified as belonging to a MG (SI-Minority). SV prevalence was measured using behaviorally specific questions based on the WHO definition of SV. SI-Minority participants received an additional scale on OBS. RESULTS SI-Minority participants reported more SV victimization compared to the non-minorities. However, this increased risk was not moderated by minority identification but linked to the socio-demographic SV risk markers common to minority individuals. Multiple-minority participants were found more at risk of SV compared to single-minority respondents. Lesbian, gay, bisexual, pan-/omnisexual, asexual, and other non-heterosexual (LGB+) participants were found more at risk than heterosexual participants. OBS was found to be significantly correlated to SV in sexual and gender minorities and in cultural minorities. CONCLUSIONS This study contributes to our understanding of the relationship between minority identification, OBS, and SV. Studying both specific and common SV vulnerabilities and outcomes within specific societal subgroups and the general population may inform policy makers when allocating resources to those interventions with the largest societal impact.
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Affiliation(s)
- Lotte De Schrijver
- International Centre for Reproductive Health, Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium; (E.F.); (I.K.)
| | - Elizaveta Fomenko
- International Centre for Reproductive Health, Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium; (E.F.); (I.K.)
| | - Barbara Krahé
- Department of Psychology, University of Potsdam, 14476 Potsdam, Germany;
| | - Kristien Roelens
- Department of Obstetrics & Gynaecology, Ghent University Hospital, 9000 Ghent, Belgium;
- Department of Human Structure and Repair, Ghent University, 9000 Ghent, Belgium
| | - Tom Vander Beken
- Department of Criminology, Criminal Law and Social Law, Institute for International Research on Criminal Policy, Ghent University, 9000 Ghent, Belgium;
| | - Ines Keygnaert
- International Centre for Reproductive Health, Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium; (E.F.); (I.K.)
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16
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Mezzatesta Gava M, Miquel L, Jarvis GE. Gender-based violence among refugee women referred to a Cultural Consultation Service in Montreal. Transcult Psychiatry 2022; 59:202-213. [PMID: 34726100 DOI: 10.1177/13634615211043767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Gender-based violence (GBV) among female refugees/asylum seekers is a major underreported/understudied psychosocial issue. The aims of this study were: to describe the proportion of GBV-related experiences among female refugees/asylum seekers referred to a Cultural Consultation Service (CCS) in Montreal; to describe their sociodemographic and clinical characteristics; and to compare these characteristics among women who make GBV their principal refugee claim (Group A), those who did not but had suffered GBV (Group B1), and those who had never reported GBV (Group B2). Data on sociodemographic and clinical variables and GBV were gathered by chart review. Data were analyzed using chi-square for categorical and ANOVA for continuous comparisons. A total of 91 female refugees/asylum seekers were evaluated from 2000 to 2013; 80% (73/91) having reported GBV, with 38.5% (35/91) using GBV as the principal reason for seeking asylum in Canada (Group A), mainly due to intimate partner violence (IPV). Fully 66.6% (38/56) of women who sought asylum for reasons other than GBV reported having experienced GBV (Group B1). When compared to the other groups, Group A women exhibited a number of statistically significant differences: they tended to migrate alone (p < .001), be divorced/single (p = .02), have more suicidal thoughts/behaviors (p < .001), and report a history of IPV (p < .001). Women from Group B1 were more likely to be diagnosed with Affective Disorders (p = .045), and to have suffered sexual violence (p < .001). Results suggest that GBV is frequently experienced by refugee/asylum seeker women in this small, tertiary care clinical sample. When assessing refugee women such as these, differences in the kind of violence suffered, migration process, family/social support, and clinical related features should be taken into account and explored by clinicians in a culturally appropriate and safe manner.
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Affiliation(s)
- Marcela Mezzatesta Gava
- Child and Adolescent Mental Health Department, 16512Sant Joan de Deu Hospital & Fundación Salud y Comunidad, Barcelona, Spain
| | - Laia Miquel
- Grup de Recerca en Addiccions Clínic, Institut Clínic de Neurociències, Barcelona, Spain
- Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer, Barcelona, Spain & Spanish Network of Addictive Disorders (RTA). RETICS, Madrid, Spain
| | - G Eric Jarvis
- Culture and Mental Health Research Unit, 5621Jewish General Hospital and McGill University, Montreal, QC, Canada
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17
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Brandon Chen Y. International migrants’ right to sexual and reproductive health care. Int J Gynaecol Obstet 2022; 157:210-215. [DOI: 10.1002/ijgo.14149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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18
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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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Pérez-Urdiales I. Undocumented immigrants' and immigrant women's access to healthcare services in the Basque Country (Spain). Glob Health Action 2021; 14:1896659. [PMID: 33975531 PMCID: PMC8118419 DOI: 10.1080/16549716.2021.1896659] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Immigrant populations experience diverse barriers to access healthcare services in the host countries. Among them, undocumented immigrants have more restricted legal access conditions and higher risk of having poorer health. Likewise, women are more likely to seek healthcare and face gender-based factors that hinder their access. OBJECTIVE This thesis analysed the access of undocumented immigrants and immigrant women to public healthcare services in the Basque Country (Spain). METHODS The thesis contained three sub-studies, carried out with qualitative and quantitative methods. For the quantitative approach, the trend in the number of consultations in a free clinic for undocumented immigrants was analysed before and after the launch of a new law, using a negative binomial regression analysis (n = 9,272). For the qualitative approach, qualitative content analysis was applied to 25 in-depth interviews with 14 immigrant women and 11 free clinic healthcare professionals. RESULTS No clear relationship was found between the application of more restrictive legal conditions for immigrants to access public healthcare services and the trend of attendance of undocumented immigrants to a free clinic. Access of undocumented immigrants and immigrant women to healthcare services was subject to barriers dependent on their characteristics, health system functioning, legal requirements and a stereotyped and poor social consideration of immigrants, shared by professionals at the health centres. Meanwhile, provision of legal information and support by individual professionals, social organizations and personal networks represented main facilitators for accessing. CONCLUSIONS For the access of undocumented immigrants and immigrant women, structural and individual barriers based on their social vulnerability were found. Among others, gender-based violence reduced women's possibility to access healthcare services and being undocumented led to restricted access entitlement and to fear rejection at health centres. Therefore, besides ensuring immigrants' legal entitlement, there is need of promoting rights-based attention to get more inclusive health systems.
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Affiliation(s)
- Iratxe Pérez-Urdiales
- Department of Nursing, Iund University of the Basque Country (UPV/EHU), Biscay, Spain
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20
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Gray C, Crawford G, Maycock B, Lobo R. Socioecological Factors Influencing Sexual Health Experiences and Health Outcomes of Migrant Asian Women Living in 'Western' High-Income Countries: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2469. [PMID: 33802277 PMCID: PMC7967613 DOI: 10.3390/ijerph18052469] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/19/2021] [Accepted: 02/28/2021] [Indexed: 12/18/2022]
Abstract
Migrant health has been identified as one of the most pressing issues of the 21st century. Migration experiences are influenced by gender and gender norms and have important implications for the sexual health of migrant women. This systematic review explored socioecological factors influencing sexual health experiences and health outcomes of migrant Asian women living in "Western" high-income countries. PRISMA guidelines were followed and this study was registered with PROSPERO. Five academic databases were searched for peer-reviewed articles published between 2000 and 2019. Of 2415 studies retrieved, 17 met the selection criteria: 12 qualitative, 4 quantitative, and 1 mixed-methods study. The four levels of Bronfenbrenner's socioecological model were applied to examine the individual, interpersonal, institutional, and societal factors of influence. Most studies (n = 13) reported individual level factors, focusing on knowledge and use of contraceptives. At a societal level, host country sociocultural factors, including gender and cultural norms, influenced knowledge, ability to access and utilise contraceptives, and access to health services. Findings suggest that the public health policy, practice, and research to improve the sexual health of migrant women requires greater consideration of the intersecting factors of gender, culture, and the migration process.
