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Poglia Mileti F, Mellini L, Tadorian M. When social, relational and sexual vulnerabilities increase vulnerability to HIV/AIDS: the case of migrants living in Switzerland. AIDS Care 2024; 36:1002-1009. [PMID: 38088934 DOI: 10.1080/09540121.2023.2289469] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 11/22/2023] [Indexed: 07/25/2024]
Abstract
There is emerging evidence that a significant proportion of migrants acquire HIV after arrival in Europe. Thus, to strengthen prevention efforts, it is crucial to understand migrants' vulnerability to HIV/AIDS. This article contributes to this understanding by analysing the perspectives of prevention actors and migrants. Data were collected through a qualitative and participative research study conducted in Switzerland. Twenty prevention actors and 28 migrants participated in in-depth interviews. Results show that migrants' difficulties in accessing and adopting measures to prevent HIV are related to three types of situational vulnerability that increase their vulnerability to HIV/AIDS: social vulnerability, which refers to social inequalities in access to care; relational vulnerability, which refers to unequal distribution of power within intimate relationships; and sexual vulnerability, which refers to stigmatization of sexualities that some people may consider as socially nonconforming. For HIV/AIDS prevention to be successful among migrants, power structures such as sexism, heterosexism, cisgenderism, ethnocentrism, and racism need to be addressed. Reducing stigma related to HIV among migrants requires a struggle against these power structures as well as health inequities.
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Affiliation(s)
| | - Laura Mellini
- Department of Social Sciences, University of Fribourg, Fribourg, Switzerland
| | - Marc Tadorian
- Social Work, University of Applied Sciences, Fribourg, Switzerland
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Sohel MS, Sifullah MK, Hossain B, Sarker MFH, Zaman NT, Obaidullah M. Exploring risky health behaviors and vulnerability to sexually transmitted diseases among transnational undocumented labor migrants from Bangladesh: a qualitative study. BMC Public Health 2024; 24:1261. [PMID: 38720262 PMCID: PMC11077713 DOI: 10.1186/s12889-024-18696-3] [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: 06/02/2023] [Accepted: 04/23/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND In Bangladesh, remittances constitute a substantial portion of the country's foreign exchange earnings and serve as a primary source of income. However, a considerable number of Bangladeshi citizens reside overseas without proper documentation, exposing them to significant challenges such as limited access to healthcare and socioeconomic opportunities. Moreover, their irregular migration status often results in engaging in risky health behaviors that further exacerbate their vulnerability. Hence, this study aimed to investigate the risky health behavior and HIV/STI susceptibility of Bangladeshi irregular international migrants residing across the globe with undocumented status. METHODS Using a qualitative Interpretative Phenomenological Approach (IPA), 25 illegal migrants were interviewed who are currently living illegally or returned to their home country. The author used a thematic approach to code and analyze the data, combining an integrated data-driven inductive approach with a deductive approach. Concurrent processing and coding were facilitated by employing the Granheim model in data analysis. RESULTS The study identified four risky health behaviors among irregular Bangladeshi migrants: hazardous living conditions, risky jobs, suicidal ideation, and tobacco consumption. Additionally, the authors found some HIV/STI risk behavior among them including engaging in unprotected sex, consuming alcohol and drugs during sexual activity, and having limited access to medical facilities. CONCLUSIONS The findings of this study can be used by health professional, governments, policymakers, NGOs, and concerned agencies to develop welfare strategies and initiatives for vulnerable undocumented migrant workers.
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Affiliation(s)
- Md Salman Sohel
- Department of Development Studies, Daffodil International University, Dhaka-1216, Bangladesh
- Department of Public Leadership, Management & Governance, East Delta University, Chattogram-4209, Bangladesh
| | - Md Khaled Sifullah
- Department of Nutrition and Food Engineering, Daffodil International University, Dhaka-1216, Bangladesh.
- Global Migration Observer, Dhaka-1216, Bangladesh.
| | - Babul Hossain
- Department of Development Studies, Daffodil International University, Dhaka-1216, Bangladesh
| | - Md Fouad Hossain Sarker
- Department of Development Studies, Daffodil International University, Dhaka-1216, Bangladesh
- Centre for Governance and Sustainability, Daffodil International University, Dhaka-1216, Bangladesh
| | - Noshin Tasnim Zaman
- School of Humanities and Social Science, BRAC University, Dhaka-1212, Bangladesh
| | - Md Obaidullah
- Department of Development Studies, Daffodil International University, Dhaka-1216, Bangladesh
- Centre For Global Migration Studies, Daffodil International University, Dhaka-1216, Bangladesh
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Ghasemi E, Bahrami T, Majdzadeh R, Negarandeh R, Rajabi F. Peer interventions to improve HIV testing uptake among immigrants: A realist review. Health Promot Perspect 2024; 14:19-31. [PMID: 38623348 PMCID: PMC11016139 DOI: 10.34172/hpp.42639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 11/22/2023] [Indexed: 04/17/2024] Open
Abstract
Background As a vulnerable group in HIV control programs, immigrants face various obstacles to HIV testing. Despite the effectiveness of peer interventions on health promotion in HIV testing, relatively little is known about how these interventions work. This realist review aims to understand why, how, and under what conditions peer interventions can improve immigrants' HIV testing uptake. Methods We followed the steps suggested by Pawson and colleagues for conducting the realist review. To test a initial program theory, we first systematically searched databases of PubMed, Web of Science, Scopus, Embase, and Cochrane, as well as the websites of UNAIDS, World Bank, Global Fund, WHO, and IOM. After data extraction and quality appraisal, data synthesis was conducted to explain the intervention pathways corresponding to context-mechanism-outcome configurations. Results Seventeen studies were included in the review. Peer interventions for improving immigrants' HIV testing uptake worked through four pathways: Following the improvement of communications (as a proximal mechanism): 1) increasing awareness, 2) reduced stigma, 3) improved support, and 4) increased access to services could lead to improved HIV testing uptake among immigrants. The identified mechanisms were influenced by three groups of individual/ interpersonal, service delivery, and structural factors. Conclusion Peer interventions with multiple strategies to be designed and implemented considering the barriers to HIV testing and also moving beyond one-size-fits-all approaches can successfully improve the immigrants' HIV testing uptake. The refined program theory in this study can help the healthcare providers and policy-makers promote the immigrants' HIV testing uptake and reduce the risk of disease transmission.
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Affiliation(s)
- Elham Ghasemi
- Community Based Participatory Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Tahereh Bahrami
- Medical Ethics and Law Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Majdzadeh
- School of Health and Social Care, University of Essex, Colchester, UK
- Knowledge Utilization Research Center, 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
| | - 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
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Mellini L, Poglia Mileti F, Tadorian M. Migrants facing intersectional vulnerability to HIV and AIDS in Switzerland: an exploratory study. CULTURE, HEALTH & SEXUALITY 2024:1-15. [PMID: 38415354 DOI: 10.1080/13691058.2024.2319335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 02/12/2024] [Indexed: 02/29/2024]
Abstract
An emerging body of evidence suggests that a significant number of HIV-positive migrants to Europe acquire HIV after arriving in their host country. There is an urgent need to rethink HIV and AIDS prevention for migrant populations and to acknowledge the specific vulnerability to HIV and AIDS that migrants face. This article uses empirical data collected in a qualitative sociological study conducted in Switzerland. We provide evidence for the heuristic value of articulating an intersectional approach within a multilevel (biographical, interactional and contextual) framework to capture the complexity of the vulnerability to HIV and AIDS. We show that migrants' specific vulnerability to HIV and AIDS results from social vulnerabilities related to many social and cultural dimensions, including migration status, socioeconomic conditions, gender and sexual identity, sexual norms, the relational context in which sex occurs, power relations and sociocultural structures of the receiving country. The three case studies presented illustrate how HIV-related processes of intersectional vulnerability are embedded in sexism, cisgenderism, and racism, and how they are closely linked to social inequalities in health. Effective HIV and AIDS prevention for migrants must take greater account of these power relations and sociocultural structures.
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Affiliation(s)
- Laura Mellini
- Department of Social Sciences, University of Fribourg, Fribourg, Switzerland
| | | | - Marc Tadorian
- School of Social Work, University of Applied Sciences, Fribourg, Switzerland
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Shobowale O, Schmidt AJ, Meireles P, Rojas Castro D, Detandt S, Stutterheim SE, Weatherburn P, Jonas KJ. Determinants of HIV Testing Among Migrant Men Who Have Sex With Men from Sub-Saharan Africa and Other Regions Residing in 10 European Countries. AIDS Behav 2024; 28:488-506. [PMID: 38326669 PMCID: PMC10876736 DOI: 10.1007/s10461-023-04239-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 02/09/2024]
Abstract
Migrant men who have sex with men (mMSM) from sub-Saharan Africa (SSA) and other regions outside Europe are highly vulnerable to HIV. However, research on the determinants of HIV testing among mMSM from SSA, and how these differ across the categories of mMSM living in Europe, is limited. Using data from the European MSM Internet Survey (EMIS-2017), we assessed HIV testing prevalence and recency in mMSM from SSA and other mMSM residing in ten European countries, as well as the determinants of HIV testing across different mMSM categories with logistic regression analyses. Ever-testing for HIV was slightly higher in mMSM from SSA (83%) compared to other mMSM categories (75-80%), except for mMSM from Latin America and Caribbean region (84%). Overall, 20% of mMSM had never tested. In multivariable analysis, higher age (adjusted odds ratio [AOR] 1.05, 95% confidence interval [CI] 1.01-1.10), higher HIV knowledge (AOR 1.45, 95%-CI 1.11-1.90), and residence in smaller settlements (AOR 0.45, 95%-CI 0.21-0.96) were significantly associated with ever testing for HIV in mMSM from SSA. Comparing mMSM from SSA to mMSM from other regions, we found varying significant similarities (higher age, residence in smaller settlements and HIV knowledge) and differences (lower educational attainment, not identifying as gay, being a student, and limited disclosure of homosexual attraction) in the determinants of ever-testing for HIV. Community-specific interventions addressing identified sociodemographic and behavioral determinants to increase HIV testing uptake in the different mMSM categories and better data for further research are warranted.
