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Fauk NK, Gesesew HA, Seran AL, Raymond C, Tahir R, Ward PR. Barriers to Accessing HIV Care Services in Host Low and Middle Income Countries: Views and Experiences of Indonesian Male Ex-Migrant Workers Living with HIV. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14377. [PMID: 36361253 PMCID: PMC9654942 DOI: 10.3390/ijerph192114377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 06/16/2023]
Abstract
Migrant populations are one of the vulnerable groups to HIV transmission and its consequences. They are also reported to experience delayed entry or linkage into HIV services and have poorer HIV-related health outcomes. This study aimed to understand barriers to accessing HIV care services in host countries among Indonesian, male, former (returned) migrant workers living with HIV. The study was carried out from December 2020 to February 2021. It utilised a qualitative design employing in-depth interviews to collect data from twenty-two returned migrant workers from Eastern Indonesia, recruited using the snowball sampling technique. A qualitative data analysis framework was used to guide a step-by-step analysis of the findings. Findings demonstrated that limited host-country language proficiency, lack of knowledge regarding healthcare systems in host countries and having 'undocumented' worker status were barriers to accessing HIV care services. Data also revealed the unavailability of HIV care services nearby migrants' work locations, long-distance travel to healthcare facilities, and challenges in accessing public transportation as barriers that impeded their access to the services. Other factors limiting the participants' access to HIV services were identified as the transient and mobile nature of migrant work requiring frequent relocation and disrupting work-life stability. Additionally, in lieu of formal HIV services, many participants self-medicated by using over-the-counter herbal or 'traditional' medicines, often because of peer or social group influence regarding the selection of informal treatment options. Recommendations arising from this study demonstrate the need to improve pre-departure information for migrant workers regarding the healthcare system and access procedures in potential host countries. Data from this study also indicate that social services should be available to assist potential migrants to access legal channels for migrant work overseas, to ensure that Indonesian migrants can safely access healthcare services in the countries for which they are providing migrant labour. Future studies to understand barriers to accessing HIV care services among various migrant groups living with HIV are warranted to build evidence for potential social policy change.
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Affiliation(s)
- Nelsensius Klau Fauk
- Research Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide 5000, Australia
- Institute of Resource Governance and Social Change, Kupang 85227, Indonesia
| | - Hailay Abrha Gesesew
- Research Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide 5000, Australia
- College of Health Sciences, Mekelle University, Mekelle 1871, Ethiopia
| | - Alfonsa Liquory Seran
- Atapupu Public Health Centre, Health Department of Belu District, Atambua 85752, Indonesia
| | - Christopher Raymond
- Research Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide 5000, Australia
| | - Roheena Tahir
- College of Medicine and Public Health, Flinders University, Adelaide 5042, Australia
| | - Paul Russell Ward
- Research Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide 5000, Australia
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Ghasemi E, Rajabi F, Negarandeh R, Vedadhir A, Majdzadeh R. HIV, migration, gender, and drug addiction: A qualitative study of intersectional stigma towards Afghan immigrants in Iran. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e1917-e1925. [PMID: 34725886 DOI: 10.1111/hsc.13622] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 10/09/2021] [Accepted: 10/12/2021] [Indexed: 06/13/2023]
Abstract
HIV-related stigma has been identified as a major barrier to the diagnosis, prevention, and treatment of HIV among immigrants. The intersection of HIV with other forms of stigma can lead to greater inequality in health outcomes and access to health services. This study aimed to improve the understanding of HIV stigma towards Afghan immigrants in Iran through an intersectional perspective. The data were collected using 25 semi-structured interviews with the following three groups: Afghan immigrants who were diagnosed with or at risk of HIV infection due to injection drug addiction or having multiple sexual partners (n = 8), HIV service providers (n = 8), and policymakers/managers/experts (n = 9). Thematic analysis was used for data analysis. The participants described different manifestations of stigma (internalized, anticipated, perceived, experienced stigma, and discrimination) associated with HIV and interlocked with other aspects of stigma, including migration, gender, and drug addiction. According to the results, the intersection of different layers of stigma should be taken into account while designing and implementing HIV prevention and treatment programmes. It was also recommended to conduct the necessary interventions such as comprehensive HIV education, social support, as well as peer and outreach services to reduce stigma and discrimination based on the immigrants' needs as well as cultural and social values.
