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Li K, Thaweesee N, Kimmel A, Dorward E, Dam A. Barriers and facilitators to utilizing HIV prevention and treatment services among migrant youth globally: A scoping review. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002851. [PMID: 38354206 PMCID: PMC10866458 DOI: 10.1371/journal.pgph.0002851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 01/04/2024] [Indexed: 02/16/2024]
Abstract
Both migrants and young people experience disproportionately high rates of HIV acquisition and poor access to HIV prevention and treatment services. To develop effective interventions and reach epidemic control, it is necessary to understand the barriers and facilitators to accessing HIV services among migrant youth. We conducted a scoping review to identify these factors for migrant youth ages 15-24, globally. We conducted a PRISMA-concordant scoping review using keyword searches in PUBMED and Web of Science for peer-reviewed primary literature published between January 2012 and October 2022. We included studies that investigated barriers and facilitators to accessing services for migrant youth participants. We used the Socio-Ecological Model as an analytical framework. The 20 studies meeting the inclusion criteria spanned 10 countries, of which 80% (n = 16) were low- and middle-income countries. Study methods included were quantitative (40%), qualitative (55%), and mixed methods (5%). Six studies included refugee youth (30%), 6 included migrant worker youth (30%), 3 included immigrant youth (15%), 2 included rural migrant youth (10%), and 1 included immigrants and refugees. The remainder represented unspecified migrant youth populations (10%). At the individual level, education level and fear of infection acted as barriers and facilitators to HIV services. At the relationship level, social support and power in relationships acted as barriers and facilitators to HIV services. At the community level, barriers to HIV services included discrimination and stigma, while community and religious outreach efforts facilitated access to HIV services. At the structural level, barriers to HIV services included stigmatizing social norms, lack of health insurance, and legal barriers. Migrant youth face significant, unique barriers to accessing HIV services. However, facilitators exist that can be leveraged to enable access. Future implementation science research, enabling policies, and adapted programmatic interventions should prioritize migrant youth as a distinctive sub-population to receive targeted HIV services.
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Affiliation(s)
- Kevin Li
- Office of HIV/AIDS, United States Agency for International Development, Washington, District of Columbia, United States of America
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- STAR, Public Health Institute, Washington, District of Columbia, United States of America
| | - Natasha Thaweesee
- Office of HIV/AIDS, United States Agency for International Development, Washington, District of Columbia, United States of America
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, United States of America
- GHTASC, Credence LLC, Washington, District of Columbia, United States of America
| | - Allison Kimmel
- Office of HIV/AIDS, United States Agency for International Development, Washington, District of Columbia, United States of America
- STAR, Public Health Institute, Washington, District of Columbia, United States of America
| | - Emily Dorward
- Office of HIV/AIDS, United States Agency for International Development, Washington, District of Columbia, United States of America
| | - Anita Dam
- Office of HIV/AIDS, United States Agency for International Development, Washington, District of Columbia, United States of America
- GHTASC, Credence LLC, Washington, District of Columbia, United States of America
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2
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Wells N, Murphy D, Ellard J, Philpot SP, Prestage G. HIV Diagnosis as Both Biographical Disruption and Biographical Reinforcement: Experiences of HIV Diagnoses Among Recently Diagnosed People Living With HIV. QUALITATIVE HEALTH RESEARCH 2023; 33:165-175. [PMID: 36633974 DOI: 10.1177/10497323221146467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Despite the potential for HIV treatments to transform the health needs of people living with HIV, receiving a positive HIV diagnosis can be a difficult experience and feelings of shock, distress and concerns for the future are commonly reported. Drawing on Michael Bury's conceptualisation of 'biographical disruption', we utilised semi-structured interviews to explore experiences of HIV diagnoses among 34 people diagnosed with HIV between 2016 and 2020 and living in Australia. Interviews were conducted between January 2018 and August 2021. Despite significant advances in biomedical HIV treatments and prevention, participants commonly experienced HIV diagnosis as emotionally challenging. For those with limited HIV awareness, HIV was commonly understood as a likely fatal condition. For some participants, receiving a positive diagnosis also engendered a degree of uncertainty as to their anticipated life trajectory, particularly its impact on future sexual and romantic relationships, options for starting a family and migration opportunities. For some gay and bisexual male participants, receiving a positive diagnosis almost confirmed a life trajectory that they had worked to avoid and their own sometimes-negative attitudes toward people living with HIV were internalised, making adjusting to diagnosis more complex. While all participants reported challenges in adjusting to an HIV diagnosis, some ultimately came to experience living with HIV as bringing about unexpected and welcome changes to their lives. Our findings highlight the complex and intersecting medical, social and emotional needs of people living with HIV when receiving and adjusting to a positive HIV diagnosis.