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Affiliation(s)
- Oladipupo Shobowale
- Department of Work and Social Psychology, Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, The Netherlands.
| | - Axel J Schmidt
- London School of Hygiene & Tropical Medicine (LSHTM), Sigma Research, London, UK
| | - Paula Meireles
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | | | - Sandrine Detandt
- Faculty of Psychology, Observatoire du Sida et des Sexualités Research Center, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Sarah E Stutterheim
- Department of Health Promotion, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Peter Weatherburn
- London School of Hygiene & Tropical Medicine (LSHTM), Sigma Research, London, UK
| | - Kai J Jonas
- Department of Work and Social Psychology, Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, The Netherlands
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Twisk DE, Meima A, Richardus JH, van Sighem A, Rokx C, den Hollander JG, Götz HM. The roles of the general practitioner and sexual health centre in HIV testing: comparative insights and impact on HIV incidence rates in the Rotterdam area, the Netherlands - a cross-sectional population-based study. BMC Public Health 2023; 23:2553. [PMID: 38129840 PMCID: PMC10734097 DOI: 10.1186/s12889-023-17483-w] [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: 01/05/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Access to HIV testing is crucial for detection, linkage to treatment, and prevention. In less urbanised areas, reliance on general practitioners (GPs) for HIV testing is probable, as sexual health centres (SHC) are mostly located within urbanised areas. Limited insight into individuals undergoing HIV testing stems from sparse standard registration of demographics at GPs. This cross-sectional study aims (1) to assess and compare HIV testing at the GP and SHC, and (2) to assess population- and provider-specific HIV incidence. METHODS Individual HIV testing data of GPs and SHC were linked to population register data (aged ≥ 15 years, Rotterdam area, 2015-2019). We reported the proportion HIV tested, and compared GP and SHC testing rates with negative binomial generalised additive models. Data on new HIV diagnoses (2015-2019) from the Dutch HIV Monitoring Foundation relative to the population were used to assess HIV incidence. RESULTS The overall proportion HIV tested was 1.14% for all residents, ranging from 0.41% for ≥ 40-year-olds to 4.70% for Antilleans. The GP testing rate was generally higher than the SHC testing rate with an overall rate ratio (RR) of 1.61 (95% CI: 1.56-1.65), but not for 15-24-year-olds (RR: 0.81, 95% CI: 0.74-0.88). Large differences in HIV testing rate (1.36 to 39.47 per 1,000 residents) and GP-SHC ratio (RR: 0.23 to 7.24) by geographical area were observed. The GPs' contribution in HIV testing was greater for GP in areas further away from the SHC. In general, population groups that are relatively often tested are also the groups with most diagnoses and highest incidence (e.g., men who have sex with men, non-western). The overall incidence was 10.55 per 100,000 residents, varying from 3.09 for heterosexual men/women to 24.04 for 25-29-year-olds. CONCLUSIONS GPs have a pivotal role in HIV testing in less urbanised areas further away from the SHC, and among some population groups. A relatively high incidence often follows relatively high testing rates. Opportunities to improve HIV testing have been found for migrants, lower-educated individuals, in areas less urbanised areas and further away from GP/SHC. Strategies include additional targeted testing, via for example SHC branch locations and outreach activities.
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Affiliation(s)
- Denise E Twisk
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
- Department of Public Health, Municipal Public Health Service Rotterdam-Rijnmond, P.O. Box 70032, Rotterdam, 3000 LP, The Netherlands.
| | - Abraham Meima
- Department of Public Health, Municipal Public Health Service Rotterdam-Rijnmond, P.O. Box 70032, Rotterdam, 3000 LP, The Netherlands
- Department Research and Business Intelligence, Municipality of Rotterdam, Rotterdam, The Netherlands
| | - Jan Hendrik Richardus
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Public Health, Municipal Public Health Service Rotterdam-Rijnmond, P.O. Box 70032, Rotterdam, 3000 LP, The Netherlands
| | | | - Casper Rokx
- Department of Internal Medicine, section of infectious diseases, Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jan G den Hollander
- Department of Internal Medicine, Maasstad Hospital, Rotterdam, The Netherlands
| | - Hannelore M Götz
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Public Health, Municipal Public Health Service Rotterdam-Rijnmond, P.O. Box 70032, Rotterdam, 3000 LP, The Netherlands
- Centre for Infectious Disease Control, National Institute for Public Health, and the Environment (RIVM), Bilthoven, The Netherlands
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Nagai S, Kitahara T, Kito K, Hitosugi M. HIV/AIDS knowledge level, awareness of public health centers and related factors: a cross-sectional study among Brazilians in Japan. BMC Public Health 2023; 23:2379. [PMID: 38037053 PMCID: PMC10691059 DOI: 10.1186/s12889-023-17308-w] [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: 08/10/2023] [Accepted: 11/22/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Accurate information is essential so that HIV infection can be detected in time for initiation of HIV/AIDS treatment. Immigrants are at high risk for delayed HIV testing and diagnosis, but foreign residents in Japan also seem to face barriers to accessing HIV/AIDS care. We aimed to assess their knowledge level of HIV/AIDS and awareness of public health centers in Japan (PHCs), and to explore factors related to these items. METHODS We conducted a cross-sectional study of Brazilians, the largest group of foreigners living in Shiga, using an anonymous, self-administered questionnaire survey in Brazilian Portuguese and Japanese via the Internet and mail. A multiple logistic regression analysis was used to examine the factors related to "Knowledge of HIV/AIDS" and "Awareness of PHCs". RESULTS A total 182 Brazilians responded. More than half of them were beginners in Japanese. Most respondents were familiar with HIV/AIDS, but only 58% knew the existence of PHCs, and only 25% knew that HIV testing is available at PHCs free of charge and anonymously. A multiple logistic regression analysis showed that PHCs were less recognized by those with intermediate (odds ratio: 5.70, 95% confidence interval: 1.53-21.23) and beginner (odds ratio: 6.81, 95% confidence interval: 1.98-23.45) Japanese proficiency than by those with advanced. CONCLUSIONS This survey revealed the knowledge level of HIV/AIDS and awareness of PHC among Brazilians in Shiga. Their lack of awareness of PHCs due to language barriers may lead to delays in HIV testing among them. Therefore, it is important for PHCs to disseminate information about medical services related to HIV/AIDS in Portuguese and plain Japanese to facilitate their access to HIV testing. However, PHC efforts alone are not enough. Medical interpreters who are familiar with Brazilian culture and customs, and the clinics that employ them, could help the Brazilian community and PHCs to overcome the language barrier and provide efficient and appropriate medical care to Brazilians. This would be one way to eliminate delays in HIV testing for Brazilians in Shiga.
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Affiliation(s)
- Shiho Nagai
- Division of Occupational and Environmental Health, Department of Social Medicine, Shiga University of Medical Science, Seta Tsukinowa Cho, Otsu City, 520- 2192, Shiga, Japan
- Department of Hematology, Shiga University of Medical Science, Seta Tsukinowa Cho, Otsu City, Shiga, Japan
| | - Teruyo Kitahara
- Division of Occupational and Environmental Health, Department of Social Medicine, Shiga University of Medical Science, Seta Tsukinowa Cho, Otsu City, 520- 2192, Shiga, Japan.
| | - Katsuyuki Kito
- Department of Hematology, Shiga University of Medical Science, Seta Tsukinowa Cho, Otsu City, Shiga, Japan
| | - Masahito Hitosugi
- Division of Legal Medicine, Department of Social Medicine, Shiga University of Medical Science, Seta Tsukinowa Cho, Otsu City, Shiga, Japan
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Ha T, Shi H, Givens D, Nguyen T, Nguyen N. Factors impacting HIV testing among young sexually active women migrant workers in Vietnamese industrial zones. BMC Public Health 2023; 23:1938. [PMID: 37803339 PMCID: PMC10559500 DOI: 10.1186/s12889-023-16841-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/26/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND Young migrant workers living in low- and middle-income countries often experience barriers and inadequate access to HIV prevention and treatment services. This study examines the prevalence of HIV testing, associated factors, and reasons for obtaining and not obtaining HIV testing among young sexually active women migrant workers in an industrial zone in Hanoi, Vietnam. METHODS A cross-sectional study was conducted among 512 sexually active young women migrant workers (aged 18 to 29) working in the Thang Long industrial zone in Hanoi, Vietnam. Data was collected via a face-to-face interview from January 2020 to June 2021. Multivariable logistic regression analysis was used to explore factors associated with ever-testing for HIV among sexually active participants. RESULTS The study found a low level of HIV testing and high rates of unprotected sex. Among those who reported being sexually active, only 23.7% of participants (n = 126) reported having ever been tested for HIV. Among those who reported never having tested for HIV, 38.2% reported not using condoms during their most recent sexual encounter. Factors associated with engaging in HIV testing included being older (25-29 years), having greater knowledge about HIV, past use of sexual and reproductive health and HIV services, and familiarity with HIV testing locations. CONCLUSIONS Overall, a low level of HIV testing, high rates of unprotected sex, and low perceived risks regarding HIV among the study participants point to a need to implement targeted HIV interventions that can improve both safe sex practices and perceptions of and knowledge about risky sexual behaviors. Such interventions should use insights from this study to address factors facilitating HIV testing among industrial zones' women migrant workers.