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Affiliation(s)
- Elham Ghasemi
- Community-Based Participatory Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Rajabi
- Community-Based Participatory Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Center for Academic and Health Policy, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Negarandeh
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - AbouAli Vedadhir
- Department of Anthropology, Faculty of Social Sciences, University of Tehran, Tehran, Iran
- Population Health Sciences, University of Bristol, Bristol, UK
- Center of Excellence in Health Sociology (CEHS), University of Tabriz, Tabriz, Iran
| | - Reza Majdzadeh
- Community-Based Participatory Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
- School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Ghasemi E, Rajabi F, Majdzadeh R, Vedadhir A, Negarandeh R. Aspects Influencing Access to HIV/AIDS Services among Afghan Immigrants in Iran: A Qualitative Study. INTERNATIONAL JOURNAL OF COMMUNITY BASED NURSING AND MIDWIFERY 2022; 10:172-183. [PMID: 35855384 PMCID: PMC9287570 DOI: 10.30476/ijcbnm.2021.91724.1805] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/23/2021] [Accepted: 10/25/2021] [Indexed: 12/05/2022]
Abstract
BACKGROUND A successful response to the risk of human immunodefficiency virus (HIV) infection among immigrants requires improved access to HIV prevention, diagnosis, and treatment services. However, most immigrants face significant challenges in accessing HIV/AIDS services. The aim of this study was to explore the aspects influencing access to HIV/AIDS services among Afghan immigrants in Iran. METHODS This was a qualitative study using conventional content analysis that was conducted from June 2018 to April 2020 in Tehran, Iran. Purposeful sampling method was performed. We conducted 25 semi-structured interviews with three groups of stakeholders including Afghan immigrants infected with or at risk of HIV (n=8), service providers (n=8), and policymakers/managers/experts (n=9). Inductive qualitative content analysis was applied according to the Granheim and Lundman method. Data were analyzed using Open Code software version 4.03. RESULTS Aspects influencing access to HIV/AIDS health services were categorized into 3 themes (that were extracted from 9 categories): 1. Cultural aspects (cultural similarities and differences, values and beliefs); 2. Psychosocial aspects (social support, stigma and discrimination); and 3. Service delivery related aspects (awareness, health services coverage and integrity, health services financing, accessibility, and continuity of care). CONCLUSION The findings suggest that efforts to improve Afghan immigrants' access to HIV/AIDS health services in Iran need to consider the cultural aspects, increasing HIV awareness, providing support, reducing stigma and discrimination, and improving health services coverage, integrity, financing, and continuity of accessible services.
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Affiliation(s)
- Elham Ghasemi
- Community-Based Participatory Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Rajabi
- Community-Based Participatory Research Center, Tehran University of Medical Sciences, Tehran, Iran,
Center for Academic and Health Policy, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Majdzadeh
- Community-Based Participatory Research Center, Tehran University of Medical Sciences, Tehran, Iran,
Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran,
Department of Epidemiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - AbouAli Vedadhir
- Department of Anthropology, School of Social Sciences, University of Tehran, Tehran, Iran,
Honorary Senior Research Fellow, Population Health Sciences, University of Bristol, Canynge Hall, UK,
Center of Excellence in Health Sociology (CEHS), University of Tabriz, Tabriz, Iran
| | - Reza Negarandeh
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
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Mamulwar M, Prasad VS, Nirmalkar A, Goli S, Jadhav S, Kumbhar S, Kale V, Michael E, Ford TM, Nazarov D, Honig L, Gangakhedkar R, Thakar M. Community-based point-of-care testing to identify new HIV infections: A cross-sectional study from Pune, India. Medicine (Baltimore) 2021; 100:e27817. [PMID: 34797308 PMCID: PMC8601338 DOI: 10.1097/md.0000000000027817] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 08/10/2021] [Accepted: 10/29/2021] [Indexed: 01/05/2023] Open
Abstract
ABSTRACT The World Health Organization recommends point-of-care testing (POCT) to detect human immunodeficiency virus (HIV) infected individuals in the community. This will help improve treatment coverage through detection of HIV infection among those who are unaware of their status.This study was planned with an objective to investigate the feasibility and acceptability of POCT for HIV in the community.A community-based cross-sectional study was conducted in rural and peri-urban areas of Pune, India. These sites were selected based on the distance from the nearest HIV testing center. Testing locations were identified in consultation with the local stakeholders and grass-root health workers to identify and capture the priority population. The POCT was performed on blood samples collected by the finger-prick method.The proportion of participants seeking HIV tests for the first time was 79.6% that signifies the feasibility of POCT. The acceptability in the peri-urban and rural areas was 70.2% and 69.7%, respectively. POCT was performed at construction sites (24.9%), nearby industries (16.1%) and parking areas of long-distance trucks (8.1%) in the peri-urban area. Three newly diagnosed HIV-infected participants (0.1%) were detected from the peri-urban areas but none from the rural areas. Two of the newly diagnosed participants and their spouses were linked to care.There was a high acceptability of POCT and wider coverage of priority population with a strategy of testing at places preferable to the study population. Therefore, we believe that community-based POCT is a promising tool for improving HIV testing coverage even in low prevalence settings with the concentrated HIV epidemic.