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Affiliation(s)
- Nathanael Wells
- HIV Epidemiology and Prevention Program, 2786Kirby Institute, University of NSW, Sydney, NSW, Australia
| | - Dean Murphy
- HIV Epidemiology and Prevention Program, 2786Kirby Institute, University of NSW, Sydney, NSW, Australia
| | - Jeanne Ellard
- 110434Australian Research Centre in Sex, Health, and Society, Melbourne, VIC, Australia
| | - Steven P Philpot
- HIV Epidemiology and Prevention Program, 2786Kirby Institute, University of NSW, Sydney, NSW, Australia
| | - Garrett Prestage
- HIV Epidemiology and Prevention Program, 2786Kirby Institute, University of NSW, Sydney, NSW, Australia
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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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4
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Philpot SP, Aung E, Templeton DJ, Stackpool G, Varma R, Power C, Robinson S, Stratigos A, Mao L, Grulich AE, Bavinton BR. Experiences of recently HIV-diagnosed gay and bisexual migrants in Australia: Implications for sexual health programmes and health promotion. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e5801-e5810. [PMID: 36107017 PMCID: PMC10087732 DOI: 10.1111/hsc.14011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 06/22/2022] [Accepted: 08/20/2022] [Indexed: 05/24/2023]
Abstract
Gay and bisexual migrants from low- and middle-income countries living in high-income countries are disproportionately diagnosed with HIV. Most research focuses on preventing HIV acquisition among HIV-negative migrant gay and bisexual men (GBM). This study is uniquely positioned to report on migrant GBM's experiences and needs at and after an HIV diagnosis. Semi-structured interviews were conducted with 24 migrant GBM diagnosed at sexual health clinics in Australia from 2017 onwards. Interviews were analysed using a codebook thematic analysis. Due to the stigma of HIV and homosexuality in their countries of origin, about half of participants had poor HIV knowledge prior to diagnosis. Absorbing diagnosis information was consequently difficult, and feelings of shame, hopelessness, lost sexual opportunities and infectiousness were common. However, many were thankful for the comprehensive clinical support they received and believed that over time life would 'normalise' with sustained undetectable viral load. None reported that their clinician stigmatised them, but the anticipation of stigma nonetheless infused their experiences after diagnosis. Many were selective about HIV disclosure, and some mentioned that clinic systems posed a risk to confidentiality. Non-permanent residents were concerned about the impacts of HIV status on future visa applications. We recommend that newly HIV-diagnosed migrant GBM receive referral to legal and culturally appropriate migration services to help absorb what a diagnosis might mean for their health and visa status. We also recommend sexual health clinics continue to assess confidentiality in their systems. Health promotion initiatives should highlight to migrant GBM that high-HIV caseload sexual health clinicians provide confidential and comprehensive care.
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Affiliation(s)
| | - Eithandee Aung
- Kirby InstituteUNSW SydneySydneyNew South WalesAustralia
| | - David J. Templeton
- Kirby InstituteUNSW SydneySydneyNew South WalesAustralia
- Department of Sexual Health Medicine and Sexual Assault Medical ServicesSydney Local Health DistrictSydneyAustralia
- Discipline of Medicine, Faculty of Medicine and Health, Central Clinical SchoolThe University of SydneySydneyAustralia
| | - Gai Stackpool
- Multicultural HIV and Hepatitis ServiceDiversity Programs and Strategy Hub, Population Health, Sydney Local Health DistrictSydneyAustralia
| | - Rick Varma
- Kirby InstituteUNSW SydneySydneyNew South WalesAustralia
- Sydney Sexual Health Centre, Population and Community HealthSouth Eastern Sydney Local Health DistrictSydneyAustralia
| | | | - Sharon Robinson
- Department of Infectious Diseases, Immunology and Sexual HealthSt George HospitalSydneyAustralia
- St George and Sutherland Clinical SchoolUNSW SydneySydneyNew South WalesAustralia
| | | | - Limin Mao
- Centre for Social Research in HealthUNSW SydneyNew South WalesSydneyAustralia
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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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Ziersch A, Walsh M, Baak M, Rowley G, Oudih E, Mwanri L. "It is not an acceptable disease": A qualitative study of HIV-related stigma and discrimination and impacts on health and wellbeing for people from ethnically diverse backgrounds in Australia. BMC Public Health 2021; 21:779. [PMID: 33892683 PMCID: PMC8063420 DOI: 10.1186/s12889-021-10679-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 03/22/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND People from ethnically diverse backgrounds living with HIV are susceptible to adverse health and wellbeing outcomes, particularly as a consequence of HIV-related stigma and discrimination (HSD), though relatively little is known about experiences in Australia. METHODS This paper reports on HSD in ethnically diverse communities in South Australia and impacts on health and wellbeing. Interviews and focus groups were conducted with 10 individuals living with HIV from ethnically diverse backgrounds, 14 ethnically diverse community leaders, and 50 service providers. Data were analysed thematically. RESULTS Findings indicated that HIV is a highly stigmatised condition in ethnically diverse communities due to fear of moral judgment and social isolation, and was experienced at the intersections of gender, sexual orientation, religion, culture, and immigration status. Experiences of HSD were damaging to health and wellbeing through non-disclosure, reduced social support, delayed testing, service access barriers, impacts on treatment adherence, and directly to mental health. CONCLUSIONS Actions addressing the impacts of HSD on people from ethnically diverse backgrounds are crucial.