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Affiliation(s)
- Toan Ha
- Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Hui Shi
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - David Givens
- Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Trang Nguyen
- Institute of Social and Medical Studies, Hanoi, Vietnam
| | - Nam Nguyen
- Institute of Social and Medical Studies, Hanoi, Vietnam
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Mlangeni N, Adetokunboh O, Lembani M, Malotle M, Ngah V, Nyasulu PS. Provision of HIV prevention and care services to farmworkers in sub-Saharan African countries. Trop Med Int Health 2023; 28:710-719. [PMID: 37643626 DOI: 10.1111/tmi.13922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
OBJECTIVES To summarise data on human immunodeficiency virus (HIV) services available to farmworkers in sub-Saharan Africa (SSA). METHODS We conducted a systematic review to understand which HIV prevention and care services were accessed by farm workers in SSA. MEDLINE (PubMed), Embase, CINAHL (EBSCO Host), Cochrane library, African Index Medicus, Scopus, Google Scholar, Open Grey, and Web of Science Proceedings Citation Index were searched. Studies were eligible for inclusion if they measured or reported on the presence of HIV workplace policy frameworks, guidelines, or programmes for HIV prevention, treatment and care services, and other treatment modalities specifically targeting farmworkers. RESULTS Nine studies published between 2005 and 2019 were included in the review. Six themes emerged from included studies, which include HIV policy, HIV prevention (awareness, education, and condom supply), voluntary counselling and testing, antiretroviral therapy (ART), linkage to care, and mobile clinic. Though availability of an HIV policy was inadequate, a significant positive impact of the HIV policy in influencing behaviour change was reported. Most of the farm workers could access HIV education and condom supply in their places of work. Access to ART, treatment support, and linkage to care was inadequate, but community outreach programmes and mobile clinics showed success in reaching a high number of workers with HIV testing and treatment. A majority of farm workers faced barriers in accessing government health facilities. CONCLUSIONS The findings suggest that there is poor access to HIV services for farmworkers in SSA. There is a dire need to scale up HIV services and programmes, including mobile health facilities, in agricultural settings. Due to high labour migration patterns among farmworkers, we recommend cross-country HIV programmes that allow continuity of care across borders.
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Affiliation(s)
- Nosimilo Mlangeni
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Division of National Health Laboratory Services, National Institute for Occupational Health, Johannesburg, South Africa
| | - Olatunji Adetokunboh
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- DSI-NRF Centre of Excellence for Epidemiological Modelling and Analysis, Stellenbosch University, Cape Town, South Africa
- The University of the People, Pasadena, California, USA
| | - Martina Lembani
- School of Public Health, University of Western Cape, Cape Town, South Africa
| | - Molebogeng Malotle
- Division of National Health Laboratory Services, National Institute for Occupational Health, Johannesburg, South Africa
| | - Vera Ngah
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Peter S Nyasulu
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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Rebolledo-Ponietsky K, Al-Kassab-Córdova A, Lucchetti-Rodríguez A, Cabieses B, Rodriguez-Morales AJ, Mezones-Holguín E. Highly active antiretroviral therapy discontinuation time is associated with therapeutic failure among human immunodeficiency virus (HIV)-infected immigrant adults: A cohort study from a Peruvian referral hospital during the Venezuelan exodus. Trop Med Int Health 2023. [PMID: 37414409 DOI: 10.1111/tmi.13909] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
OBJECTIVE To evaluate the association between Highly Active Antiretroviral Therapy (HAART) discontinuation time and therapeutic failure (TF) in Venezuelan immigrants with HIV that restart HAART. METHODS We carried out a retrospective cohort study in a large hospital in Peru. We included Venezuelan immigrants who restarted HAART and were followed over at least 6 months. The primary outcome was TF. Secondary outcomes were immunologic (IF), virologic (VF) and clinical (CF) failures. The exposure variable was HAART discontinuation, categorised as no discontinuation, less than 6 months, and 6 months or more. We applied generalised linear models Poisson family with robust standard errors to calculate crude (cRR) and adjusted (aRR) relative risks by statistical and epidemiological criteria. RESULTS We included 294 patients, 97.2% were males, and the median age was 32 years. Out of all the patients, 32.7% discontinued HAART for less than 6 months, 15.0% discontinued for more than 6 months and the remaining 52.3% did not discontinue. The cumulative incidence of TF was 27.9%, 24.5% in VF, 6.0% in IF and 6.0% in CF. Compared with non-discontinued HAART patients, the discontinuation for less than 6 months (aRR = 1.98 [95% CI: 1.27-3.09]) and from 6 months to more (aRR = 3.17 [95% CI: 2.02-4.95]) increased the risk of TF. Likewise, treatment discontinuation of up to 6 months (aRR = 2.32 [95% CI: 1.40-3.84]) and from 6 months to more (aRR = 3.93 [95% CI: 2.39-6.45]) increased the risk of VF. CONCLUSIONS HAART discontinuation increases the probability of TF and VF in Venezuelan immigrants.
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Affiliation(s)
| | - Ali Al-Kassab-Córdova
- Centro de Excelencia en Investigaciones Económicas y Sociales en Salud, Universidad San Ignacio de Loyola, Lima, Peru
| | - Aldo Lucchetti-Rodríguez
- Facultad de Ciencias de la Salud, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
- Hospital Nacional Arzobispo Loayza, Servicio de Enfermedades Infecciosas y Tropicales, Ministerio de Salud, Lima, Peru
| | - Baltica Cabieses
- Facultad de Medicina Clínica Alemana, Centro de Salud Global Intercultural, Instituto de Ciencias e Innovación en Medicina, Universidad del Desarrollo, Santiago, Chile
| | - Alfonso J Rodriguez-Morales
- Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de las Américas-Institución Universitaria Visión de las Américas, Pereira, Risaralda, Colombia
- Master's Program in Clinical Epidemiology and Biostatistics, Universidad Cientifica del Sur, Lima, Peru
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, Lebanon
| | - Edward Mezones-Holguín
- Facultad de Ciencias de la Salud, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
- Epi-gnosis Solutions, Piura, Peru
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Zhou Y, Luo Y, Cheng F, Zeng H, Wu L, Gao L, Xu J. Migration experiences and reported commercial and non-commercial sexual behaviors among newly diagnosed HIV infections in China: a cross-sectional study. BMC Infect Dis 2023; 23:370. [PMID: 37264345 DOI: 10.1186/s12879-023-08333-6] [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: 02/28/2023] [Accepted: 05/16/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Migration is known to influence human health. China has a high migration rate and a significant number of people who are HIV-positive, but little is known about how these factors intersect in sexual risk behaviors. OBJECTIVE This study aimed to explore sexual risk behaviors between migrants and non-migrants among newly diagnosed HIV infections, and assess the changes of sexual risk behaviors with length of stay in the current city of migrants. METHODS A cross-sectional questionnaire was conducted among people newly diagnosed with HIV from July 2018 to December 2020 who lived in Zhejiang Province. In the study, sexual risk behaviors included having multiple sexual partners and unprotected sexual behaviors (in commercial sexual behaviors, non-commercial sexual behaviors, heterosexual behaviors, and homosexual behaviors). Binary logistic regression models were employed to explore the influencing factors of sexual risk behaviors, measured by multiple sexual partners and unprotected sexual partners. RESULTS A total of 836 people newly diagnosed with HIV/AIDS were incorporated in the study and 65.31% (546) were migrants. The percentages of non-commercial sexual behaviors among migrants were statistically higher than those of non-migrants. Commercial heterosexual behavior was higher among non-migrants compared with migrants. The proportion of study participants having unprotected sexual behaviors and multiple sexual partners with commercial/non-commercial partners was both higher among migrants compared with non-migrants. Among migrants, the likelihood of sexual risk behaviors in both commercial and non-commercial sex increased in the first 3 years and reduced after 10 years. Compared with non-migrants, migrants were statistically associated with multiple sexual partners [P = .007, odds ratio (OR) = 1.942]. However, migrants did not exhibit a significant difference in unprotected sexual behaviors compared with non-migrants. In addition, migrants aged between 18 and 45 years who relocated to the current city in the past 2-3 years tended to have multiple sexual partners (P < .05). CONCLUSIONS People newly diagnosed with HIV engaged in different sexual risk behaviors among migrants and non-migrants and more attention should be paid to migrants. For non-migrants, it is urgent to promote the prevention of commercial sexual behaviors. For migrants, prevention of non-commercial sexual behaviors and universal access to health care especially for new arrivals who migrated to the current city for 2-3 years are needed. Moreover, sexual health education and early HIV diagnosis are necessary for the entire population.
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Affiliation(s)
- Yuyin Zhou
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, 866 Yuhangtang Rd, 310058, Hangzhou, China
- Department of Pharmacy, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yan Luo
- Shenzhen Pingshan District Center for Disease Control and Prevention, Shenzhen, China
- Hangzhou Center for Disease Control and Prevention, Hangzhou, China
| | - Feng Cheng
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Institute for Healthy China, Tsinghua University, Beijing, China
| | - Huatang Zeng
- Shenzhen Health Development Research and Data Management Center, Shenzhen, China
| | - Liqun Wu
- Shenzhen Health Development Research and Data Management Center, Shenzhen, China
| | - Liangmin Gao
- Institute for International and Area Studies, Tsinghua University, Beijing, China
| | - Junfang Xu
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, 866 Yuhangtang Rd, 310058, Hangzhou, China.