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Affiliation(s)
- Corie Gray
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Bentley 6102, Australia; (G.C.); (R.L.)
| | - Gemma Crawford
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Bentley 6102, Australia; (G.C.); (R.L.)
| | - Bruce Maycock
- College of Medicine & Health, University of Exeter, Devon EX4 4PY, UK;
| | - Roanna Lobo
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Bentley 6102, Australia; (G.C.); (R.L.)
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21
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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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Liu C, Ahlberg M, Hjern A, Stephansson O. Perinatal health of refugee and asylum-seeking women in Sweden 2014-17: a register-based cohort study. Eur J Public Health 2020; 29:1048-1055. [PMID: 31274154 PMCID: PMC6896976 DOI: 10.1093/eurpub/ckz120] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background An increasing number of migrants have fled armed conflict, persecution and deteriorating living conditions, many of whom have also endured risky migration journeys to reach Europe. Despite this, little is known about the perinatal health of migrant women who are particularly vulnerable, such as refugees, asylum-seekers, and undocumented migrants, and their access to perinatal care in the host country. Methods Using the Swedish Pregnancy Register, we analyzed indicators of perinatal health and health care usage in 31 897 migrant women from the top five refugee countries of origin between 2014 and 2017. We also compared them to native-born Swedish women. Results Compared to Swedish-born women, migrant women from Syria, Iraq, Somali, Eritrea and Afghanistan had higher risks of poor self-rated health, gestational diabetes, stillbirth and infants with low birthweight. Within the migrant population, asylum-seekers and undocumented migrants had a higher risk of poor maternal self-rated health than refugee women with residency, with an adjusted risk ratio (RR) of 1.84 and 95% confidence interval (95% CI) of 1.72–1.97. They also had a higher risk of preterm birth (RR 1.47, 95% CI 1.21–1.79), inadequate antenatal care (RR 2.56, 95% CI 2.27–2.89) and missed postpartum care visits (RR 1.15, 95% CI 1.10–1.22). Conclusion Refugee, asylum-seeking and undocumented migrant women were vulnerable during pregnancy and childbirth. Living without residence permits negatively affected self-rated health, pregnancy and birth outcomes in asylum-seekers and undocumented migrants. Pregnant migrant women’s special needs should be addressed by those involved in the asylum reception process and by health care providers.
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Affiliation(s)
- Can Liu
- Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Public Health Sciences, Centre for Health Equity Studies, Karolinska Institutet/Stockholm University, Stockholm, Sweden
| | - Mia Ahlberg
- Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska University Hospital and Institutet, Stockholm, Sweden
| | - Anders Hjern
- Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Public Health Sciences, Centre for Health Equity Studies, Karolinska Institutet/Stockholm University, Stockholm, Sweden
| | - Olof Stephansson
- Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska University Hospital and Institutet, Stockholm, Sweden
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23
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Padovese V, Farrugia A, Almabrok Ali Ghath S, Rossoni I. Sexually transmitted infections' epidemiology and knowledge, attitude and practice survey in a set of migrants attending the sexual health clinic in Malta. J Eur Acad Dermatol Venereol 2020; 35:509-516. [PMID: 32967045 DOI: 10.1111/jdv.16949] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 09/04/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND The number of international migrants is estimated at 272 million people worldwide. In Europe, migrants face the disproportionate burden of infectious diseases, including hepatitis B and C, HIV and sexually transmitted infections (STIs). High-risk behaviours, sexual abuse, poor living conditions and barriers to accessing health care may affect migrants' sexual health, leading to infections. OBJECTIVES The study evaluates STIs and HIV prevalence and knowledge, attitude and practice (KAP) in non-European migrants attending the sexual health clinic in Malta. It also seeks to explore situations of human trafficking (HT), sex/gender-based violence (S/GBV) and female genital mutilations (FGM). METHODS This is a mixed-method study, based on quantitative and qualitative research within a single centre. An anonymous pretested questionnaire was administered to non-European migrants attending the genitourinary clinic (GUC) with the assistance of an ethnocultural agent. Demographics, STI diagnoses and risk behaviours were collected from the GUC database, linked to the questionnaires and analysed. RESULTS A total of 143 migrants took part in the study, 73% were young male and 16.7% men who have sex with men (MSM). Forty-one different nationalities were recorded, and the top ones were Nigerian (12%), Filipino (7.4%) and Chinese (5.4%). Concerning risk behaviours, 33.8% of respondents had never used a condom and 76.5% had had sex with multiple partners in the 6 months prior to the study. STI prevalence was 73.1%. Of the patients interviewed, six females were Chinese sex workers employed in massage parlours, potentially trafficked to Malta. CONCLUSIONS The study outcomes support the need of improving awareness about STIs/HIV risk and testing. In migrants at particular risk for HIV, combination prevention strategies should include access to pre-exposure prophylaxis and antiretrovirals independently from migrants' legal status. Finally, STIs/HIV prevention in migrants should be linked with interventions tackling HT and other forms of S/GBV.
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Affiliation(s)
- V Padovese
- Genitourinary Clinic, Department of Dermatology and Venereology, Mater Dei Hospital, Msida, Malta.,International Foundation for Dermatology, Migrant Health Dermatology Working Group, London, UK
| | - A Farrugia
- Genitourinary Clinic, Department of Dermatology and Venereology, Mater Dei Hospital, Msida, Malta
| | - S Almabrok Ali Ghath
- Genitourinary Clinic, Department of Dermatology and Venereology, Mater Dei Hospital, Msida, Malta
| | - I Rossoni
- Department of Criminology, University of Malta, Msida, Malta.,Italian Centre for the Promotion of Mediation (CIPM), Milan, Italy
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24
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Orzechowski M, Nowak M, Bielińska K, Chowaniec A, Doričić R, Ramšak M, Łuków P, Muzur A, Zupanič-Slavec Z, Steger F. Social diversity and access to healthcare in Europe: how does European Union's legislation prevent from discrimination in healthcare? BMC Public Health 2020; 20:1399. [PMID: 32928175 PMCID: PMC7490891 DOI: 10.1186/s12889-020-09494-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/03/2020] [Indexed: 11/29/2022] Open
Abstract
Background Social diversity can affect healthcare outcomes in situations when access to healthcare is limited for specific groups. Although the principle of equality is one of the central topics on the agenda of the European Union (EU), its scope in the field of healthcare, however, is relatively unexplored. The aim of this study is to identify and systematically analyze primary and secondary legislation of the EU Institutions that concern the issue of access to healthcare for various minority groups. In our research, we have concentrated on three features of diversity: a) gender identity and sexual orientation, b) race and ethnicity, and c) religion or belief. Method and materials For the purpose of this analysis, we conducted a search of database Eur-Lex, the official website of European Union law and other public documents of the European Union, based on specific keywords accompanied by review of secondary literature. Relevant documents were examined with regard to the research topic. Our search covered documents that were in force between 13 December 2007 and 31 July 2019. Results Generally, the EU legal system prohibits discrimination on grounds of religion or belief, racial or ethnic origin, sex, and sexual orientation. However, with regard to the issue of non-discrimination in access to healthcare EU secondary law provides protection against discrimination only on the grounds of racial or ethnic origin and sex. The issue of discrimination in healthcare on the grounds of religion or belief, gender identity and sexual orientation is not specifically addressed under EU secondary law. Discussion The absence of regulations regarding non-discrimination in the EU secondary law in the area of healthcare may result from the division of competences between the European Union and the Member States. Reluctance of the Member States to adopt comprehensive antidiscrimination regulations leads to a situation, in which protection in access to healthcare primarily depends on national regulations. Conclusions Our study shows that EU antidiscriminatory law with regard to access to healthcare is fragmentary. Prohibition of discrimination of the level of European binding law does not fully encompass all aspects of social diversity.