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Affiliation(s)
- Anna Ziersch
- College of Medicine and Public Health, Flinders University, Adelaide, Australia.
| | - Moira Walsh
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Melanie Baak
- School of Education, University of South Australia, Adelaide, Australia
| | - Georgia Rowley
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Enaam Oudih
- Relationships Australia South Australia, Adelaide, Australia
| | - Lillian Mwanri
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
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7
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Walia AM, Fairley CK, Bradshaw CS, Chen MY, Chow EPF. Disparities in characteristics in accessing public Australian sexual health services between Medicare-eligible and Medicare-ineligible men who have sex with men. Aust N Z J Public Health 2020; 44:363-368. [PMID: 32865864 DOI: 10.1111/1753-6405.13029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 07/01/2020] [Accepted: 07/01/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Accessible health services are a key element of effective human immunodeficiency virus (HIV) and sexually transmitted infection (STI) control. This study aimed to examine whether there were any differences in accessing sexual health services between Medicare-eligible and Medicare-ineligible men who have sex with men (MSM) in Melbourne, Australia. METHODS We conducted a retrospective, cross-sectional study of MSM attending Melbourne Sexual Health Centre between 2016 and 2019. Demographic characteristics, sexual practices, HIV testing practices and STI diagnoses were compared between Medicare-eligible and Medicare-ineligible MSM. RESULTS We included 5,085 Medicare-eligible and 2,786 Medicare-ineligible MSM. Condomless anal sex in the past 12 months was more common in Medicare-eligible compared to Medicare-ineligible MSM (74.4% vs. 64.9%; p<0.001) although the number of partners did not differ between groups. There was no difference in prior HIV testing practices between Medicare-eligible and Medicare-ineligible MSM (76.1% vs. 77.7%; p=0.122). Medicare-ineligible MSM were more likely to have anorectal chlamydia compared to Medicare-eligible MSM (10.6% vs. 8.5%; p=0.004). CONCLUSIONS Medicare-ineligible MSM have less condomless sex but a higher rate of anorectal chlamydia, suggesting they might have limited access to STI testing or may be less willing to disclose high-risk behaviour. Implications for public health: Scaling up access to HIV and STI testings for Medicare-ineligible MSM is essential.
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Affiliation(s)
- Anysha M Walia
- Melbourne Sexual Health Centre, Alfred Health, Victoria.,Central Clinical School, Monash University, Victoria
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Victoria.,Central Clinical School, Monash University, Victoria
| | - Catriona S Bradshaw
- Melbourne Sexual Health Centre, Alfred Health, Victoria.,Central Clinical School, Monash University, Victoria
| | - Marcus Y Chen
- Melbourne Sexual Health Centre, Alfred Health, Victoria.,Central Clinical School, Monash University, Victoria
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Victoria.,Central Clinical School, Monash University, Victoria.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Victoria
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8
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Gray C, Crawford G, Lobo R, Maycock B. Co-Designing an Intervention to Increase HIV Testing Uptake with Women from Indonesia At-Risk of HIV: Protocol for a Participatory Action Research Study. Methods Protoc 2019; 2:E41. [PMID: 31164620 PMCID: PMC6632167 DOI: 10.3390/mps2020041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 05/20/2019] [Accepted: 05/20/2019] [Indexed: 01/05/2023] Open
Abstract
Early diagnosis is a critical component of the global response to the human immunodeficiency virus (HIV). In Australia, more than two-thirds of women from Southeast Asia are diagnosed late with HIV. There is limited evidence regarding the barriers to HIV testing and which interventions work to increase an uptake among migrants living in high-income countries. This participatory action research (PAR) project will work with women from Indonesia to co-design an intervention to increase HIV testing uptake in Western Australia. The project will involve trained community researchers, representatives from relevant organizations, and community women born in Indonesia. We will conduct three PAR cycles. Phase one will use focus groups to understand enablers for HIV testing among community members. In phase two, data will be presented back to members of the participating communities who will be invited to co-design an intervention to increase HIV testing. The final cycle will focus on implementing and evaluating the resulting intervention. This project will add to the small body of literature on pathways and enablers to HIV testing, and to new insights regarding interventions that work for women from migrant communities and why.
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Affiliation(s)
- Corie Gray
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, 6102 Bentley, Australia.
| | - Gemma Crawford
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, 6102 Bentley, Australia.
| | - Roanna Lobo
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, 6102 Bentley, Australia.
| | - Bruce Maycock
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, 6102 Bentley, Australia.
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9
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Ghimire S, Hallett J, Gray C, Lobo R, Crawford G. What Works? Prevention and Control of Sexually Transmitted Infections and Blood-Borne Viruses in Migrants from Sub-Saharan Africa, Northeast Asia and Southeast Asia Living in High-Income Countries: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E1287. [PMID: 30974851 PMCID: PMC6480002 DOI: 10.3390/ijerph16071287] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 04/03/2019] [Accepted: 04/05/2019] [Indexed: 01/05/2023]
Abstract
Migration is a significant risk factor for the acquisition of human immunodeficiency virus (HIV), hepatitis B virus (HBV) and other sexually transmitted infections (STIs). An increasing proportion of these infections in high-income countries, such as Australia, are among migrants moving from low and middle-income countries with a high prevalence of HIV, HBV and other STIs. This systematic review explored the prevention and control of HIV, HBV and other STIs in migrants (>18 years) from Southeast Asia, Northeast Asia and sub-Saharan Africa living in high-income countries with universal health care. This systematic review followed PRISMA guidelines and was registered with PROSPERO. Six academic databases were searched for articles published between 2002 and 2018. Sixteen peer-reviewed articles met the inclusion criteria, consisting of fourteen quantitative and two qualitative studies conducted in Australia, the Netherlands, Canada, Spain, Italy, and Germany. Three levels of interventions were identified: individual, community and structural interventions. Most studies addressed factors at an individual level; interventions were most commonly outreach testing for HIV, HBV and other STIs. Few studies addressed structural factors or demonstrated comprehensive evaluation of interventions. Limited population-specific findings could be determined. To prevent further transmission of HIV, HBV and other STIs, comprehensive public health approaches must consider the complex interactions between migration, health care system determinants, and broader socioeconomic and sociocultural factors.