- Department of Pharmacy, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
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Goldenberg SM, Pearson J, Moreheart S, Nazaroff H, Krüsi A, Braschel M, Bingham B, Shannon K. Prevalence and structural correlates of HIV and STI testing among a community-based cohort of women sex workers in Vancouver Canada. PLoS One 2023; 18:e0283729. [PMID: 36996154 PMCID: PMC10062647 DOI: 10.1371/journal.pone.0283729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 03/15/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND In light of the stark inequities in HIV and sexually transmitted infections (STIs) experienced by women sex workers, empirical evidence is needed to inform accessible and sex worker-friendly models of voluntary, confidential and non-coercive HIV and STI testing. We evaluated the prevalence and structural correlates of HIV/STI testing in the last 6 months in a large, community-based cohort of women sex workers in Vancouver, Canada. METHODS Data were drawn from an open community-based open cohort of women sex workers (January 2010-August 2021) working across diverse street, indoor, and online environments in Vancouver, Canada. Using questionnaire data collected by experiential (sex workers) and community-based staff, we measured prevalence and used bivariate and multivariable logistic regression to model correlates of recent HIV/STI testing at enrollment. RESULTS Of 897 participants, 37.2% (n = 334) identified as Indigenous, 31.4% as Women of Color/Black (n = 282), and 31.3% (n = 281) as White. At enrollment, 45.5% (n = 408) reported HIV testing, 44.9% (n = 403) reported STI testing, 32.6% (n = 292) reported receiving both HIV and STI testing, and 57.9% (n = 519) had received an HIV and/or STI test in the last 6 months. In adjusted multivariable analysis, women accessing sex worker-led/specific services had higher odds of recent HIV/STI testing, (Adjusted Odds Ratio (AOR): 1.91, 95% Confidence Interval (CI): 1.33-2.75), whereas Women of Color and Black women (AOR: 0.52, 95%CI: 0.28-0.98) faced significantly lower odds of recent HIV/STI testing. CONCLUSIONS Scaling-up community-based, sex worker-led and tailored services is recommended to enhance voluntary, confidential, and safe access to integrated HIV/STI testing, particularly for Women of Color and Black Women. Culturally safe, multilingual HIV/STI testing services and broader efforts to address systemic racism within and beyond the health system are needed to reduce inequities and promote safe engagement in services for racialized sex workers.
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Affiliation(s)
- Shira M. Goldenberg
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA, United States of America
- Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
- Division of Social Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jennie Pearson
- Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
- Division of Social Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Sarah Moreheart
- Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC Canada
| | - Hannah Nazaroff
- Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
| | - Andrea Krüsi
- Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
- Division of Social Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Melissa Braschel
- Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
| | - Brittany Bingham
- Division of Social Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- Vancouver Coastal Health, Indigenous Health, Vancouver, BC, Canada
| | - Kate Shannon
- Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
- Division of Social Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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Zhang K, Chan PSF, Li X, Fang Y, Cai Y, Zou H, Cao B, Cao H, Hu T, Chen Y, Wang Z. Low Behavioral Intention to Use Any Type of HIV Testing and HIV Self-Testing among Migrant Male Factory Workers Who Are at High Risk of HIV Infection in China: A Secondary Data Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5029. [PMID: 36981938 PMCID: PMC10048950 DOI: 10.3390/ijerph20065029] [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: 12/06/2022] [Revised: 03/02/2023] [Accepted: 03/10/2023] [Indexed: 06/18/2023]
Abstract
This study investigated the prevalence of and factors associated with behavioral intention to take up any type of HIV testing and HIV self-testing (HIVST) in the next six months among male migrant workers, who were at high risk of HIV infection, in Shenzhen, China. This was a secondary data analysis. A total of 363 subjects who had sexual intercourse with non-regular female sex partners and/or female sex workers in the past six months were selected. Logistic regression models were fitted for data analysis. About 16.5% of participants reported having used HIV testing in their lifetime and 12.7% for HIVST. Among the participants, 25.6% and 23.7% intended to take up any type of HIV testing and HIVST in the next six months, respectively. Significant factors associated with the behavioral intention to take up HIV testing and HIVST included individual-level factors based of the Health Belief Model (e.g., perceived benefit, perceived cue to action, perceived self-efficacy) and interpersonal-level factors (e.g., frequency of exposure to health-related content or HIV and STI-related content on short video apps). This study provided practical implications for designing interventions to increase the uptake of HIV testing and HIVST among migrant workers.
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Affiliation(s)
- Kechun Zhang
- Longhua District Center for Disease Control and Prevention, Shenzhen 518110, China
| | - Paul Shing-fong Chan
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Xinyue Li
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Yuan Fang
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong, China
| | - Yong Cai
- School of Public Health, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen 518107, China
- Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia
| | - Bolin Cao
- School of Media and Communication, Shenzhen University, Shenzhen 518060, China
| | - He Cao
- Longhua District Center for Disease Control and Prevention, Shenzhen 518110, China
| | - Tian Hu
- Longhua District Center for Disease Control and Prevention, Shenzhen 518110, China
| | - Yaqi Chen
- Longhua District Center for Disease Control and Prevention, Shenzhen 518110, China
| | - Zixin Wang
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
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Lyons N, Bhagwandeen B, Edwards J. Examining the Correlates of HIV Testing for Venezuelan Migrants in Trinidad. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2148. [PMID: 36767515 PMCID: PMC9916155 DOI: 10.3390/ijerph20032148] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/19/2023] [Accepted: 01/20/2023] [Indexed: 06/18/2023]
Abstract
An important preventive measure in the fight against the HIV epidemic is the adoption of HIV testing. The government of the Republic of Trinidad and Tobago conducted a registration exercise in 2019 for undocumented migrants and refugees from Venezuela residing in the country. These migrants were allowed access to the public health system. In this study, we observed the correlates of HIV testing in Venezuelan migrants residing in Trinidad. A convenience sample of n = 250 migrants was collected via telephone survey from September through December 2020. Variables of interest included social factors, health needs, and uptake of HIV testing. Pearson χ2 tests examined the associations between study variables, and multivariable logistic regression with backward elimination produced the odds of taking an HIV test. In our study, 40.8% of migrants reported having received an HIV test since arriving in Trinidad. Persons who migrated with family or friends had greater odds of getting an HIV test relative to persons who arrived alone (OR = 2.912, 95% CI: 1.002-8.466), and migrants who knew where to get an HIV test also greater odds of getting a test relative to person who did not know where to get a test (OR = 3.173, 95% CI: 1.683-5.982). Migrants with known physical health problems had greater odds of getting an HIV test relative to migrants without these health problems (OR = 1.856, 95% CI: 1.032-3.337). Persons who arrived with family or friends had greater odds of experiencing difficulties accessing public health care relative to persons who arrived alone (OR = 3.572, 95% CI: 1.352-9.442). Migrants earning between $1000 and $2999 TT per month had greater odds of experiencing trouble accessing public health services relative to persons who had monthly earnings of less than $1000 TT (OR = 2.567, 95% CI: 1.252-5.264). This was the first quantitative study on HIV testing among Venezuelan migrants in Trinidad. Migrants still experience difficulties accessing healthcare, which, in turn influences national HIV prevention and control efforts. The results gathered may help in developing HIV prevention plans that are led by a national health policy that takes migrant communities' needs into account.
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Affiliation(s)
- Nyla Lyons
- Medical Research Foundation of Trinidad and Tobago, 7 Queen’s Part E, Port-of-Spain, Trinidad and Tobago
| | - Brendon Bhagwandeen
- School of Mathematical and Computer Sciences, Heriot Watt University Malaysia, 1 Jalan Venna P5/2, Precinct 5, Putrajaya 62200, Malaysia
| | - Jeffrey Edwards
- Medical Research Foundation of Trinidad and Tobago, 7 Queen’s Part E, Port-of-Spain, Trinidad and Tobago
- Department of Para-Clinical Sciences, Faculty of Medical Sciences, University of the West Indies, St. Augustine, Trinidad and Tobago
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15
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Essayagh F, Essayagh T, Essayagh M, Khouchoua M, Lemriss H, Rattal M, Bukassa G, Essayagh S. Disease burden among migrants in Morocco in 2021: A cross‑sectional study. PLoS One 2023; 18:e0281129. [PMID: 36706106 PMCID: PMC9882623 DOI: 10.1371/journal.pone.0281129] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 01/13/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Morocco, traditionally an emigration country, has evolved into not only a transit country to Europe but also a country of residence for an increasing number of migrants, with 102,400 migrants in 2019. This is due to its geographic location, the induced effects of its "African policy," and the various laws adopted by Moroccan legislators in recent years. The purpose of this study is to determine the prevalence of communicable and noncommunicable diseases among migrants such as Hepatitis C virus (HCV), human immunodeficiency virus (HIV), diabetes, and hypertension. METHODS We conducted a cross-sectional study in Oujda, Morocco, between November and December 2021. Face-to-face interviews with enrolled migrants aged 18 years and over, present in Oujda and attending an association, were carried out to collect socio-demographic data, lifestyle behaviors, and clinical parameters. Diabetes and hypertension were the primary outcomes. The Pearson's chi-squared test and the student's t-test were used to assess the bivariate associations between primary outcomes and categorical and continuous variables. In a multivariate model, we adjusted for predictors that were significant (p-value ≤0.05) in bivariate analysis to estimate Adjusted Odd Ratios (AOR) and 95% confidence intervals (CI). RESULTS There were 495 migrants enrolled, with a male/female ratio of two and an average age of 27.3±11.5 years (mean±standard deviation), ranging from 18 to 76 years. Hepatitis C virus, human immunodeficiency virus, diabetes, and hypertension were found in 1%, 0.2%, 3.8%, and 27.7% of the population, respectively. Family history of diabetes was a risk factor for diabetes in the Oujda migrant population, with an Adjusted Odds Ratio (AOR) of 5.36; CI% [1.23-23.28]. Age (AOR of 1.1; CI% [1.06-1.13]) and African origin (AOR of 3.07; CI% [1.06-8.92]) were identified as risk factors for hypertension. CONCLUSION Migrants in Oujda are healthy. The high prevalence of hypertension, as well as the presence of HCV and HIV positive cases, emphasizes the importance of routine screening for hypertension, HCV, and HIV in order to detect and treat these diseases as early as possible.