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Affiliation(s)
- Marcin Orzechowski
- Institute of the History, Philosophy and Ethics of Medicine, Ulm University, Parkstraße 11, 89073, Ulm, Germany.
| | - Marianne Nowak
- Institute of the History, Philosophy and Ethics of Medicine, Ulm University, Parkstraße 11, 89073, Ulm, Germany
| | - Katarzyna Bielińska
- Center for Bioethics and Biolaw, Faculty of Philosophy, University of Warsaw, Warsaw, Poland
| | - Anna Chowaniec
- Center for Bioethics and Biolaw, Faculty of Philosophy, University of Warsaw, Warsaw, Poland
| | - Robert Doričić
- Department of Social Sciences and Medical Humanities, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Mojca Ramšak
- Institute for History of Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Paweł Łuków
- Center for Bioethics and Biolaw, Faculty of Philosophy, University of Warsaw, Warsaw, Poland
| | - Amir Muzur
- Department of Social Sciences and Medical Humanities, Faculty of Medicine, University of Rijeka, Rijeka, Croatia.,Department of Public Health, Faculty of Health Studies, University of Rijeka, Rijeka, Croatia
| | - Zvonka Zupanič-Slavec
- Institute for History of Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Florian Steger
- Institute of the History, Philosophy and Ethics of Medicine, Ulm University, Parkstraße 11, 89073, Ulm, Germany
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25
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Freedman J, Crankshaw TL, Mutambara VM. Sexual and reproductive health of asylum seeking and refugee women in South Africa: understanding the determinants of vulnerability. Sex Reprod Health Matters 2020; 28:1758440. [PMID: 32425112 PMCID: PMC7888032 DOI: 10.1080/26410397.2020.1758440] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Women asylum seekers and refugees face huge challenges related to their sexual and reproductive health (SRH) and rights. In this article we explore the structural determinants of vulnerability to poor SRH for these women in South Africa, and focus particularly on the political, legal and economic structures which render them vulnerable. Based on a qualitative study carried out in Durban, South Africa, we argue that it is vital to go beyond analyses which prioritise the socio-cultural barriers to sexual and reproductive health and rights for asylum seekers and refugees, and to consider the wider national and international policies and legislation which create barriers to these women's rights to SRH.
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Affiliation(s)
- Jane Freedman
- Professor, Centre for Sociological and Political Research (CRESPPA), Université Paris 8 Paris, France
| | - Tamaryn L Crankshaw
- Senior Research Fellow, Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
| | - Victoria M Mutambara
- Post-Doctoral Researcher, HEARD, Univerity of KwaZulu-Natal, Durban, South Africa
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26
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Alarcão V, Stefanovska-Petkovska M, Virgolino A, Santos O, Ribeiro S, Costa A, Nogueira P, Pascoal PM, Pintassilgo S, Machado FL. Fertility, Migration and Acculturation (FEMINA): a research protocol for studying intersectional sexual and reproductive health inequalities. Reprod Health 2019; 16:140. [PMID: 31511027 PMCID: PMC6737681 DOI: 10.1186/s12978-019-0795-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 08/23/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The existing knowledge on the interplay between reproductive and sexual health, migration and acculturation is recent and inconsistent, particularly on the sociocultural motives and constraints regarding fertility. Therefore, sexual and reproductive health (SRH) surveys are needed to provide accurate and comparable indicators to identify and address SRH inequalities, with specific focus on under researched aspects, such as the interrelation between migration and gender. FEMINA (FErtility, MIgratioN and Acculturation) aims to investigate intersectional SRH inequalities among Cape Verdean immigrant and Portuguese native families and how they impact on fertility in Portugal. This study will use a comprehensive approach exploring simultaneously the components of SRH, namely regarding identities, perceptions and practices of both women and men among lay people and relevant experts and stakeholders. The project has three main goals: 1) to identify social determinants of SRH among Cape Verdean immigrant and Portuguese native men and women of reproductive age; 2) to gain understanding of the diversity of the sexual and reproductive experiences and expectations of Cape Verdean immigrant and Portuguese native men and women of reproductive age, considering the singularities of their migratory, social and family dynamics; and 3) to produce recommendations for policy makers, employers and service providers on how to better address the SRH needs of Portuguese-born and immigrant populations. METHODS The study will address these goals using a mixed methods approach, including: a cross-sectional telephone survey with a probabilistic sample of 600 Cape Verdean immigrant and 600 Portuguese native women and men (women aged 18 to 49 and men aged 18 to 54), residents of the Greater Lisbon Area; a qualitative research through in-depth interviews with a subsample of 30 Cape Verdean immigrants and 30 Portuguese native men and women; and a Delphi technique for finding consensus on good practices in SRH for the entire population with a special emphasis on immigrants, namely extra-EU migrants. DISCUSSION Data will be used to produce a comprehensive set of indicators to monitor SRH in Portugal, to foster a greater understanding of its specificities and challenges to policy and decision makers, and to provide targeted recommendations to promote inclusive and migrant sensitive SRH services.
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Affiliation(s)
- Violeta Alarcão
- Centro de Investigação e Estudos de Sociologia (CIES-IUL), Instituto Universitário de Lisboa (ISCTE-IUL), Av. das Forças Armadas, 1649-026 Lisboa, Portugal
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
- Instituto de Medicina Preventiva e Saúde Pública, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
| | - Miodraga Stefanovska-Petkovska
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
| | - Ana Virgolino
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
- Instituto de Medicina Preventiva e Saúde Pública, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
| | - Osvaldo Santos
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
- Instituto de Medicina Preventiva e Saúde Pública, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
| | - Sofia Ribeiro
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
| | - Andreia Costa
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
- Escola Superior de Enfermagem de Lisboa, Lisboa, Portugal
| | - Paulo Nogueira
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
- Instituto de Medicina Preventiva e Saúde Pública, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
- Laboratório de Biomatemática, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
| | - Patrícia M. Pascoal
- CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, 1649-013 Lisboa, Portugal
- Escola de Psicologia e Ciências da Vida, Universidade Lusófona de Humanidades e Tecnologias, Lisboa, Portugal
| | - Sónia Pintassilgo
- Centro de Investigação e Estudos de Sociologia (CIES-IUL), Instituto Universitário de Lisboa (ISCTE-IUL), Av. das Forças Armadas, 1649-026 Lisboa, Portugal
| | - Fernando Luís Machado
- Centro de Investigação e Estudos de Sociologia (CIES-IUL), Instituto Universitário de Lisboa (ISCTE-IUL), Av. das Forças Armadas, 1649-026 Lisboa, Portugal
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Origlia Ikhilor P, Hasenberg G, Kurth E, Asefaw F, Pehlke-Milde J, Cignacco E. Communication barriers in maternity care of allophone migrants: Experiences of women, healthcare professionals, and intercultural interpreters. J Adv Nurs 2019; 75:2200-2210. [PMID: 31172543 PMCID: PMC6852258 DOI: 10.1111/jan.14093] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 03/18/2019] [Accepted: 04/11/2019] [Indexed: 11/26/2022]
Abstract
Aim To describe communication barriers faced by allophone migrant women in maternity care provision from the perspectives of migrant women, healthcare professionals, and intercultural interpreters. Background Perinatal health inequality of migrant women hinges on barriers to services, with a major barrier being language. Their care is often also perceived as demanding due to conflicting values or complex situations. Potentially divergent perceptions of users and providers may hinder efficient communication. Design Qualitative explorative study. Methods A convenience sample of 36 participants was recruited in the German speaking region of Switzerland. The sample consisted of four Albanian and six Tigrinya speaking women, 22 healthcare professionals and four intercultural interpreters (March–June 2016) who participated in three focus group discussions and seven semi‐structured interviews. Audio recordings of the discussions and interviews were transcribed and thematically analysed. Results The analysis revealed three main themes: the challenge of understanding each other's world, communication breakdowns and imposed health services. Without interpretation communication was reduced to a bare minimum and thus insufficient to adequately inform women about treatment and address their expectations and needs. Conclusion A primary step in dismantling barriers is guaranteed intercultural interpreting services. Additionally, healthcare professionals need to continuously develop and reflect on their transcultural communication. Institutions must enable professionals to respond flexibly to allophone women's needs and to offer care options that are safe and in accordance to their cultural values. Impact Our results give the foundation of tenable care of allophonic women and emphasize the importance of linguistic understanding in care quality.