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Affiliation(s)
- Megha Mamulwar
- ICMR National AIDS Research Institute, Bhosari, Pune, India
| | | | - Amit Nirmalkar
- ICMR National AIDS Research Institute, Bhosari, Pune, India
| | - Sarita Goli
- ICMR National AIDS Research Institute, Bhosari, Pune, India
| | - Sachin Jadhav
- ICMR National AIDS Research Institute, Bhosari, Pune, India
| | | | - Varsha Kale
- ICMR National AIDS Research Institute, Bhosari, Pune, India
| | | | | | | | - Lyle Honig
- AIDS Healthcare Foundation, New Delhi, India
| | | | - Madhuri Thakar
- ICMR National AIDS Research Institute, Bhosari, Pune, India
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Joshi RK, Mehendale SM. Determinants of consistently high HIV prevalence in Indian Districts: A multi-level analysis. PLoS One 2019; 14:e0216321. [PMID: 31063471 PMCID: PMC6504102 DOI: 10.1371/journal.pone.0216321] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 04/19/2019] [Indexed: 01/12/2023] Open
Abstract
Introduction Factors associated with persistently high Human Immunodeficiency Virus (HIV) prevalence levels in several districts of India are not well understood. This study was undertaken to determine the association of socio-demographic characteristics, economic factors, awareness about HIV and Sexually Transmitted Infections (STIs), and condom use with consistently high HIV prevalence in the Indian districts and to ascertain whether these associations differed across various regions of India. Methods This study was carried out including all 640 districts of India. Secondary analysis of data obtained from the Census of India-2011, HIV Sentinel Surveillance in India and District Level Household Survey-III was done. Population profile, socio-economic characteristics, levels of HIV/STI/condom awareness and condom use, were compared between the districts with and without consistently high HIV prevalence. Due to the presence of collinearity among predictor variables, we used principal component analysis and the principal component scores were included as covariates for further analysis. Considering the districts at level 1 and the regions at level 2, multi-level analysis was done by generalised linear mixed models. Variance partition coefficient and median odds ratio were also calculated. Results Sixty-three districts with consistently high HIV prevalence were found clustered in the South and the North-east regions of India. Population size, density and urbanisation were found to be positively associated with consistently high HIV prevalence in these districts. Higher levels of literacy, better socio-economic status, higher proportion of population in reproductive age group and late marriages were positively associated with consistently high HIV prevalence in all regions of India except in the Southern region. Higher levels of knowledge about the role of condoms in HIV prevention and condom use were associated with low HIV prevalence at the district level. Conclusions Considerable heterogeneity among factors associated with consistently high HIV prevalence at the district level in different regions of India necessitates special region-specific strategies for HIV control. Increasing awareness about HIV alone is not sufficient for controlling the HIV epidemic and there is a need to raise knowledge levels about preventive measures against HIV and promote the use of condoms amongst population.