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Affiliation(s)
- Firdaous Essayagh
- Faculté des Sciences juridiques, économiques et sociales, Laboratoire Droit privé et enjeux de développement, Université Sidi Mohamed Ben Abdellah, Fès, Morocco
| | - Touria Essayagh
- Laboratoire Sciences et Technologies de la Santé, Hassan First University of Settat, Institut Supérieur des Sciences de la Santé, Settat, Morocco
- * E-mail:
| | - Meriem Essayagh
- Office Nationale de Sécurité Sanitaire des produits Alimentaires, Oriental, Morocco
| | | | - Hajar Lemriss
- Laboratoire Sciences et Technologies de la Santé, Hassan First University of Settat, Institut Supérieur des Sciences de la Santé, Settat, Morocco
| | - Mourad Rattal
- Laboratoire Sciences et Technologies de la Santé, Hassan First University of Settat, Institut Supérieur des Sciences de la Santé, Settat, Morocco
| | - Germain Bukassa
- Department of Indigenous Services Canada/Government of Canada, Health Surveillance and Assessment Unit, First Nations and Inuit Health, Regina, SK, Canada
| | - Sanah Essayagh
- Faculté des Sciences et Techniques, Laboratoire Agroalimentaire et Santé, Hassan First University of Settat, Settat, Morocco
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Somerset S, Jones W, Evans C, Cirelli C, Mbang D, Blake H. Opt-in HIV testing in construction workplaces: an exploration of its suitability, using the socioecological framework. BMC Public Health 2022; 22:1409. [PMID: 35870921 PMCID: PMC9308504 DOI: 10.1186/s12889-022-13787-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 06/06/2022] [Indexed: 11/17/2022] Open
Abstract
Background Late diagnosis of HIV remains a challenge, despite improved testing and treatment. Testing is often targeted at high-risk groups; workplace events might normalise testing and allow access to a wider population. The construction workforce has a number of risk factors for HIV. In the Test@Work study, HIV tests were delivered within general health checks to construction employees, with high uptake and acceptability. This paper reports on the experiences of construction managers and health professionals involved in Test@Work and explores the suitability of construction worksites as a venue for opt-in HIV testing. Methods Qualitative interviews (n = 24) were conducted with construction managers who had facilitated health check/HIV testing (n = 13), and delivery partners (n = 11) including i) healthcare volunteers who had delivered general health checks (n = 7) and, ii) HIV professionals who had conducted HIV testing (n = 4) at 21 Test@Work events held on construction sites. Interviews explored their experiences of these events and views towards HIV testing in the workplace. Exit questionnaires (n = 107) were completed by delivery partners after every event, providing qualitative data identifying facilitators and barriers to effective delivery. Thematic analysis identified themes that were mapped against a socioecological framework. Results Delivery partners reported high engagement of construction workers with workplace HIV testing, peer-to-peer encouragement for uptake, and value for accessibility of onsite testing. HIV professionals valued the opportunity to reach an untested population, many of whom had a poor understanding of their exposure to HIV risk. Managers valued the opportunity to offer workplace health checks to employees but some identified challenges with event planning, or provision of private facilities. Conclusions The construction sector is complex with a largely male workforce. Providing worksite HIV testing and education to an untested population who have poor knowledge about HIV risk helped to normalise testing, encourage uptake and reduce HIV-related stigma. However, there are practical barriers to testing in the construction environment. Rapid testing may not be the most suitable approach given the challenges of maintaining confidentiality on construction worksites and alternatives should be explored. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13787-5.
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Lin M, Chai CS, Liang JC. A mediation model of the relationship between university students' news media literacy and xenophobia: The role of intellectual humility, perceived threat, and blind patriotism. Front Psychol 2022; 13:1036497. [PMID: 36425821 PMCID: PMC9679528 DOI: 10.3389/fpsyg.2022.1036497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 10/10/2022] [Indexed: 09/19/2023] Open
Abstract
The dissemination of misinformation and disinformation has increased the need for news media literacy. This study administered a self-developed questionnaire to measure the relationship between news media literacy and xenophobia among college students in China (N = 430). The questionnaire measured five variables: news media literacy, xenophobia, blind patriotism, perceived threat, and intellectual humility. Confirmatory factor analysis (CFA) was used to validate this five-variable survey, and the analyses indicated satisfactory construct validity. Results from structural equation modeling indicated that intellectual humility was a significant predictor of news media literacy, and blind patriotism and perceived threat mediated the relationship between news media literacy and xenophobia. This study provides insights for researchers and instructors who are promoting news media literacy education in schools.
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Affiliation(s)
- Muyingnan Lin
- Department of Curriculum and Instruction, Faculty of Education, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Ching Sing Chai
- Department of Curriculum and Instruction, Faculty of Education, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Jyh-Chong Liang
- Program of Learning Sciences and Institute for Research Excellence in Learning Sciences, National Taiwan Normal University, Taipei, Taiwan
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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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Experiences of Migrant People Living with HIV in a Multidisciplinary HIV Care Setting with Rapid B/F/TAF Initiation and Cost-Covered Treatment: The ‘ASAP’ Study. J Pers Med 2022; 12:jpm12091497. [PMID: 36143282 PMCID: PMC9503330 DOI: 10.3390/jpm12091497] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 09/02/2022] [Accepted: 09/09/2022] [Indexed: 11/21/2022] Open
Abstract
This study aimed to explore the experiences of migrant people living with HIV (MLWH) enrolled in a Montreal-based multidisciplinary HIV care clinic with rapid antiretroviral treatment (ART) initiation and cost-covered ART. Between February 2020 and March 2022, 32 interviews were conducted with 16 MLWH at three time-points (16 after 1 week of ART initiation, 8 after 24 weeks, 8 after 48 weeks). Interviews were analyzed via the Framework Method. Thirty categories were identified, capturing experiences across the HIV care cascade. At diagnosis, most MLWH described “initially experiencing distress”. At linkage, almost all MLWH discussed “navigating the health system with difficulty”. At treatment initiation, almost all MLWH expressed “being satisfied with treatment”, particularly due to a lack of side effects. Regarding care retention, all MLWH noted “facing psychosocial or health-related challenges beyond HIV”. Regarding ART adherence, most MLWH expressed “being satisfied with treatment” with emphasis on their taking control of HIV. At viral suppression, MLWH mentioned “finding more peace of mind since becoming undetectable”. Regarding their perceived health-related quality of life, most MLWH indicated “being helped by a supportive social network”. Efficient, humanizing, and holistic approaches to care in a multidisciplinary setting, coupled with rapid and free ART initiation, seemed to help alleviate patients’ concerns, address their bio-psycho-social challenges, encourage their initial and sustained engagement with HIV care and treatment, and ultimately contribute to positive experiences.
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Borchmann O, Omland LH, Gerstoft J, Larsen CS, Johansen IS, Lunding S, Jensen J, Obel N, Hansen ABE. Length of stay in Denmark before HIV diagnosis and linkage to care: a population-based study of migrants living with HIV, Denmark, 1995 to 2020. EURO SURVEILLANCE : BULLETIN EUROPEEN SUR LES MALADIES TRANSMISSIBLES = EUROPEAN COMMUNICABLE DISEASE BULLETIN 2022; 27. [PMID: 35904057 PMCID: PMC9336168 DOI: 10.2807/1560-7917.es.2022.27.30.2100809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BackgroundMigrants face an increased risk of HIV infection and late presentation for HIV care.AimTo examine delays in HIV diagnosis, linkage to care (LTC), and risk of late presentation for migrants living with HIV in Denmark.MethodsWe conducted a population-based, nationwide study of adult migrants (n = 2,166) presenting for HIV care between 1 January 1995 and 31 December 2020 in Denmark. Time from immigration to HIV diagnosis and from diagnosis to LTC, and late presentation were assessed, stratified by migrants' geographical regions of origin, using descriptive statistics.ResultsThe demographics of the migrant population changed over time. Overall, migrants diagnosed with HIV after immigration to Denmark resided a median of 3.7 (IQR: 0.8-10.2) years in Denmark before diagnosis. Median time from HIV diagnosis to LTC was 6 (IQR: 0-24) days. Migrants diagnosed with HIV infection before immigration had a median of 38 (IQR: 0-105) days from arrival in Denmark to LTC. The corresponding median times for 2015-20 alone were 4.1 (IQR: 0.9-13.1) years, 0 (IQR: 0-8) days, and 62 (IQR: 25-152) days, respectively. The overall proportion of late presentation among migrants diagnosed with HIV after immigration was 60%, and highest among migrants from sub-Saharan Africa and East and South Asia.ConclusionHIV diagnosis is still substantially delayed in Danish migrants, while LTC is timely. The proportions with late presentation are high. These results call for targeted interventions to reduce the number of migrants with undiagnosed HIV infections and of late presenters.