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Affiliation(s)
- Paola Origlia Ikhilor
- Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Gabriele Hasenberg
- Institute of Midwifery, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Elisabeth Kurth
- Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland.,Familystart of both Basel, Basel, Switzerland
| | - Fana Asefaw
- Outpatient Clinic for Child and Adolescent Psychiatry and Psychotherapy, Clienia Littenheid AG, Winterthur, Switzerland
| | - Jessica Pehlke-Milde
- Institute of Midwifery, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Eva Cignacco
- Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
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28
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Balinska MA, Nesbitt R, Ghantous Z, Ciglenecki I, Staderini N. Reproductive health in humanitarian settings in Lebanon and Iraq: results from four cross-sectional studies, 2014-2015. Confl Health 2019; 13:24. [PMID: 31198436 PMCID: PMC6556966 DOI: 10.1186/s13031-019-0210-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 05/31/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Reproductive health is an important component of humanitarian response. Displaced women need access to family planning, antenatal care, and the presence of a skilled birth attendant at delivery. Since the beginning of the Syrian conflict in 2011, Lebanon and Iraq have been hosting large numbers of refugees, thereby straining local capacities to provide these services. In order to identify salient health needs, Médecins Sans Frontières conducted a survey in several sites hosting refugees and internally displaced persons across the region. Here we describe the reproductive health profile of Syrian refugees, Iraqi displaced persons, and vulnerable Lebanese and their use of services. METHODS We conducted four cross-sectional surveys in 2014-2015 in two sites in Lebanon and two sites in Iraq. Depending on the site, two-stage cluster sampling or systematic sampling was intended, but non-probability methods were employed at the second stage due to implementation challenges. We collected information on overall health (including reproductive health) and demographic information from heads of households on the basis of a standardized questionnaire. Pearson chi-square tests were used to compare proportions, and generalized linear models were used to calculate odds ratios with regard to risk factors. All analyses were performed using the survey suite of commands in Stata version 14.1. RESULTS A total of 23,604 individuals were surveyed, including 5925 women of childbearing age. Overall, it was reported that 7.5% of women were currently pregnant and 12.8% had given birth within the previous 12 months. It was reported that pregnancy was unplanned for 57% of currently pregnant women and 66.7% of women who had delivered in the previous year. A slight majority of women from both groups had accessed antenatal care at least once. Amongst women who had delivered in the previous year, 84.5% had done so with a skilled birth attendant and 22.1% had had a cesarean section. Location and head of household education were predictors of unplanned pregnancy in multivariable analysis. Head of household education was also significantly associated with higher uptake of antenatal care. CONCLUSIONS Considering the large number of pregnant women and women having recently delivered in these settings, addressing their sexual and reproductive health needs emerges as a crucial aspect of humanitarian response. This study identified unmet needs for family planning and high cesarean section rates at all sites, suggesting both lack of access to certain services (contraception, antenatal care), but also over-recourse to cesarean section. These specific challenges can impact directly on maternal and child health and need today to be kept high on the humanitarian agenda.
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Affiliation(s)
- Marta A. Balinska
- Médecins Sans Frontières Switzerland, Rue de Lausanne 78, 1211 Geneva, Switzerland
| | - Robin Nesbitt
- Médecins Sans Frontières Switzerland, P. O. Box 527, Nhlangano, Swaziland
| | - Zeina Ghantous
- Médecins Sans Frontières France, Genifor Center, Clémenceau Street, Bloc C, Beirut, Lebanon
| | - Iza Ciglenecki
- Médecins Sans Frontières Switzerland, Rue de Lausanne 78, 1211 Geneva, Switzerland
| | - Nelly Staderini
- Médecins Sans Frontières Switzerland, Rue de Lausanne 78, 1211 Geneva, Switzerland
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Affiliation(s)
- Peter Leusink
- Radboud University Medical Centre, Department of Primary and Community Care, Unit Gender and Women's Health, PO Box 9101/118, 6500 HB Nijmegen, Netherlands
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30
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Abubakar I, Aldridge RW, Devakumar D, Orcutt M, Burns R, Barreto ML, Dhavan P, Fouad FM, Groce N, Guo Y, Hargreaves S, Knipper M, Miranda JJ, Madise N, Kumar B, Mosca D, McGovern T, Rubenstein L, Sammonds P, Sawyer SM, Sheikh K, Tollman S, Spiegel P, Zimmerman C. The UCL-Lancet Commission on Migration and Health: the health of a world on the move. Lancet 2018; 392:2606-2654. [PMID: 30528486 PMCID: PMC7612863 DOI: 10.1016/s0140-6736(18)32114-7] [Citation(s) in RCA: 417] [Impact Index Per Article: 69.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 08/27/2018] [Accepted: 08/29/2018] [Indexed: 12/22/2022]
Abstract
With one billion people on the move or having moved in 2018, migration is a global reality, which has also become a political lightning rod. Although estimates indicate that the majority of global migration occurs within low-income and middle-income countries (LMICs), the most prominent dialogue focuses almost exclusively on migration from LMICs to high-income countries (HICs). Nowadays, populist discourse demonises the very same individuals who uphold economies, bolster social services, and contribute to health services in both origin and destination locations. Those in positions of political and economic power continue to restrict or publicly condemn migration to promote their own interests. Meanwhile nationalist movements assert so-called cultural sovereignty by delineating an us versus them rhetoric, creating a moral emergency. In response to these issues, the UCL-Lancet Commission on Migration and Health was convened to articulate evidence-based approaches to inform public discourse and policy. The Commission undertook analyses and consulted widely, with diverse international evidence and expertise spanning sociology, politics, public health science, law, humanitarianism, and anthropology. The result of this work is a report that aims to be a call to action for civil society, health leaders, academics, and policy makers to maximise the benefits and reduce the costs of migration on health locally and globally. The outputs of our work relate to five overarching goals that we thread throughout the report. First, we provide the latest evidence on migration and health outcomes. This evidence challenges common myths and highlights the diversity, dynamics, and benefits of modern migration and how it relates to population and individual health. Migrants generally contribute more to the wealth of host societies than they cost. Our Article shows that international migrants in HICs have, on average, lower mortality than the host country population. However, increased morbidity was found for some conditions and among certain subgroups of migrants, (eg, increased rates of mental illness in victims of trafficking and people fleeing conflict) and in populations left behind in the location of origin. Currently, in 2018, the full range of migrants’ health needs are difficult to assess because of poor quality data. We know very little, for example, about the health of undocumented migrants, people with disabilities, or lesbian, gay, bisexual, transsexual, or intersex (LGBTI) individuals who migrate or who are unable to move. Second, we examine multisector determinants of health and consider the implication of the current sector-siloed approaches. The health of people who migrate depends greatly on structural and political factors that determine the impetus for migration, the conditions of their journey, and their destination. Discrimination, gender inequalities, and exclusion from health and social services repeatedly emerge as negative health influences for migrants that require cross-sector responses. Third, we critically review key challenges to healthy migration. Population mobility provides economic, social, and cultural dividends for those who migrate and their host communities. Furthermore, the right to the highest attainable standard of health, regardless of location or migration status, is enshrined in numerous human rights instruments. However, national sovereignty concerns overshadow these benefits and legal norms. Attention to migration focuses largely on security concerns. When there is conjoining of the words health and migration, it is either focused on small subsets of society and policy, or negatively construed. International agreements, such as the UN Global Compact for Migration and the UN Global Compact on Refugees, represent an opportunity to ensure that international solidarity, unity of intent, and our shared humanity triumphs over nationalist and exclusionary policies, leading to concrete actions to protect the health of migrants. Fourth, we examine equity in access to health and health services and offer evidence-based solutions to improve the health of migrants. Migrants should be explicitly included in universal health coverage commitments. Ultimately, the cost of failing to be health-inclusive could be more expensive to national economies, health security, and global health than the modest investments required. Finally, we look ahead to outline how our evidence can contribute to synergistic and equitable health, social, and economic policies, and feasible strategies to inform and inspire action by migrants, policy makers, and civil society. We conclude that migration should be treated as a central feature of 21st century health and development. Commitments to the health of migrating populations should be considered across all Sustainable Development Goals (SDGs) and in the implementation of the Global Compact for Migration and Global Compact on Refugees. This Commission offers recommendations that view population mobility as an asset to global health by showing the meaning and reality of good health for all. We present four key messages that provide a focus for future action.