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Affiliation(s)
- Sajana Ghimire
- School of Public Health, Curtin University, Kent Street, Bentley, Perth, WA 6102, Australia.
| | - Jonathan Hallett
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Kent Street, Bentley, Perth, WA 6102, Australia.
| | - Corie Gray
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Kent Street, Bentley, Perth, WA 6102, Australia.
| | - Roanna Lobo
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Kent Street, Bentley, Perth, WA 6102, Australia.
| | - Gemma Crawford
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Kent Street, Bentley, Perth, WA 6102, Australia.
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10
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Gray C, Lobo R, Narciso L, Oudih E, Gunaratnam P, Thorpe R, Crawford G. Why I Can't, Won't or Don't Test for HIV: Insights from Australian Migrants Born in Sub-Saharan Africa, Southeast Asia and Northeast Asia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E1034. [PMID: 30901957 PMCID: PMC6466030 DOI: 10.3390/ijerph16061034] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 03/10/2019] [Accepted: 03/15/2019] [Indexed: 12/18/2022]
Abstract
People born in sub-Saharan Africa and Southeast Asia are overrepresented in HIV notifications in Australia. Just under half of all notifications among people from sub-Saharan Africa and Southeast Asia are diagnosed late. Increased HIV testing among these communities is necessary to ensure early diagnosis, better care and reduce likelihood of HIV onward transmission. Recently, Australia has made new HIV testing methods available: rapid HIV testing and self-testing kits. We conducted 11 focus groups with 77 participants with people from sub-Saharan Africa, Southeast Asia and Northeast Asia in four jurisdictions in Australia. Focus groups discussed barriers to HIV testing and the acceptability of new testing methods. Barriers to HIV testing included: cost and eligibility of health services, low visibility of HIV in Australia, HIV-related stigma, and missed opportunities by general practitioners (GPs) for early diagnosis of HIV and linkage into care. Participants had low levels of knowledge on where to test for HIV and the different methods available. Diverse opportunities for testing were considered important. Interventions to increase HIV testing rates among sub-Saharan African, Southeast Asia and Northeast Asian migrants in Australia need to be multi-strategic and aimed at individual, community and policy levels. New methods of HIV testing, including rapid HIV testing and self-testing, present an opportunity to engage with migrants outside of traditional health care settings.
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Affiliation(s)
- Corie Gray
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Kent Street, Bentley, WA 6102, Australia.
| | - Roanna Lobo
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Kent Street, Bentley, WA 6102, Australia.
| | - Lea Narciso
- Communicable Disease Control Branch, Public Health and Clinical Systems, Department for Health and Wellbeing, Government of South Australia, Adelaide, SA 5000, Australia.
| | - Enaam Oudih
- PEACE Multicultural Services, Relationships Australia South Australia, Adelaide, SA 5000, Australia.
| | - Praveena Gunaratnam
- The Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia.
| | - Rachel Thorpe
- Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, VIC 3086, Australia.
| | - Gemma Crawford
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Kent Street, Bentley, WA 6102, Australia.
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Rade DA, Crawford G, Lobo R, Gray C, Brown G. Sexual Health Help-Seeking Behavior among Migrants from Sub-Saharan Africa and South East Asia living in High Income Countries: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E1311. [PMID: 29932158 PMCID: PMC6069090 DOI: 10.3390/ijerph15071311] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 06/18/2018] [Accepted: 06/18/2018] [Indexed: 12/30/2022]
Abstract
The number of migrants has increased globally. This phenomenon has contributed to increasing health problems amongst migrants in high-income countries, including vulnerability for HIV acquisition and other sexual health issues. Adaptation processes in destination countries can present difficulties for migrants to seek help from and gain access to health services. This study examined migrants’ from sub-Saharan Africa (SSA) and South East Asia (SEA) sexual health help-seeking behavior in high-income countries with universal health coverage. The systematic review followed PRISMA guidelines and was registered with PROSPERO. Several databases were searched from 2000 to 2017. Of 2824 studies, 15 met the inclusion criteria. These consisted of 12 qualitative and three quantitative studies conducted in Australia, Spain, the United Kingdom, Belgium, Scotland, Ireland, and Sweden. Migrants experienced a range of difficulties accessing health services, specifically those related to sexual health, in high-income countries. Few studies described sources of sexual health help-seeking or facilitators to help-seeking. Barriers to access were numerous, including: stigma, direct and indirect costs, difficulty navigating health systems in destination countries and lack of cultural competency within health services. More culturally secure health services, increased health service literacy and policy support to mitigate costs, will improve health service access for migrants from SSA and SEA. Addressing the structural drivers for stigma and discrimination remains an ongoing and critical challenge.