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Affiliation(s)
- Olivia Borchmann
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre Hospital, Hvidovre, Denmark
| | - Lars Haukali Omland
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jan Gerstoft
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | | | - Suzanne Lunding
- Department of Internal Medicine, Herlev University Hospital, Herlev, Denmark
| | - Janne Jensen
- Department of Internal Medicine, Kolding Hospital, Kolding, Denmark
| | - Niels Obel
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Ann-Brit Eg Hansen
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre Hospital, Hvidovre, Denmark
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Papageorgiou V, Davies B, Cooper E, Singer A, Ward H. Influence of Material Deprivation on Clinical Outcomes Among People Living with HIV in High-Income Countries: A Systematic Review and Meta-analysis. AIDS Behav 2022; 26:2026-2054. [PMID: 34894331 PMCID: PMC9046343 DOI: 10.1007/s10461-021-03551-y] [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] [Accepted: 11/27/2021] [Indexed: 11/06/2022]
Abstract
Despite developments in HIV treatment and care, disparities persist with some not fully benefiting from improvements in the HIV care continuum. We conducted a systematic review to explore associations between social determinants and HIV treatment outcomes (viral suppression and treatment adherence) in high-income countries. A random effects meta-analysis was performed where there were consistent measurements of exposures. We identified 83 observational studies eligible for inclusion. Social determinants linked to material deprivation were identified as education, employment, food security, housing, income, poverty/deprivation, socioeconomic status/position, and social class; however, their measurement and definition varied across studies. Our review suggests a social gradient of health persists in the HIV care continuum; people living with HIV who reported material deprivation were less likely to be virologically suppressed or adherent to antiretrovirals. Future research should use an ecosocial approach to explore these interactions across the lifecourse to help propose a causal pathway.
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Affiliation(s)
- Vasiliki Papageorgiou
- Patient Experience Research Centre, School of Public Health, Imperial College London, London, UK.
| | - Bethan Davies
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Emily Cooper
- Patient Experience Research Centre, School of Public Health, Imperial College London, London, UK
| | - Ariana Singer
- School of Public Health, Imperial College London, London, UK
| | - Helen Ward
- Patient Experience Research Centre, School of Public Health, Imperial College London, London, UK
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22
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Global Health Facility-Based Interventions to Achieve UNAIDS 90-90-90: A Systematic Review and Narrative Analysis. AIDS Behav 2022; 26:1489-1503. [PMID: 34694526 DOI: 10.1007/s10461-021-03503-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2021] [Indexed: 10/20/2022]
Abstract
To evaluate whether health facility-based HIV interventions align with UNAIDS 90-90-90 targets, we performed a systematic review through the lens of UNAIDS targets. We searched 11 databases, retrieving 5201 citations with 26 eligible studies classified by country income and UNAIDS target. We analyzed whether reporting of study outcome metrics was in line with UNAIDS targets using a standardized extraction form and results were summarized in a narrative synthesis given data heterogeneity. We also assessed the quality of randomized trials with the Cochrane Risk of Bias Tool and observational studies with the Newcastle-Ottawa Scale. Stratification of interventions by country income level revealed themes in successful interventions that provide insight for scale-up in similar resource contexts. Few studies reported outcomes using metrics according to UNAIDS targets. Standardization of reporting according to the UNAIDS framework could facilitate comparability of interventions and inform country-level progress on an international scale.
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23
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Zhang Y, Wiseman V, Applegate TL, Lourenco RDA, Street DJ, Smith K, Jamil MS, Terris-Prestholt F, Fairley CK, McNulty A, Hynes A, Johnson K, Chow EPF, Bavinton BR, Grulich A, Stoove M, Holt M, Kaldor J, Guy R, Ong JJ. Preferences for HIV Testing Services and HIV Self-Testing Distribution Among Migrant Gay, Bisexual, and Other Men Who Have Sex With Men in Australia. Front Med (Lausanne) 2022; 9:839479. [PMID: 35514755 PMCID: PMC9063480 DOI: 10.3389/fmed.2022.839479] [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: 12/20/2021] [Accepted: 03/16/2022] [Indexed: 01/13/2023] Open
Abstract
Background In Australia, undiagnosed HIV rates are much higher among migrant gay, bisexual, or other men who have sex with men (GBMSM) than Australian-born GBMSM. HIV self-testing is a promising tool to overcome barriers to HIV testing and improve HIV testing uptake among migrant GBMSM. We compared the preferences for HIV testing services, including HIV self-testing, among migrant and Australian-born GBMSM. Methods Preferences were assessed via two discrete choice experiments (DCEs). Participants were recruited between December 2017 and January 2018 using online and offline advertising and randomly assigned to complete one of two online DCE surveys. Migrant GBMSM were classified as being born in a country with a reciprocal healthcare agreement (RHCA) with Australia (providing free or subsided health care) or not. Latent class analysis and mixed logit models were used to explore heterogeneity in preferences. Findings We recruited 1,606 GBMSM, including 583 migrant men of whom 419 (72%) were born in non-RHCA countries. Most participants preferred a free or cheap oral test with higher accuracy and a shorter window period to facilitate early detection of infections. Cost was more important for men born in non-RHCA countries than for men from RHCA countries or Australia. All groups preferred accessing kits through online distributers or off the shelf purchasing from pharmacies. Men born in RHCA countries least preferred accessing HIV self-testing kits from a medical clinic, while more than half of men from non-RHCA countries most preferred sourcing kits from a clinic. Sex-on-premises venues were the least preferred location to access test kits among all groups. In addition, two latent class analyses explored heterogeneity in preferences among men from non-RHCA countries and we found four latent classes for HIV testing services and two latent classes for HIVST distribution. Interpretation Our findings emphasise the need for high-performing and low-cost HIV self-testing kits that are accessible from a variety of distribution points as a component of Australia's HIV response, especially for those who do not have access to free or subsidised health care in Australia.
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Affiliation(s)
- Ye Zhang
- Kirby Institute, The University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia,*Correspondence: Ye Zhang
| | - Virginia Wiseman
- Kirby Institute, The University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia,Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Tanya L. Applegate
- Kirby Institute, The University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Richard De Abreu Lourenco
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW, Australia
| | - Deborah J. Street
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW, Australia
| | - Kirsty Smith
- Kirby Institute, The University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Muhammad S. Jamil
- Global Human immunodeficiency virus (HIV), Hepatitis and Sexually transmitted infections (STIs) Programmes, World Health Organization, Geneva, Switzerland
| | - Fern Terris-Prestholt
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Christopher K. Fairley
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Anna McNulty
- Sydney Sexual Health Centre, Sydney, NSW, Australia,School of Population Health, The University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Adam Hynes
- Thorne Harbour Health, Melbourne, VIC, Australia
| | | | - Eric P. F. Chow
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia,Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Benjamin R. Bavinton
- Kirby Institute, The University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Andrew Grulich
- Kirby Institute, The University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | | | - Martin Holt
- Centre for Social Research in Health, The University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - John Kaldor
- Kirby Institute, The University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Rebecca Guy
- Kirby Institute, The University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Jason J. Ong
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
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24
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Gruer LD, Cézard GI, Wallace LA, Hutchinson SJ, Douglas AF, Buchanan D, Katikireddi SV, Millard AD, Goldberg DJ, Sheikh A, Bhopal RS. Complex differences in infection rates between ethnic groups in Scotland: a retrospective, national census-linked cohort study of 1.65 million cases. J Public Health (Oxf) 2022; 44:60-69. [PMID: 33480434 PMCID: PMC7928762 DOI: 10.1093/pubmed/fdaa267] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 10/30/2020] [Accepted: 12/17/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Ethnicity can influence susceptibility to infection, as COVID-19 has shown. Few countries have systematically investigated ethnic variations in infection. METHODS We linked the Scotland 2001 Census, including ethnic group, to national databases of hospitalizations/deaths and serological diagnoses of bloodborne viruses for 2001-2013. We calculated age-adjusted rate ratios (RRs) in 12 ethnic groups for all infections combined, 15 infection categories, and human immunodeficiency virus (HIV), hepatitis B (HBV) and hepatitis C (HCV) viruses. RESULTS We analysed over 1.65 million infection-related hospitalisations/deaths. Compared with White Scottish, RRs for all infections combined were 0.8 or lower for Other White British, Other White and Chinese males and females, and 1.2-1.4 for Pakistani and African males and females. Adjustment for socioeconomic status or birthplace had little effect. RRs for specific infection categories followed similar patterns with striking exceptions. For HIV, RRs were 136 in African females and 14 in males; for HBV, 125 in Chinese females and 59 in males, 55 in African females and 24 in males; and for HCV, 2.3-3.1 in Pakistanis and Africans. CONCLUSIONS Ethnic differences were found in overall rates and many infection categories, suggesting multiple causative pathways. We recommend census linkage as a powerful method for studying the disproportionate impact of COVID-19.