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Affiliation(s)
- Ibrahim Abubakar
- Institute for Global Health, University College London, London, UK.
| | - Robert W Aldridge
- Institute for Health Informatics, University College London, London, UK
| | - Delan Devakumar
- Institute for Global Health, University College London, London, UK
| | - Miriam Orcutt
- Institute for Global Health, University College London, London, UK
| | - Rachel Burns
- Institute for Global Health, University College London, London, UK
| | - Mauricio L Barreto
- Centre for Data and Knowledge Integration for Health, Fundação Oswaldo Cruz, Salvador-Bahia, Brazil
| | - Poonam Dhavan
- International Organization for Migration, Geneva, Switzerland
| | - Fouad M Fouad
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Nora Groce
- Leonard Cheshire Centre, Institute of Epidemiology and Healthcare, University College London, London, UK
| | - Yan Guo
- School of Public Health, Peking University, Beijing, China
| | - Sally Hargreaves
- Institute of Infection and Immunity, St George's, University of London, London, UK; International Health Unit, Section of Infectious Diseases and Immunity, Imperial College London, London, UK
| | - Michael Knipper
- Institute for the History of Medicine, Justus Liebig University Giessen, Giessen, Germany
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Nyovani Madise
- African Institute for Development Policy, Lilongwe, Malawi; Centre for Global Health, Population, Poverty and Policy, University of Southampton, Southampton, UK
| | - Bernadette Kumar
- Norwegian Centre for Minority Health Research, Oslo, Norway; Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Davide Mosca
- International Organization for Migration, Geneva, Switzerland
| | - Terry McGovern
- Program on Global Health Justice and Governance, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Leonard Rubenstein
- Center for Public Health and Human Rights, Johns Hopkins University, Baltimore, MD, USA; Johns Hopkins Bloomberg School of Public Health, and Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA
| | - Peter Sammonds
- Institute for Risk and Disaster Reduction, University College London, London, UK
| | - Susan M Sawyer
- Department of Paediatrics, University of Melbourne, University of Melbourne, Parkville, VIC, Australia; Centre for Adolescent Health, and Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC, Australia
| | - Kabir Sheikh
- Public Health Foundation of India, Institutional Area Gurgaon, India; Nossal Institute of Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Stephen Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Paul Spiegel
- Department of International Health, Johns Hopkins University, Baltimore, MD, USA; Johns Hopkins Center for Humanitarian Health, Johns Hopkins University, Baltimore, MD, USA
| | - Cathy Zimmerman
- Gender, Violence and Health Centre, London School of Hygiene and Tropical Medicine, London, UK
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Pérez-Urdiales I, San Sebastián M, Goicolea I. Free clinic utilisation by immigrants after the introduction of a restrictive health policy in the Basque Country (Spain). Public Health 2018; 163:9-15. [DOI: 10.1016/j.puhe.2018.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 06/01/2018] [Accepted: 06/05/2018] [Indexed: 11/25/2022]
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De Schrijver L, Vander Beken T, Krahé B, Keygnaert I. Prevalence of Sexual Violence in Migrants, Applicants for International Protection, and Refugees in Europe: A Critical Interpretive Synthesis of the Evidence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E1979. [PMID: 30208610 PMCID: PMC6165364 DOI: 10.3390/ijerph15091979] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 09/07/2018] [Indexed: 11/21/2022]
Abstract
(1) Background: Sexual violence (SV) is a major public health problem, with negative socio-economic, physical, mental, sexual, and reproductive health consequences. Migrants, applicants for international protection, and refugees (MARs) are vulnerable to SV. Since many European countries are seeing high migratory pressure, the development of prevention strategies and care paths focusing on victimised MARs is highly needed. To this end, this study reviews evidence on the prevalence of SV among MAR groups in Europe and the challenges encountered in research on this topic. (2) Methods: A critical interpretive synthesis of 25 peer-reviewed academic studies and 22 relevant grey literature documents was conducted based on a socio-ecological model. (3) Results: Evidence shows that SV is highly frequent in MARs in Europe, yet comparison with other groups is still difficult. Methodologically and ethically sound representative studies comparing between populations are still lacking. Challenges in researching SV in MARs are located at the intrapersonal, interpersonal, community, societal, and policy levels. (4) Conclusions: Future research should start with a clear definition of the concerned population and acts of SV to generate comparable data. Participatory qualitative research approaches could be applied to better grasp the complexity of interplaying determinants of SV in MARs.
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Affiliation(s)
- Lotte De Schrijver
- UGent-International Centre for Reproductive Health, 9000 Ghent, Belgium.
| | - Tom Vander Beken
- UGent-Institute for International Research on Criminal Policy, 9000 Ghent, Belgium.
| | - Barbara Krahé
- Department of Psychology, University of Potsdam, 14476 Potsdam, Germany.
| | - Ines Keygnaert
- UGent-International Centre for Reproductive Health, 9000 Ghent, Belgium.
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Use of modern contraceptive methods and its association with QOL among Nepalese female migrants living in Japan. PLoS One 2018; 13:e0197243. [PMID: 29768459 PMCID: PMC5955577 DOI: 10.1371/journal.pone.0197243] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 04/28/2018] [Indexed: 12/22/2022] Open
Abstract
Introduction Modern contraceptive use among migrants may be limited due to factors such as language barriers, socio-economic condition, and inadequate knowledge. Limited evidence is available on the factors associated with the use of modern contraceptive methods by migrants in Japan. Moreover, evidence remains scarce on the quality of life (QOL) of migrants in relation to contraceptive use. As the Nepalese migrant population in Japan is increasing, this study was conducted to address their sexual and reproductive health issues. Therefore, the objectives of this study were to examine the factors associated with the use of modern contraceptive methods and to explore the association between the use of modern contraceptive methods and QOL among married Nepalese female migrants in Japan. Methods This is a cross-sectional study conducted among 189 married Nepalese female migrants residing in five prefectures of Japan from August to October 2016. This study employed snowball sampling to recruit the migrants. Simple and multiple logistic analyses were used to examine the association between independent variables and the use of modern contraceptive methods. Similarly, multiple linear regression analysis was used to examine the association between the use of modern contraceptive methods and quality of life. Results Migrants who had higher knowledge of modern contraceptive methods were more likely to use them (Adjusted Odds Ratio [AOR] = 1.31; 95% Confidence Interval [CI]: 1.07, 1.60). The psychological domain scores were higher in those who used modern contraceptive methods (Coefficient [B] = 0.58; 95% CI: 0.05, 1.11). Conclusion This study highlights the importance of the knowledge of modern contraceptive methods to increase their use. Also, the use of modern contraceptive methods improves the psychological QOL domain scores of the migrants using them. These results suggest a need for sexual and reproductive health education for migrants, especially pertaining to modern contraceptive use.
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Guillon M, Celse M, Geoffard PY. Economic and public health consequences of delayed access to medical care for migrants living with HIV in France. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2018; 19:327-340. [PMID: 28343331 DOI: 10.1007/s10198-017-0886-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Accepted: 03/13/2017] [Indexed: 05/26/2023]
Abstract
In 2013, migrants accounted for 46% of newly diagnosed cases of HIV (human immunodeficiency virus) infection in France. These populations meet with specific obstacles leading to late diagnosis and access to medical care. Delayed access to care (ATC) for HIV-infected migrants reduces their life expectancy and quality of life. Given the reduction of infectivity under antiretroviral (ARV) treatment, delayed ATC for HIV-infected migrants may also hinder the control of the HIV epidemic. The objective of this study is to measure the public health and economic consequences of delayed ATC for migrants living with HIV in France. Using a healthcare payer perspective, our model compares the lifetime averted infections and costs of early vs. late ATC for migrants living with HIV in France. Early and late ATC are defined by an entry into care with a CD4 cell count of 350 and 100/mm3, respectively. Our results show that an early ATC is dominant, even in the worst-case scenario. In the most favorable scenario, early ATC generates an average net saving of €198,000 per patient, and prevents 0.542 secondary infection. In the worst-case scenario, early ATC generates an average net saving of €32,000 per patient, and prevents 0.299 secondary infection. These results are robust to various adverse changes in key parameters and to a definition of late ATC as an access to care at a CD4 level of 200/mm3. In addition to individual health benefits, improving ATC for migrants living with HIV proves efficient in terms of public health and economics. These results stress the benefit of ensuring early ATC for all individuals living with HIV in France.