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Affiliation(s)
- Donna Angelina Rade
- School of Public Health, Curtin University, Kent Street, Bentley, WA 6102, Australia.
| | - Gemma Crawford
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Kent Street, Bentley, WA 6102, Australia.
| | - Roanna Lobo
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Kent Street, Bentley, WA 6102, Australia.
| | - Corie Gray
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Kent Street, Bentley, WA 6102, Australia.
| | - Graham Brown
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Kent Street, Bentley, WA 6102, Australia.
- Australian Research Centre in Sex, Health and Society School of Psychology and Public Health, La Trobe University, Bundoora, VIC 3086, Australia.
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12
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Gray C, Crawford G, Reid A, Lobo R. HIV knowledge and use of health services among people from South-East Asia and sub-Saharan Africa living in Western Australia. Health Promot J Austr 2018; 29:274-281. [PMID: 29687507 DOI: 10.1002/hpja.168] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 04/16/2018] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND HIV notifications among people born in sub-Saharan Africa and South-East Asia have increased in Australia in the last decade. People born in these regions have the highest rates of HIV diagnosis by region of birth and are overrepresented in late or advanced presentation of HIV infection. METHODS This study developed and tested a questionnaire for reliability through test-retest. A cross-sectional survey using intercept and online recruitment of HIV knowledge and use of health services was then undertaken among people born in sub-Saharan Africa and South-East Asia, who had arrived in Australia less than 10 years ago and were living in Western Australia (n = 209). Results were reported on by gender and length of time in Australia. RESULTS Participants had a reasonable knowledge of HIV transmission, but held a number of incorrect beliefs. Two-thirds (65%) of participants reported a barrier to accessing health services in Australia. Just over a third (34%) of participants had ever tested for HIV, despite indicating that they believed HIV testing was important. CONCLUSIONS This project indicates a very low rate of HIV testing among this priority population. Further action is required to improve early diagnosis of HIV and reduce onward transmission of HIV infection within these communities. SO WHAT?: We need targeted interventions that extend beyond knowledge to increase HIV testing rates among this population.
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Affiliation(s)
- Corie Gray
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Bentley, WA, Australia
| | - Gemma Crawford
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Bentley, WA, Australia
| | - Alison Reid
- School of Public Health, Curtin University, Bentley, WA, Australia
| | - Roanna Lobo
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Bentley, WA, Australia
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13
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Botfield JR, Newman CE, Zwi AB. Drawing them in: professional perspectives on the complexities of engaging 'culturally diverse' young people with sexual and reproductive health promotion and care in Sydney, Australia. CULTURE, HEALTH & SEXUALITY 2017; 19:438-452. [PMID: 27665932 DOI: 10.1080/13691058.2016.1233354] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Young people from minority ethnic, migrant and refugee backgrounds are widely recognised as being under-served by mainstream sexual and reproductive healthcare in developed economy nations. This paper documents the views of professionals in Australia on the complexities of, and best practice approaches to, engaging members of this group with sexual and reproductive health promotion and care. Semi-structured interviews were conducted with 23 purposively selected key informants (health service providers, policymakers, academics and community advocates). Interviews were transcribed verbatim and coded in NVivo10 using interpretive thematic analysis. Principles of 'cultural competence' were employed to structure the interpretation of findings. Five key themes reveal pivotal aspects of how professionals work in, and make sense of, this complex field. These may be summarised as: (1) appreciating the complexities of cultural diversity; (2) recognising structural barriers and disincentives to engagement; (3) normalising sexual health; (4) balancing 'youth-friendly' and 'culturally-competent' priorities; and (5) going beyond simple translation. As migration to Australia continues to diversify the population, an integrated, national approach to the design and delivery of sexual and reproductive health promotion and care would be of value, along with training and support for those involved. Implications may have resonance for other countries similarly engaged in facilitating the successful settlement of migrants and refugees.
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Affiliation(s)
- Jessica R Botfield
- a Health, Rights and Development, School of Social Sciences , UNSW Australia , Kensington , Australia
| | - Christy E Newman
- b Centre for Social Research in Health , UNSW Australia , Kensington , Australia
| | - Anthony B Zwi
- a Health, Rights and Development, School of Social Sciences , UNSW Australia , Kensington , Australia
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Mey A, Plummer D, Dukie S, Rogers GD, O'Sullivan M, Domberelli A. Motivations and Barriers to Treatment Uptake and Adherence Among People Living with HIV in Australia: A Mixed-Methods Systematic Review. AIDS Behav 2017; 21:352-385. [PMID: 27826734 DOI: 10.1007/s10461-016-1598-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
In Australia, approximately 30% of people diagnosed with HIV are not accessing treatment and 8% of those receiving treatment fail to achieve viral suppression. Barriers limiting effective care warrant further examination. This mixed-methods systematic review accessed health and social sector research databases between November and December 2015 to identify studies that explored the perspective of people living with HIV in Australia. Articles were included for analysis if they described the experiences, knowledge, attitudes and beliefs, in relation to treatment uptake and adherence, published between January 2000 and December 2015. Quality appraisal utilised the Mixed Methods Appraisal Tool Version 2011. Seventy-two studies that met the inclusion criteria were reviewed. The interplay of lack of knowledge, fear, stigma, physical, emotional and social issues were found to negatively impact treatment uptake and adherence. Strategies targeting both the individual and the wider community are needed to address these barriers.