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Affiliation(s)
- L D Gruer
- Usher Institute, University of Edinburgh, Edinburgh EH8 9AG, UK
| | - G I Cézard
- Population and Health Research Group, School of Geography and Sustainable development, University of St Andrews, St Andrews KY16 9AL, UK
| | - L A Wallace
- Health Protection Scotland, NHS National Services Scotland, Glasgow G2 6QE, UK
| | - S J Hutchinson
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow G4 0BA, UK
| | - A F Douglas
- Usher Institute, University of Edinburgh, Edinburgh EH8 9AG, UK
| | - D Buchanan
- Information Services Division, NHS National Services Scotland, Edinburgh EH12 9EB, UK
| | - S V Katikireddi
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow G2 3AX, UK
| | - A D Millard
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow G2 3AX, UK
| | - D J Goldberg
- Health Protection Scotland, NHS National Services Scotland, Glasgow G2 6QE, UK
| | - A Sheikh
- Usher Institute, University of Edinburgh, Edinburgh EH8 9AG, UK
| | - R S Bhopal
- Usher Institute, University of Edinburgh, Edinburgh EH8 9AG, UK
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25
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van Bilsen WPH, Bil JP, Prins JM, Brinkman K, Leyten E, van Sighem A, Bedert M, Davidovich U, Burns F, Prins M. Testing and healthcare seeking behavior preceding HIV diagnosis among migrant and non-migrant individuals living in the Netherlands: Directions for early-case finding. PLoS One 2022; 17:e0264435. [PMID: 35245293 PMCID: PMC8896686 DOI: 10.1371/journal.pone.0264435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 02/10/2022] [Indexed: 11/29/2022] Open
Abstract
Objectives To assess differences in socio-demographics, HIV testing and healthcare seeking behavior between individuals diagnosed late and those diagnosed early after HIV-acquisition. Design Cross-sectional study among recently HIV-diagnosed migrant and non-migrant individuals living in the Netherlands. Methods Participants self-completed a questionnaire on socio-demographics, HIV-testing and healthcare seeking behavior preceding HIV diagnosis between 2013–2015. Using multivariable logistic regression, socio-demographic determinants of late diagnosis were explored. Variables on HIV-infection, testing and access to care preceding HIV diagnosis were compared between those diagnosed early and those diagnosed late using descriptive statistics. Results We included 143 individuals with early and 101 with late diagnosis, of whom respectively 59/143 (41%) and 54/101 (53%) were migrants. Late diagnosis was significantly associated with older age and being heterosexual. Before HIV diagnosis, 89% of those with early and 62% of those with late diagnosis had ever been tested for HIV-infection (p<0.001), and respectively 99% and 97% reported healthcare usage in the Netherlands in the two years preceding HIV diagnosis (p = 0.79). Individuals diagnosed late most frequently visited a general practitioner (72%) or dentist (62%), and 20% had been hospitalized preceding diagnosis. In these settings, only in respectively 20%, 2%, and 6% HIV-testing was discussed. Conclusion A large proportion of people diagnosed late had previously tested for HIV and had high levels of healthcare usage. For earlier-case finding of HIV it therefore seems feasible to successfully roll out interventions within the existing healthcare system. Simultaneously, efforts should be made to encourage future repeated or routine HIV testing among individuals whenever they undergo an HIV test.
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Affiliation(s)
- Ward P. H. van Bilsen
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
- * E-mail:
| | - Janneke P. Bil
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Jan M. Prins
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Kees Brinkman
- Department of Internal Medicine, Division of Infectious Diseases, OLVG, Amsterdam, The Netherlands
| | - Eliane Leyten
- Department of Internal Medicine, Division of Infectious Diseases, Haaglanden Medical Center, Den Haag, The Netherlands
| | | | - Maarten Bedert
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Udi Davidovich
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
- Department of Social Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Fiona Burns
- Insitute for Global Health, University College London, London, United Kingdom
| | - Maria Prins
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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26
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Hempel S, Ferguson L, Bolshakova M, Yagyu S, Fu N, Motala A, Gruskin S. Frameworks, measures, and interventions for HIV-related internalised stigma and stigma in healthcare and laws and policies: systematic review protocol. BMJ Open 2021; 11:e053608. [PMID: 34887280 PMCID: PMC8663079 DOI: 10.1136/bmjopen-2021-053608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION There is strong global commitment to eliminate HIV-related stigma. Wide variation exists in frameworks and measures, and many strategies to prevent, reduce or mitigate stigma have been proposed but critical factors determining success or failure remain elusive. METHODS AND ANALYSIS Building on existing knowledge syntheses, we designed a systematic review to identify frameworks, measures and intervention evaluations aiming to address internalised stigma, stigma and discrimination in healthcare, and stigma and discrimination at the legal or policy level. The review addresses four key questions (KQ): KQ1: Which conceptual frameworks have been proposed to assess internal stigma, stigma and discrimination experienced in healthcare settings, and stigma and discrimination entrenched in national laws and policies? KQ2: Which measures of stigma have been proposed and what are their descriptive properties? KQ3: Which interventions have been evaluated that aimed to reduce these types of stigma and discrimination or mitigate their adverse effects and what are the effectiveness and unintended consequences? KQ4: What common 'critical factors for success or failure' can be identified across interventions that have been evaluated? We will search PubMed, PsycINFO, Web of Science, Universal Human Rights Index, HeinOnline, PAIS, HIV Legal Network, CDSR, Campbell Collaboration, PROSPERO and Open Science Framework. Critical appraisal will assess the source, processes and consensus finding for frameworks; COnsensus-based Standards for the selection of health Measurement Instruments criteria for measures; and risk of bias for interventions. Quality of evidence grading will apply . A gap analysis will provide targeted recommendations for future research. We will establish a compendium of frameworks, a comprehensive catalogue of available measures, and a synthesis of intervention characteristics to advance the science of HIV-related stigma. PROSPERO REGISTRATION NUMBER CRD42021249348.
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Affiliation(s)
- Susanne Hempel
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Laura Ferguson
- Institute on Inequalities in Global Health, University of Southern California, Los Angeles, California, USA
| | - Maria Bolshakova
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Sachi Yagyu
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Ning Fu
- Department of Economics, Shanghai University of Finance and Economics, Shanghai, China
| | - Aneesa Motala
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Sofia Gruskin
- Institute on Inequalities in Global Health, University of Southern California, Los Angeles, California, USA
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27
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Zhou W, Deng W, Luo J, Bai Y, He Z, Wang H. Predictors for HIV testing among Chinese workers in infrastructure construction enterprises in Kenya. BMC Public Health 2021; 21:2213. [PMID: 34863140 PMCID: PMC8642875 DOI: 10.1186/s12889-021-12234-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 11/13/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There are increasing Chinese migrants in sub-Saharan Africa currently. Most of them are engaged in infrastructure construction. Research has shown that they stay at particular risk of HIV and are recommended for HIV testing. However, their HIV testing behavior, and its relevant factors, have not been researched among them by now. This study describes the recent HIV testing behavior and relevant factors among Chinese migrant workers in Kenya. METHODS A cross-sectional survey was conducted among 110 male Chinese workers from six different Chinese infrastructure construction enterprises in Kenya. Furthermore, a two-stage cluster random sampling method was used to select participants. We used a questionnaire that included HIV testing history, demographic characteristics, and putative multilevel facilitators of HIV testing. Logistic regression was used to explore the predictors of recent HIV testing behavior among Chinese migrant workers in Kenya. RESULT Of the 110 participants, 30 (27.27%) were tested for HIV in the recent year. All participants were male, and the majority were married (73.2%). The mean age was 37.49 years (SD = 9.73; range: 23 to 63), and a considerable proportion refused to answer questions about transactional sexual behaviors in the last year. Most were able to obtain HIV-related information (91.8%) and were exposed to HIV-related information in the last year (68.2%), but only 47.6% had sufficient HIV knowledge. Nearly one-fifth of them believed that selling sex and paying for sex is acceptable. Multiple logistic regression analysis indicated that participants who could accept the 'pay for sex' (OR: 2.74; 95% CI: 1.02, 7.36) and exposed to HIV related information (OR: 4.75; 95% CI: 1.29, 17.44) were more likely to test for HIV in the recent 1 year. CONCLUSION Higher current HIV test rates were associated with a more open sexual attitude towards paying for sex and being exposed to HIV-related information in the last year among Chinese workers in Kenya. More specific attention to HIV should be attached to this population to increase the rate of HIV testing among them.
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Affiliation(s)
- Wenjuan Zhou
- School of literature and journalism, Central South University, Changsha, Hunan Province, China
| | - Wenyu Deng
- Xiang Ya Nursing School, Central South University, Changsha, Hunan Province, China
| | - Junfei Luo
- School of literature and journalism, Central South University, Changsha, Hunan Province, China
| | - Yin Bai
- School of literature and journalism, Central South University, Changsha, Hunan Province, China
| | - Zeyi He
- School of literature and journalism, Central South University, Changsha, Hunan Province, China
| | - Honghong Wang
- Xiang Ya Nursing School, Central South University, Changsha, Hunan Province, China.
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28
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Koning SM, Flaim A, Baldiga L, Feingold DA. Legal status as a life course determinant of health: parent status, adjudication stages, and HIV knowledge among highlanders in Thailand. BMC Public Health 2021; 21:1839. [PMID: 34635078 PMCID: PMC8507192 DOI: 10.1186/s12889-021-11811-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 09/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rising nativism and political volatility worldwide threaten to undermine hard-won achievements in human rights and public health. Risks are particularly acute for hundreds of millions of migrants, minorities, and Indigenous peoples, who face disproportionately high health burdens, including HIV/AIDS, and precarious legal status (LS). While LS is receiving increasing attention as a social determinant of health and HIV, understandings are still limited to select immigrant communities. Its effects on health among stateless communities, particularly in the Global South, remain largely unknown. Moreover, widespread limitations in census measures of LS reduce its complexity to a simplistic citizen/non-citizen binary or insufficient proxies. Thailand's ethnolinguistically diverse highlander population experiences disproportionately high HIV prevalence and comprises one of the world's largest and most protracted cases of statelessness, an acute condition of precarious LS. As such, analysis of LS and health outcomes among highlanders is both critically warranted, and useful as a case study outside of the migration paradigm. METHODS Drawing on the UNESCO Highland Peoples Survey II (2010), an unprecedented and unique cross-sectional census of highlanders in Thailand, we mobilize complex measures of LS in adjusted ordinal logistic regression models to assess how parent citizenship and LS adjudication over the early life course condition adult HIV knowledge-a key protective factor against transmission (n = 8079). RESULTS Adjusted ordinal logistic regression on knowledge scores reveal that parent citizenship predicts odds of greater knowledge by 1.4- to 2.2-fold, depending on ethnic group. This is partially explained by divergent stages of LS adjudication between birth and adulthood, including successful birth registration and adult citizenship acquisition, along with secondary school completion. Precisely how these factors contribute to HIV knowledge varies by ethnic group. CONCLUSIONS This study advances knowledge of LS outside of the migration paradigm, reveals heretofore unexamined connections between LS and access to public health information, and elucidates how instabilities in LS adjudication stages underlie health inequalities over the life course. Findings indicate that securing success in public health and human rights agendas requires attention to how states adjudicate and deploy LS in multiple stages across the life course to structure access and exclusion among migrant and non-migrant communities alike.