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Affiliation(s)
- Marlène Guillon
- Université Clermont Auvergne, CNRS, CERDI and Paris School of Economics, 63-65 Boulevard François Mitterrand, 63000, Clermont-Ferrand, France.
| | - Michel Celse
- Conseil National du Sida-French National AIDS Council, 39-43 Quai André Citroën, 75902, Paris Cedex 15, France
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Aung E, Blondell SJ, Durham J. Interventions for Increasing HIV Testing Uptake in Migrants: A Systematic Review of Evidence. AIDS Behav 2017; 21:2844-2859. [PMID: 28710710 DOI: 10.1007/s10461-017-1833-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Migrants have been identified as being at greater risk for late HIV testing and diagnosis. Late diagnosis is of concern because timely diagnosis and initiation of treatment can both optimise health outcomes and reduce transmission. We reviewed and evaluated interventions that aimed to increase HIV testing uptake in migrant populations. Of 6511 papers retrieved, 10 met the inclusion criteria and were included in the review. Three types of interventions were identified (exposure to HIV prevention messages, HIV education programs, and direct offer of testing). All interventions were based on individual models of behaviour change targeting migrants or GPs. While important, interventions that also address broader health system and structural factors that contribute to late HIV-diagnosis in at-risk members of migrant populations are needed. Integrating PITC into existing primary healthcare settings shows promise of creating an enabling environment within patient-doctor relationships that can encourage HIV testing uptake among migrant populations.
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Pérez-Urdiales I, Goicolea I. [How do immigrant women access health services in the Basque Country? Perceptions of health professionals]. Aten Primaria 2017; 50:368-376. [PMID: 28916244 PMCID: PMC6836993 DOI: 10.1016/j.aprim.2017.05.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 05/24/2017] [Indexed: 11/30/2022] Open
Abstract
Objetivo Explorar la percepción de las profesionales sanitarias que trabajan en centros sanitarios alternativos sobre las barreras y los facilitadores en el acceso de las mujeres inmigrantes a los servicios sanitarios públicos generales y de salud sexual y reproductiva en el País Vasco. Emplazamiento País Vasco. Diseño Análisis de contenido cualitativo basado en 11 entrevistas individuales. Participantes Profesionales sanitarias que trabajan en centros sanitarios alternativos de atención primaria y salud sexual y reproductiva. Método La recolección de datos se realizó entre septiembre y diciembre de 2015 en cuatro centros sanitarios alternativos. Tras su transcripción, se identificaron unidades de significado, códigos y categorías. Resultados Del análisis emergieron cuatro categorías que representan cómo las características de las mujeres inmigrantes (Dime cómo eres y te diré cómo accedes), la actitud del personal administrativo y sanitario («Cuando ya les atienden, estupendamente. El problema está con los administrativos»), el funcionamiento del sistema sanitario (Sistema de salud inflexible, pasivo y receptor de necesidades) y las políticas sanitarias («Si no cumples los requisitos, pues no entras. La ley es la ley») influyen en el acceso a los servicios sanitarios públicos de las mujeres inmigrantes. Conclusiones Este estudio indica que hay un considerable número de barreras y pocos facilitadores en el acceso de las mujeres inmigrantes a los servicios sanitarios públicos y de salud sexual y reproductiva en el País Vasco. Los centros sanitarios alternativos se presentaron como favorecedores en la mejora de la salud de la población inmigrante y en su acceso.
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Affiliation(s)
- Iratxe Pérez-Urdiales
- Departamento de Enfermería I, Facultad de Medicina y Enfermería, Universidad del País Vasco (UPV/EHU), Leioa, Bizkaia, España.
| | - Isabel Goicolea
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Suecia
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Frati ER, Fasoli E, Martinelli M, Colzani D, Bianchi S, Carnelli L, Amendola A, Olivani P, Tanzi E. Sexually Transmitted Infections: A Novel Screening Strategy for Improving Women's Health in Vulnerable Populations. Int J Mol Sci 2017. [PMID: 28632191 PMCID: PMC5486132 DOI: 10.3390/ijms18061311] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: Migrant women are one of the most vulnerable population to health problems and well-being. This study aimed at implementing a counseling and preventive strategy for sexually transmitted infections (STIs) in undocumented migrant women in Milan, Italy. Methods: Women (ages 18–65) were enrolled at the NAGA Centre (2012–2013) and asked for a urine sample in order to carry out molecular detection of Human papillomavirus (HPV), Chlamydia trachomatis (Ct), Trichomonas vaginalis (Tv), Neisseria gonorrhoeae (Ng)-DNA. Socio-demographic and sexual behavior information were collected. All HPV/Ct+ women were offered Pap tests and/or were prescribed antibiotic treatment. Results: 537/757 women participated in the study (acceptability rate: 70.9%). Most of the women were from Latin America (45.6%) and Eastern Europe (30.7%); >60% of them had stable partners, did not use contraception and had had at least one pregnancy. The prevalence rates of HPV, Ct, Tv and Ng infections were 24.2%, 7.8%, 4.8% and 0%, respectively. In all, 43.2% of the positive women agreed to undergo a gynecological examination and accepted suitable treatment. Conclusions: This study shows an overall high prevalence of STIs in undocumented migrant women in Milan. The screening strategy based on counseling and urine testing contributed to the successfully high acceptability rate. More appropriate health services that adequately address all aspects of women’s health are required.
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Affiliation(s)
- Elena R Frati
- Department of Biomedical Sciences for Health, University of Milan, Via C. Pascal 36, 20133 Milan, Italy.
| | - Ester Fasoli
- Department of Biomedical Sciences for Health, University of Milan, Via C. Pascal 36, 20133 Milan, Italy.
| | - Marianna Martinelli
- Department of Biomedical Sciences for Health, University of Milan, Via C. Pascal 36, 20133 Milan, Italy.
| | - Daniela Colzani
- Department of Biomedical Sciences for Health, University of Milan, Via C. Pascal 36, 20133 Milan, Italy.
| | - Silvia Bianchi
- Department of Biomedical Sciences for Health, University of Milan, Via C. Pascal 36, 20133 Milan, Italy.
| | - Luciana Carnelli
- Lega Italiana per la Lotta contro i Tumori (LILT), Section of Milan, Viale Molise 5, 20137 Milan, Italy.
| | - Antonella Amendola
- Department of Biomedical Sciences for Health, University of Milan, Via C. Pascal 36, 20133 Milan, Italy.
- Coordinated Research Center "EpiSoMI", University of Milan, Via C. Pascal 36, 20133 Milan, Italy.
- CIRI-IV, Department of Health Sciences, University of Genoa, Via A. Pastore 1, 16100 Genoa, Italy.
| | - Pierfranco Olivani
- NAGA Centre, Associazione Volontaria di Assistenza Socio-Sanitaria e per i Diritti di Cittadini Stranieri, Rom e Sinti, Via L. L. Zamenhof 7/A, 20136 Milan, Italy.
| | - Elisabetta Tanzi
- Department of Biomedical Sciences for Health, University of Milan, Via C. Pascal 36, 20133 Milan, Italy.
- Coordinated Research Center "EpiSoMI", University of Milan, Via C. Pascal 36, 20133 Milan, Italy.
- CIRI-IV, Department of Health Sciences, University of Genoa, Via A. Pastore 1, 16100 Genoa, Italy.