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Affiliation(s)
- Amary Mey
- School of Medicine, Griffith University, Gold Coast Campus, Southport, QLD, Australia.
| | - David Plummer
- School of Medicine, Griffith University, Gold Coast Campus, Southport, QLD, Australia
| | - Shailendra Dukie
- School of Pharmacy, Griffith University, Gold Coast Campus, Southport, QLD, Australia
| | - Gary D Rogers
- School of Medicine, Griffith University, Gold Coast Campus, Southport, QLD, Australia
| | - Maree O'Sullivan
- Gold Coast Hospital and Health Service, Southport, QLD, Australia
| | - Amber Domberelli
- School of Medicine, Griffith University, Gold Coast Campus, Southport, QLD, Australia
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15
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Subsidized optimal ART for HIV-positive temporary residents of Australia improves virological outcomes: results from the Australian HIV Observational Database Temporary Residents Access Study. J Int AIDS Soc 2015; 18:19392. [PMID: 25680919 PMCID: PMC4327894 DOI: 10.7448/ias.18.1.19392] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 11/13/2014] [Accepted: 11/28/2014] [Indexed: 11/30/2022] Open
Abstract
Introduction HIV-positive (HIV+) temporary residents living in Australia legally are unable to access government subsidized antiretroviral treatment (ART) which is provided via Medicare to Australian citizens and permanent residents. Currently, there is no information systematically being collected on non-Medicare eligible HIV+ patients in Australia. The objectives of this study are to describe the population recruited to the Australian HIV Observational Database (AHOD) Temporary Residents Access Study (ATRAS) and to determine the short- and long-term outcomes of receiving (subsidized) optimal ART and the impact on onwards HIV transmission. Methods ATRAS was established in 2011. Eligible patients were recruited via the AHOD network. Key HIV-related characteristics were recorded at baseline and prospectively. Additional visa-related information was also recorded at baseline, and updated annually. Descriptive statistics were used to describe the ATRAS cohort in terms of visa status by key demographic characteristics, including sex, region of birth, and HIV disease status. CD4 cell count (mean and SD) and the proportion with undetectable (<50 copies/ml) HIV viral load are reported at baseline, 6 and 12 months of follow-up. We also estimate the proportion reduction of onward HIV transmission based on the reduction in proportion of people with detectable HIV viral load. Results A total of 180 patients were recruited to ATRAS by June 2012, and by July 2013 39 patients no longer required ART via ATRAS, 35 of whom became eligible for Medicare-funded medication. At enrolment, 63% of ATRAS patients were receiving ART from alternative sources, 47% had an undetectable HIV viral load (<50 copies/ml) and the median CD4 cell count was 343 cells/µl (IQR: 222–479). At 12 months of follow-up, 85% had an undetectable viral load. We estimated a 75% reduction in the risk of onward HIV transmission with the improved rate of undetectable viral load. Conclusions The immunological and virological improvements highlight the importance of supplying optimal ART to this vulnerable population. The increase in proportion with undetectable HIV viral load shows the potentially significant impact on HIV transmission in addition to the personal health benefit for each individual.
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Feigin R, Sapir Y, Patinkin N, Turner D. Breaking through the silence: the experience of living with HIV-positive serostatus, and its implications on disclosure. SOCIAL WORK IN HEALTH CARE 2013; 52:826-845. [PMID: 24117031 DOI: 10.1080/00981389.2013.827143] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
AIDS has reached pandemic proportions and despite advances in medical treatment both the medical and social consequences of HIV-positive serostatus continue to be of concern throughout the world. In countries with greater access to antiretroviral therapy (ARV), HIV/AIDS it is no longer defined as fatal, but rather a chronic disease, thereby this study seeks to understand the experience of individuals living with HIV-positive serostatus, a multifaceted disease, from the time the infection is diagnosed through the four post-diagnosis years, and in particular its implications on the issue of disclosure. A qualitative analysis was conducted, based on 13 in-depth interviews with participants who are HIV-positive and the data was analyzed by inductive content analysis. The results identify six themes, four central elements that compose the experience of living with HIV: the emotional experience, the stigma attached to HIV, the inner dialogue, and disclosure. A three-phase coping process and personality differences were found, all of which will be discussed. The issue of disclosure was found to be cardinal and problematic in its impact on the patient's wellbeing.