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Affiliation(s)
- Rajneesh Kumar Joshi
- Symbiosis International University, Pune, India
- National AIDS Research Institute (ICMR), Pune, India
- * E-mail:
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Shin SS, Carpenter CL, Ekstrand ML, Wang Q, Grover S, Zetola NM, Yadav K, Sinha S, Nyamathi AM. Cervical cancer awareness and presence of abnormal cytology among HIV-infected women on antiretroviral therapy in rural Andhra Pradesh, India. Int J STD AIDS 2019; 30:586-595. [PMID: 30813859 DOI: 10.1177/0956462419825950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cervical cancer is a leading cause of death among women in low- and middle-income countries, and women living with HIV are at high risk for cervical cancer. The objective of this study was to estimate the prevalence and correlates of cervical cancer and pre-cancer lesions and to examine cervical cancer knowledge among women living with HIV receiving antiretroviral therapy in rural Andhra Pradesh, India. We conducted cytology-based screening and administered a standardized questionnaire among 598 HIV-infected women. We found 5 (0.8%), 39 (6.5%), 29 (4.9%), and 4 (0.7%) had atypical squamous cells of undetermined significance (ASCUS), low-grade squamous intraepithelial lesion (LSIL), high-grade squamous intraepithelial lesion (HSIL), and squamous cervical carcinoma (SCC), respectively. In multivariable logistic regression analysis, ASCUS/LSIL was independently associated with age >16 years old at first sexual encounter and smokeless tobacco use. We found no factors associated with HSIL/SCC. In total, 101 women (16.9%) had heard of cervical cancer and 28 (27.7%) of them correctly identified HIV infection as a risk factor. In light of the high prevalence of pre-cancer lesions and low level of cervical cancer knowledge in our study population, focused interventions are needed to improve cervical cancer literacy and prevention among rural women living with HIV.
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Affiliation(s)
- Sanghyuk S Shin
- 1 Sue & Bill Gross School of Nursing, University of California, Irvine, CA, USA
| | | | - Maria L Ekstrand
- 3 Center for AIDS Prevention Studies, University of California, San Francisco, CA, USA
| | - Qiao Wang
- 1 Sue & Bill Gross School of Nursing, University of California, Irvine, CA, USA
| | - Surbhi Grover
- 4 Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,5 Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
| | - Nicola M Zetola
- 4 Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,5 Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
| | - Kartik Yadav
- 1 Sue & Bill Gross School of Nursing, University of California, Irvine, CA, USA
| | - Sanjeev Sinha
- 6 Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Adeline M Nyamathi
- 1 Sue & Bill Gross School of Nursing, University of California, Irvine, CA, USA
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Rai T, Lambert HS, Ward H. Migration as a risk and a livelihood strategy: HIV across the life course of migrant families in India. Glob Public Health 2016; 12:381-395. [PMID: 27002744 PMCID: PMC5327870 DOI: 10.1080/17441692.2016.1155635] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Migrant workers are understood to be vulnerable to HIV. However, little is known about the experience of migration-based households following HIV infection. This qualitative study examined the migration-HIV relationship beyond the point of infection, looking at how it affects livelihood choices, household relationships and the economic viability of migrant families. We conducted semi-structured interviews with 33 HIV-positive migrant men and women recruited from an anti-retroviral therapy (ART) centre in north India. Following infection among the migrant men, contact with free, public-sector HIV services was often made late, after the development of debilitating symptoms, abandonment of migrant work and return to native villages. After enrolment at the ART centre participants’ health eventually stabilised but they now faced serious economic debt, an inflexible treatment regimen and reduced physical strength. Insecure migrant job markets, monthly drug collection and discriminatory employment policies impeded future migration plans. HIV-positive wives of migrants occupied an insecure position in the rural marital household that depended on their husbands’ health and presence of children. The migration-HIV relationship continued to shape the life course of migrant families beyond the point of infection, often exposing them again to the economic insecurity that migration had helped to overcome, threatening their long-term survival.
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Affiliation(s)
- Tanvi Rai
- a School of Public Health , Imperial College London , London , UK
| | - Helen S Lambert
- b School of Social and Community Medicine , University of Bristol , Bristol , UK
| | - Helen Ward
- a School of Public Health , Imperial College London , London , UK
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