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Ayre K, Khalifeh H. Immigrant women and women with learning disabilities have complex mental health needs and service use in the perinatal period. EVIDENCE-BASED MENTAL HEALTH 2017; 20:55-57. [PMID: 28377384 PMCID: PMC10688522 DOI: 10.1136/eb-2017-102607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 03/28/2017] [Accepted: 03/29/2017] [Indexed: 11/04/2022]
Affiliation(s)
- Karyn Ayre
- Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Hind Khalifeh
- Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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Kentikelenis AE, Shriwise A. International organizations and migrant health in Europe. Public Health Rev 2016; 37:19. [PMID: 29450061 PMCID: PMC5809970 DOI: 10.1186/s40985-016-0033-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 10/12/2016] [Indexed: 11/10/2022] Open
Abstract
International organizations have defined and managed different aspects of migrant health issues for decades, yet we lack a systematic understanding of how they reach decisions and what they do on the ground. The present article seeks to clarify the state of knowledge on the relationship between international organizations and migrant health in Europe. To do so, we review the operations of six organizations widely recognized as key actors in the field of migrant health: the European Commission, the Regional Office for Europe of the World Health Organization, the International Organization on Migration, Médecins du Monde, Médecins Sans Frontières, and the Open Society Foundation. We find that international organizations operate in a complementary fashion, with each taking on a unique role in migrant health provision. States often rely on international organizations as policy advisors or sub-contractors for interventions, especially in the case of emergencies. These linkages yield a complex web of relationships, which can vary depending on the country under consideration or the health policy issue in question.
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Affiliation(s)
- Alexander E. Kentikelenis
- Department of Sociology, University of Oxford, Oxford, UK
- Trinity College, Broad Street, Oxford, OX1 3BH UK
| | - Amanda Shriwise
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
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Epidemiology of hepatitis C virus and genotype distribution in immigrants crossing to Europe from North and sub-Saharan Africa. Travel Med Infect Dis 2016; 14:517-526. [PMID: 27502972 DOI: 10.1016/j.tmaid.2016.05.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 04/07/2016] [Accepted: 05/04/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND The association between the prevalence of hepatitis C virus (HCV) and immigration is rarely studied, particularly for the immigrants crossing to the resettlement countries. Most of the published data are confined to those immigrants who were resident in European countries and rarely immigrated before they reach the final destination. Libya is a large country in North Africa with the longest coast of the Mediterranean Sea facing the European Union. It has been considered as the main transient station for African immigrants to Europe. The objectives of this study were to determine: (1) the prevalence of HCV in African immigrants gathered in Libya from different African countries on their way to Europe and (2) HCV genotype distribution in these immigrants and its correlation with different demographic factors. METHODS A total of 14 205 serum samples were collected in a 3-year period (2013-2015) from different immigrants from North and sub-Saharan Africa who resided in the African immigrant campus, Tripoli, Libya. The participants were interviewed, and relevant information was collected, including socio-demographic, ethnic, and geographic variables. Each serum sample was tested for anti-HCV antibody using ELISA. The genotypes were determined and assigned using a specific genotyping assay and correlated with demographic and potential risk factors of the recruited individuals. RESULTS Of the immigrants studied, 1078 (7.6%) were positive for HCV. The prevalence of HCV infection ranged from 1.4% to 18.7%; it was higher among individuals arriving from Nile river (3.6-18.7%) of North Africa, followed by those who arrived from the West African region (2.1-14.1%), Horn of Africa (HOA, 6.8-9.9%), and Maghreb countries (1.4-2.7%). The relative risk factor attributable to gender variation was not significant (95% Cl: 0.8513-1.2381). Five genotypes were detected in 911 African immigrants. Genotypic analysis showed that the predominant HCV genotypes in this group were genotypes 4, 1, and 2 that accounted for 329 (36.1%), 326 (35.8%), and 131 (14.4%) strains, respectively, followed by genotype 3 that accounted for 87 (9.5%) strains. Genotype 5 was isolated mainly from 18 HOA (2%) and 20 West African (2.2%) individuals. CONCLUSIONS The prevalence of HCV is considered high with a unique disparate distribution among African immigrants crossing to Europe. This indicated that the prevalence of HCV is high among these immigrants and thus may be reflected on the HCV prevalence in the guest countries. The broad genetic heterogeneity of HCV genotypes detected here may impact the efficacy of prevention and control efforts for HCV in both Europe and North and sub-Saharan Africa; hence, an integrated global policy of actions is needed.
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Keygnaert I. In Search of the Third Eye, When the Two Others Are Shamefacedly Shut? Comment on "Are Sexual and Reproductive Health Policies Designed for All? Vulnerable Groups in Policy Documents of Four European Countries and Their Involvement in Policy Development". Int J Health Policy Manag 2016; 5:325-7. [PMID: 27239882 DOI: 10.15171/ijhpm.2016.16] [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: 11/30/2015] [Accepted: 02/08/2016] [Indexed: 11/09/2022] Open
Abstract
Ivanova et al explored how vulnerable groups and principles of human rights are incorporated into national sexual and reproductive health (SRH) policies in 4 countries. They adapted the EquiFrame of Amin and colleagues of 2011, to SRH vulnerable groups which we believe could now be used for analysis of national SRH polices beyond those 4 countries. Although we fully agree with the authors' two main findings that vulnerable groups and human rights' principles are not sufficiently integrated in SRH policies nor granted the possibility to participate in the process of development in those four countries, we do believe that these shortcomings are not limited to those countries only nor to the identified vulnerable groups either. We are convinced that the issue of SRH as such is still framed within a very limited logic for all with vulnerable groups being perceived as an extra threat or an extra burden.
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Affiliation(s)
- Ines Keygnaert
- ICRH, Faculty of Medicine & Health Sciences, Ghent University, Ghent, Belgium
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What the eye does not see: a critical interpretive synthesis of European Union policies addressing sexual violence in vulnerable migrants. REPRODUCTIVE HEALTH MATTERS 2015; 23:45-55. [PMID: 26718996 DOI: 10.1016/j.rhm.2015.11.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Revised: 11/08/2015] [Accepted: 11/11/2015] [Indexed: 11/24/2022] Open
Abstract
In Europe, refugees, asylum seekers and undocumented migrants are more vulnerable to sexual victimisation than European citizens. They face more challenges when seeking care. This literature review examines how legal and policy frameworks at national, European and international levels condition the prevention of and response to sexual violence affecting these vulnerable migrant communities living in the European Union (EU). Applying the Critical Interpretive Synthesis method, we reviewed 187 legal and policy documents and 80 peer-reviewed articles on migrant sexual health for elements on sexual violence and further analysed the 37 legal and 12 peer-reviewed articles among them that specifically focused on sexual violence in vulnerable migrants in the EU-27 States. Legal and policy documents dealing with sexual violence, particularly but not exclusively in vulnerable migrants, apply 'tunnel vision'. They ignore: a) frequently occurring types of sexual violence, b) victimisation rates across genders and c) specific risk factors within the EU such as migrants' legal status, gender orientation and living conditions. The current EU policy-making paradigm relegates sexual violence in vulnerable migrants as an 'outsider' and 'female only' issue while EU migration and asylum policies reinforce its invisibility. Effective response must be guided by participatory rights- and evidence-based policies and a public health approach, acknowledging the occurrence and multiplicity of sexual victimisation of vulnerable migrants of all genders within EU borders.