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Affiliation(s)
- Rena Feigin
- a Bob Shapell School of Social Work, Tel Aviv University , Tel Aviv , Israel
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17
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McMahon T, Ward PR. HIV among immigrants living in high-income countries: a realist review of evidence to guide targeted approaches to behavioural HIV prevention. Syst Rev 2012; 1:56. [PMID: 23168134 PMCID: PMC3534573 DOI: 10.1186/2046-4053-1-56] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 10/29/2012] [Indexed: 11/10/2022] Open
Abstract
UNLABELLED BACKGROUND Immigrants from developing and middle-income countries are an emerging priority in HIV prevention in high-income countries. This may be explained in part by accelerating international migration and population mobility. However, it may also be due to the vulnerabilities of immigrants including social exclusion along with socioeconomic, cultural and language barriers to HIV prevention. Contemporary thinking on effective HIV prevention stresses the need for targeted approaches that adapt HIV prevention interventions according to the cultural context and population being addressed. This review of evidence sought to generate insights into targeted approaches in this emerging area of HIV prevention. METHODS We undertook a realist review to answer the research question: 'How are HIV prevention interventions in high-income countries adapted to suit immigrants' needs?' A key goal was to uncover underlying theories or mechanisms operating in behavioural HIV prevention interventions with immigrants, to uncover explanations as how and why they work (or not) for particular groups in particular contexts, and thus to refine the underlying theories. The realist review mapped seven initial mechanisms underlying culturally appropriate HIV prevention with immigrants. Evidence from intervention studies and qualitative studies found in systematic searches was then used to test and refine these seven mechanisms. RESULTS Thirty-four intervention studies and 40 qualitative studies contributed to the analysis and synthesis of evidence. The strongest evidence supported the role of 'consonance' mechanisms, indicating the pivotal need to incorporate cultural values into the intervention content. Moderate evidence was found to support the role of three other mechanisms - 'understanding', 'specificity' and 'embeddedness' - which indicated that using the language of immigrants, usually the 'mother tongue', targeting (in terms of ethnicity) and the use of settings were also critical elements in culturally appropriate HIV prevention. There was mixed evidence for the roles of 'authenticity' and 'framing' mechanisms and only partial evidence to support role of 'endorsement' mechanisms. CONCLUSIONS This realist review contributes to the explanatory framework of behavioural HIV prevention among immigrants living in high-income countries and, in particular, builds a greater understanding of the suite of mechanisms that underpin adaptations of interventions by the cultural context and population being targeted.
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Affiliation(s)
- Tadgh McMahon
- Multicultural HIV and Hepatitis Service, PO Box M139, MISSENDEN ROAD, Camperdown, NSW, 2050, Australia
- Discipline of Public Health, School of Medicine, Flinders University, GPO Box 2100, Flinders, SA, 5001, Australia
| | - Paul R Ward
- Discipline of Public Health, School of Medicine, Flinders University, GPO Box 2100, Flinders, SA, 5001, Australia
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Resilience among asylum seekers living with HIV. BMC Public Health 2012; 12:926. [PMID: 23110402 PMCID: PMC3539981 DOI: 10.1186/1471-2458-12-926] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2012] [Accepted: 10/22/2012] [Indexed: 11/24/2022] Open
Abstract
Background A small body of evidence demonstrates the challenges faced by migrant communities living with HIV but has yet to consider in-depth the experience of asylum seekers whose residency status is undetermined. The overall aim of our study was to explore the experiences of those who are both living with HIV and seeking asylum. This paper focuses on the stressors precipitated by the HIV diagnosis and by going through the asylum system; as well as participants’ resilience in responding to these stressors and the consequences for their health and wellbeing. Methods We conducted an ethnographic study. Fieldwork took place in the UK between 2008–2009 and included: 350 hours of observation at voluntary services providing support to black and minority ethnic groups living with HIV; 29 interviews and four focus group discussions with those who were seeking asylum and living with HIV; and 15 interviews with their health and social care providers. Data were analysed using the constant comparative method. Results There were three main stressors that threatened participants’ resilience. First, migration caused them to leave behind many resources (including social support). Second, stigmatising attitudes led their HIV diagnosis to be a taboo subject furthering their isolation. Third, they found themselves trapped in the asylum system, unable to influence the outcome of their case and reliant on HIV treatment to stay alive. Participants were, however, very resourceful in dealing with these experiences. Resilience processes included: staying busy, drawing on personal faith, and the support received through HIV care providers and voluntary organisations. Even so, their isolated existence meant participants had limited access to social resources, and their treatment in the asylum system had a profound impact on perceived health and wellbeing. Conclusions Asylum seekers living with HIV in the UK show immense resilience. However, their isolation means they are often unable to deal with their treatment in the asylum system, with negative consequences for their perceived health and wellbeing.
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Herrmann S, Wardrop J, John M, Gaudieri S, Lucas M, Mallal S, Nolan D. The impact of visa status and Medicare eligibility on people diagnosed with HIV in Western Australia: a qualitative report. Sex Health 2012; 9:407-13. [DOI: 10.1071/sh11181] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Accepted: 04/02/2012] [Indexed: 11/23/2022]
Abstract
Background: In Australia, temporary visa holders are ineligible for Medicare and subsidised antiretroviral drugs. Additionally, HIV testing is not mandatory for visas unless applicants seek work in the health sector. We sought to understand the impact of HIV and issues of access and adherence to antiretroviral therapy (ART) in people holding temporary visas and permanent residents. Methods: Data were gathered from interviews with 22 participants. Information concerning medication adherence, side effects, CD4 T-cell count, viral load and rate of response to generic drugs were collected. Results: The mean age was 33.4 years (±s.d. = 6.0), 21 out of 22 were from HIV-prevalent areas in East Africa and Asia, 14 out of 22 were on temporary visas, 12 were ineligible for Medicare, 14 out of 22 were diagnosed during health screening, 19 out of 22 risk exposures were in country of origin, 8 out of 17 were taking generic ART at an average cost of $180 per month, adherence was excellent and self-reported side-effects were relatively infrequent. Participants applying for visa continuations and permanent residency were fearful, believing their HIV serostatus would prejudice their applications. Patients cited belief in ART efficacy, were motivated to maintain therapy and were anxious about lack of access to treatment in their countries of origin. Conclusion: Adherence to antiretroviral drugs in Medicare-ineligible HIV-infected individuals is excellent despite limited access to treatment. The threat of visa non-renewal and the likely failure of applications for permanent residency result in considerable anxiety and confidentiality concerns.
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Dominicé Dao MI, Ferreira JF, Vallier N, Roulin D, Hirschel B, Calmy A. Health perceptions of African HIV-infected patients and their physicians. PATIENT EDUCATION AND COUNSELING 2010; 80:185-190. [PMID: 19945817 DOI: 10.1016/j.pec.2009.10.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2009] [Revised: 10/27/2009] [Accepted: 10/28/2009] [Indexed: 05/28/2023]
Abstract
OBJECTIVE We explored how patients from Sub Saharan Africa (SSA) infected with HIV and living in Switzerland, and their treating physicians perceived their health, whether these perceptions correlated with biological markers, and what organisational changes participants considered likely to improve quality of care. METHODS A prospective standardized questionnaire was submitted to HIV-infected patients from SSA and their physicians. Results were correlated with biological data. RESULTS While physicians deduced improved health status from laboratory results, these did not provide an adequate surrogate marker of good health for patients. Patients experienced important social and economical difficulties with adverse consequences on their mental health. They requested social assistance, whereas physicians sought improved cultural competency. CONCLUSION Patients and physicians did not agree in their evaluation of patients' health status. Patients did not perceive their health through biological markers, but linked their mental health with their socioeconomic context. Physicians underestimated patients' biological health and their evaluation of global health. PRACTICE IMPLICATIONS Exploring difficulties perceived by physicians with specific patients lead to identification of structural weaknesses, resulting in suggestions to improve physicians' medical training and patients' care. This illustrates the importance of accessing patients' perspective and not relying solely on physicians' perception of the problem.
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Affiliation(s)
- Melissa I Dominicé Dao
- Geneva University Hospitals, Community Medicine and Primary Care Department, Geneva, Switzerland.
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Thomas F, Aggleton P, Anderson J. “If I cannot access services, then there is no reason for me to test”: the impacts of health service charges on HIV testing and treatment amongst migrants in England. AIDS Care 2010; 22:526-31. [DOI: 10.1080/09540120903499170] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Felicity Thomas
- a Thomas Coram Research Unit, Institute of Education , University of London , 27/28 Woburn Square, London , WC1H 0AA , UK
| | - Peter Aggleton
- b School of Education and Social Work , University of Sussex , Sussex , UK
| | - Jane Anderson
- c Department of Sexual Health , Homerton University Hospital , London , UK
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Horyniak D, Stoové M, Yohannes K, Breschkin A, Carter T, Hatch B, Tomnay J, Hellard M, Guy R. The impact of immigration on the burden of HIV infection in Victoria, Australia. Sex Health 2009; 6:123-8. [DOI: 10.1071/sh08088] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2008] [Accepted: 03/09/2009] [Indexed: 11/23/2022]
Abstract
Background: Accurate estimates of the number of people diagnosed and living with HIV infection within a health jurisdiction provide the basis for planning of clinical service provision. Case reporting of new diagnoses does not account for inwards and outwards migration of people with HIV infection, thereby providing an inaccurate basis for planning. Methods: The Victorian passive surveillance system records all cases of HIV diagnosed in Victoria and distinguishes between new Victorian diagnoses (cases whose first ever HIV diagnosis was in Victoria) and cases previously diagnosed interstate and overseas. In order to gain an understanding of the impact of population movement on the burden of HIV infection in Victoria, we compared the characteristics of people first diagnosed in Victoria with those previously diagnosed elsewhere. Results: Between 1994 and 2007 there were 3111 HIV notifications in Victoria, including 212 (7%) ‘interstate diagnoses’ and 124 (4%) ‘overseas diagnoses’. The proportion of cases diagnosed outside Victoria increased from 6.4% between 1994 and 2000 to 13.8% between 2001 and 2007. Compared with ‘new diagnoses’, a larger proportion of ‘interstate diagnoses’ reported male-to-male sex as their HIV exposure, were Australian-born and diagnosed in Victoria at a general practice specialising in gay men’s health. Compared with ‘new diagnoses’, a larger proportion of ‘overseas diagnoses’ were female, reported heterosexual contact as their HIV exposure, and were diagnosed in Victoria at a sexual health clinic. Conclusions: Between 1994 and 2007 more than 10% of Victorian HIV diagnoses were among people previously diagnosed elsewhere. Characteristics of both interstate and overseas diagnoses differed from new diagnoses. Service planning needs to be responsive to the characteristics of people moving to Victoria with previously diagnosed HIV infection.
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Lemoh C, Biggs BA, Hellard M. Working with West African migrant communities on HIV prevention in Australia. Sex Health 2008; 5:313-4. [DOI: 10.1071/sh08060] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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