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Galle A, Van Parys AS, Roelens K, Keygnaert I. Expectations and satisfaction with antenatal care among pregnant women with a focus on vulnerable groups: a descriptive study in Ghent. BMC WOMENS HEALTH 2015; 15:112. [PMID: 26627054 PMCID: PMC4667492 DOI: 10.1186/s12905-015-0266-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 11/18/2015] [Indexed: 11/26/2022]
Abstract
Background Previous studies demonstrate that people’s satisfaction with healthcare influences their further use of that healthcare system. Satisfied patients are more likely to take part in the decision making process and to complete treatment. One of the important determinants of satisfaction is the fulfillment of expectations. This study aims to analyse both expectations and satisfaction with antenatal care among pregnant women, with a particular focus on vulnerable groups. Methods A quantitative descriptive study was conducted in 155 women seeking antenatal care at the University Hospital of Ghent (Belgium), of whom 139 completed the questionnaire. The statistical program SPSS-21 was used for data analysis. Results Women had high expectations relating to continuity of care and women-centered care, while expectations regarding availability of other services and complete care were low. We observed significantly lower expectations among women without higher education, with low income, younger than 26 years and women who reported intimate partner violence. General satisfaction with antenatal care was high. Women were satisfied with their relationship with the healthcare worker, however ; they evaluated the information received during the consultation and the organizational aspects of antenatal care as less satisfactory. Conclusions In order to improve satisfaction with antenatal care, organizational aspects of antenatal care (e.g. reducing waiting times and increasing accessibility) need to be improved. In addition, women would appreciate a better provision of information during consultation. More research is needed for an in-depth understanding of the determinants of satisfaction and the relationship with low socio economic status (SES). Electronic supplementary material The online version of this article (doi:10.1186/s12905-015-0266-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anna Galle
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, International Centre for Reproductive Health, Ghent University, De Pintelaan 185, UZP 114, 9000, Ghent, Belgium.
| | - An-Sofie Van Parys
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, International Centre for Reproductive Health, Ghent University, De Pintelaan 185, UZP 114, 9000, Ghent, Belgium.
| | - Kristien Roelens
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, International Centre for Reproductive Health, Ghent University, De Pintelaan 185, UZP 114, 9000, Ghent, Belgium.
| | - Ines Keygnaert
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, International Centre for Reproductive Health, Ghent University, De Pintelaan 185, UZP 114, 9000, Ghent, 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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Alvarez-Nieto C, Pastor-Moreno G, Grande-Gascón ML, Linares-Abad M. Sexual and reproductive health beliefs and practices of female immigrants in Spain: a qualitative study. Reprod Health 2015; 12:79. [PMID: 26329808 PMCID: PMC4557225 DOI: 10.1186/s12978-015-0071-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 08/17/2015] [Indexed: 11/12/2022] Open
Abstract
Background Sexuality and reproduction are two areas that have been dealt with differently over time and across cultures. Immigrant women resident in Spain, are largely of childbearing age and have some specific needs. Female immigrants have specific beliefs and behaviors which may influence how they approach to the Spanish sexual and reproductive health services. There is less visibility of the health problems presented by women immigrants. This article aims to shed light on the sexual and reproductive health beliefs and experiences of female immigrants in a region of southern Spain. Methods A descriptive study design with qualitative data collection and analysis methods were used. Data were collected through face-to-face in-depth interviews using a semi- structured interview guide that collected information on women’s perception and beliefs about their sexual and reproductive health. Thirteen interviews were conducted in 2013 with a multi-ethnic sample of female immigrants, currently all are residing in Andalusia. Interview topics included questions about awareness and beliefs about sexuality and reproduction. Content analysis was used. Results We have found that female immigrant brings along all of her beliefs, opinions, attitudes and behaviors regarding sexuality, contraceptives, what is “correct” and what is not, etc. The sexual behavior is conditioned by the prevailing social rules of country of origin, and these rules act ambivalently. In general, knowledge of contraceptive methods was big, but there were perceptions that reproductive health was woman’s domain, due to gender norms and traditional family planning geared exclusively towards women. Conclusion Results suggest that women’s behavior is influenced by the precepts of their origin societies. Therefore, sexual and reproductive health processes should be adapted and incorporated into our society, with special attention being paid to the immigrant population.
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Affiliation(s)
- Carmen Alvarez-Nieto
- Department of Nursing, University of Jaén, Campus Las Lagunillas, Building B3 Faculty of Health Sciences, 23071, Jaén, Spain.
| | - Guadalupe Pastor-Moreno
- Department of Nursing, University of Jaén, Campus Las Lagunillas, Building B3 Faculty of Health Sciences, 23071, Jaén, Spain.
| | - María Luisa Grande-Gascón
- Department of Nursing, University of Jaén, Campus Las Lagunillas, Building B3 Faculty of Health Sciences, 23071, Jaén, Spain.
| | - Manuel Linares-Abad
- Department of Nursing, University of Jaén, Campus Las Lagunillas, Building B3 Faculty of Health Sciences, 23071, Jaén, Spain.
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Keygnaert I, Vettenburg N, Roelens K, Temmerman M. Sexual health is dead in my body: participatory assessment of sexual health determinants by refugees, asylum seekers and undocumented migrants in Belgium and The Netherlands. BMC Public Health 2014; 14:416. [PMID: 24886093 PMCID: PMC4012172 DOI: 10.1186/1471-2458-14-416] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 04/25/2014] [Indexed: 11/28/2022] Open
Abstract
Background Although migrants constitute an important proportion of the European population, little is known about migrant sexual health. Existing research mainly focuses on migrants’ sexual health risks and accessibility issues while recommendations on adequate sexual health promotion are rarely provided. Hence, this paper explores how refugees, asylum seekers and undocumented migrants in Belgium and the Netherlands define sexual health, search for sexual health information and perceive sexual health determinants. Methods Applying Community-based Participatory Research as the overarching research approach, we conducted 223 in-depth interviews with refugees, asylum seekers and undocumented migrants in Belgium and the Netherlands. The Framework Analysis Technique was used to analyse qualitative data. We checked the extensiveness of the qualitative data and analysed the quantitative socio-demographic data with SPSS. Results Our results indicate that gender and age do not appear to be decisive determinants. However, incorporated cultural norms and education attainment are important to consider in desirable sexual health promotion in refugees, asylum seekers and undocumented migrants in Belgium and the Netherlands. Furthermore, our results demonstrate that these migrants have a predominant internal health locus of control. Yet, most of them feel that this personal attitude is hugely challenged by the Belgian and Dutch asylum system and migration laws which force them into a structural dependent situation inducing sexual ill-health. Conclusion Refugees, asylum seekers and undocumented migrants in Belgium and the Netherlands are at risk of sexual ill-health. Incorporated cultural norms and attained education are important determinants to address in desirable sexual health promotion. Yet, as their legal status demonstrates to be the key determinant, the prime concern is to alter organizational and societal factors linked to the Belgian and Dutch asylum system. Refugees, asylum seekers and undocumented migrants in Belgium and the Netherlands should be granted the same opportunity as Belgian and Dutch citizens have, to become equally in control of their sexual health and sexuality.
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Affiliation(s)
- Ines Keygnaert
- International Centre for Reproductive Health, Faculty of Medicine & Health Sciences, Ghent University, De Pintelaan 185 UZP114, 9000 Ghent, Belgium.
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Verran A, Evans S, Lin DJ, Griffiths F. The experiences and perceptions of family planning of female Chinese asylum seekers living in the UK. ACTA ACUST UNITED AC 2014; 41:122-7. [PMID: 24744056 DOI: 10.1136/jfprhc-2013-100764] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Chinese family planning policy is unique. There is limited sex education and the state is highly influential. This has resulted in extremely wide coverage of contraception with long-acting methods being favoured. The Chinese constitute a large proportion of asylum applicants to the UK. This study examines how their experiences and decisions about family planning in the UK are shaped by their cultural background. METHODS Data were drawn from 10 semi-structured qualitative interviews with female Chinese asylum seekers recruited through a family planning clinic in the UK. RESULTS The increased autonomy provided by the UK system was appreciated by the participants. Choice of contraceptive method was influenced by traditional cultural beliefs and values, and the effect of hormonal contraception on menstruation was particularly concerning. Women arrived from China with little knowledge of contraception. Friends from a similar background were the most trusted source of advice. When transitioning from China to the UK unwanted pregnancies had occurred amongst unmarried women who had missed out on sex education while living in China. CONCLUSIONS Chinese societal and cultural practices continue to influence family planning decisions made within the UK. Culturally competent health strategies are needed to ensure Chinese immigrant women fully benefit from family planning within the UK.
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Affiliation(s)
- Alice Verran
- Medical Student, Warwick Medical School, University of Warwick, Coventry, UK
| | - Sarah Evans
- Research Fellow, Warwick Medical School, University of Warwick, Coventry, UK
| | - Daniel J Lin
- Medical Student, Warwick Medical School, University of Warwick, Coventry, UK
| | - Frances Griffiths
- Professor of Medicine in Society, Warwick Medical School, University of Warwick, Coventry, UK
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