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Affiliation(s)
- Stephanie M. Koning
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, 610 Walnut Street, 707 WARF Building, Madison, WI 53726 USA
- Present address: Institute for Policy Research, Northwestern University, 2040 Sheridan Road, Evanston, IL 60208 USA
| | - Amanda Flaim
- James Madison College and the Department of Sociology, Michigan State University, 307 S Case Hall, 842 Chestnut Rd, East Lansing, MI 48823 USA
| | - Leo Baldiga
- James Madison College, Michigan State University, 307 S Case Hall, 842 Chestnut Rd, East Lansing, MI 48823 USA
| | - David A. Feingold
- United Nations, Educational, Scientific, and Cultural Organization (ret.)/Ophidian Research Institute, 19 Soi 35, Sukhumvit Road, Klongton-nua, Wattana, Bangkok, 10110 Thailand
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29
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Voluntary HIV and Viral Hepatitis Testing in Newly Arrived Migrant Men in a First Reception Center in the North of Paris—a Qualitative Study on the Perception and Forms of Participation. JOURNAL OF INTERNATIONAL MIGRATION AND INTEGRATION 2021. [DOI: 10.1007/s12134-021-00897-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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30
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Pantazis N, Rosinska M, van Sighem A, Quinten C, Noori T, Burns F, Cortes Martins H, Kirwan PD, O'Donnell K, Paraskevis D, Sommen C, Zenner D, Pharris A. Discriminating Between Premigration and Postmigration HIV Acquisition Using Surveillance Data. J Acquir Immune Defic Syndr 2021; 88:117-124. [PMID: 34138772 DOI: 10.1097/qai.0000000000002745] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/02/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Migrant populations are overrepresented among persons diagnosed with HIV in the European Union and the European Economic Area. Understanding the timing of HIV acquisition (premigration or postmigration) is crucial for developing public health interventions and for producing reliable estimates of HIV incidence and the number of people living with undiagnosed HIV infection. We summarize a recently proposed method for determining the timing of HIV acquisition and apply it to both real and simulated data. METHODS The considered method combines estimates from a mixed model, applied to data from a large seroconverters' cohort, with biomarker measurements and individual characteristics to derive probabilities of premigration HIV acquisition within a Bayesian framework. The method is applied to a subset of data from the European Surveillance System (TESSy) and simulated data. FINDINGS Simulation study results showed good performance with the probabilities of correctly classifying a premigration case or a postmigration case being 87.4% and 80.4%, respectively. Applying the method to TESSy data, we estimated the proportions of migrants who acquired HIV in the destination country were 31.9%, 37.1%, 45.3%, and 45.2% for those originating from Africa, Europe, Asia, and other regions, respectively. CONCLUSIONS Although the considered method was initially developed for cases with multiple biomarkers' measurements, its performance, when applied to data where only one CD4 count per individual is available, remains satisfactory. Application of the method to TESSy data, estimated that a substantial proportion of HIV acquisition among migrants occurs in destination countries, having important implications for public health policy and programs.
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Affiliation(s)
- Nikos Pantazis
- Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Magdalena Rosinska
- Department of Epidemiology of Infectious Diseases and Surveillance, National Institute of Public Health-National Institute of Hygiene, Warsaw, Poland
| | | | - Chantal Quinten
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Teymur Noori
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Fiona Burns
- Institute for Global Health, University College London, London, United Kingdom
| | | | - Peter D Kirwan
- Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge, United Kingdom
- Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Division, Public Health England, London, United Kingdom
| | - Kate O'Donnell
- HSE-Health Protection Surveillance Centre, Dublin, Ireland
| | - Dimitrios Paraskevis
- Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | | | - Dominik Zenner
- Centre for Global Public Health, Institute for Population Health Sciences, Queen Mary University London, London, United Kingdom
| | - Anastasia Pharris
- European Centre for Disease Prevention and Control, Stockholm, Sweden
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31
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Bedert M, Davidovich U, de Bree G, van Bilsen W, van Sighem A, Zuilhof W, Brinkman K, van der Valk M, de Wit J. Understanding Reasons for HIV Late Diagnosis: A Qualitative Study Among HIV-Positive Individuals in Amsterdam, The Netherlands. AIDS Behav 2021; 25:2898-2906. [PMID: 33788120 PMCID: PMC8373722 DOI: 10.1007/s10461-021-03239-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2021] [Indexed: 12/18/2022]
Abstract
Since the introduction of effective anti-retroviral therapy, early diagnosis and treatment of HIV have become increasingly important from individual and public health perspectives. People who are diagnosed with a CD4 count below 350 cells/µL blood are today considered to be “late” diagnoses. In an effort to understand the reasons for late diagnosis, we conducted in-depth interviews (n = 14) in Amsterdam, the Netherlands. Two main factors were identified: psychosocial factors and health-system factors. Psychosocial factors relate to people’s personal relationship with health professionals, low risk perception, fear related to the outcome of testing, and trauma from observed past experiences of living with HIV. Health-system factors relate to institutional barriers and missed opportunities during client-provider interactions. We conclude that in order to mitigate late diagnosis, the social and institutional context within which HIV testing is conducted should be addressed.
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Affiliation(s)
- Maarten Bedert
- Amsterdam UMC, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Udi Davidovich
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands
| | | | | | | | - Wim Zuilhof
- SOA AIDS Nederland, Amsterdam, The Netherlands
| | - Kees Brinkman
- Onze Lieve Vrouwenziekenhuis, Amsterdam, The Netherlands
| | - Marc van der Valk
- Amsterdam UMC, Location AMC & DC Klinieken Valeriusplein, Amsterdam, The Netherlands
| | - John de Wit
- Utrecht University, Utrecht, The Netherlands
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Saatci D, Ranger TA, Garriga C, Clift AK, Zaccardi F, Tan PS, Patone M, Coupland C, Harnden A, Griffin SJ, Khunti K, Dambha-Miller H, Hippisley-Cox J. Association Between Race and COVID-19 Outcomes Among 2.6 Million Children in England. JAMA Pediatr 2021; 175:928-938. [PMID: 34152371 PMCID: PMC8218232 DOI: 10.1001/jamapediatrics.2021.1685] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
IMPORTANCE Although children mainly experience mild COVID-19 disease, hospitalization rates are increasing, with limited understanding of underlying factors. There is an established association between race and severe COVID-19 outcomes in adults in England; however, whether a similar association exists in children is unclear. OBJECTIVE To investigate the association between race and childhood COVID-19 testing and hospital outcomes. DESIGN, SETTING, PARTICIPANTS In this cohort study, children (0-18 years of age) from participating family practices in England were identified in the QResearch database between January 24 and November 30, 2020. The QResearch database has individually linked patients with national SARS-CoV-2 testing, hospital admission, and mortality data. EXPOSURES The main characteristic of interest is self-reported race. Other exposures were age, sex, deprivation level, geographic region, household size, and comorbidities (asthma; diabetes; and cardiac, neurologic, and hematologic conditions). MAIN OUTCOMES AND MEASURES The primary outcome was hospital admission with confirmed COVID-19. Secondary outcomes were SARS-CoV-2-positive test result and any hospital attendance with confirmed COVID-19 and intensive care admission. RESULTS Of 2 576 353 children (mean [SD] age, 9.23 [5.24] years; 48.8% female), 410 726 (15.9%) were tested for SARS-CoV-2 and 26 322 (6.4%) tested positive. A total of 1853 children (0.07%) with confirmed COVID-19 attended hospital, 343 (0.01%) were admitted to the hospital, and 73 (0.002%) required intensive care. Testing varied across race. White children had the highest proportion of SARS-CoV-2 tests (223 701/1 311 041 [17.1%]), whereas Asian children (33 213/243 545 [13.6%]), Black children (7727/93 620 [8.3%]), and children of mixed or other races (18 971/147 529 [12.9%]) had lower proportions. Compared with White children, Asian children were more likely to have COVID-19 hospital admissions (adjusted odds ratio [OR], 1.62; 95% CI, 1.12-2.36), whereas Black children (adjusted OR, 1.44; 95% CI, 0.90-2.31) and children of mixed or other races (adjusted OR, 1.40; 95% CI, 0.93-2.10) had comparable hospital admissions. Asian children were more likely to be admitted to intensive care (adjusted OR, 2.11; 95% CI, 1.07-4.14), and Black children (adjusted OR, 2.31; 95% CI, 1.08-4.94) and children of mixed or other races (adjusted OR, 2.14; 95% CI, 1.25-3.65) had longer hospital admissions (≥36 hours). CONCLUSIONS AND RELEVANCE In this large population-based study exploring the association between race and childhood COVID-19 testing and hospital outcomes, several race-specific disparities were observed in severe COVID-19 outcomes. However, ascertainment bias and residual confounding in this cohort study should be considered before drawing any further conclusions. Overall, findings of this study have important public health implications internationally.
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Affiliation(s)
- Defne Saatci
- Primary Care Epidemiology, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Tom A. Ranger
- Primary Care Epidemiology, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Cesar Garriga
- Primary Care Epidemiology, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Ash Kieran Clift
- Primary Care Epidemiology, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom,Cancer Research UK Oxford Centre, Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Francesco Zaccardi
- Leicester Real World Evidence Unit, Leicester Diabetes Centre, University of Leicester, Leicester, United Kingdom
| | - Pui San Tan
- Primary Care Epidemiology, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Martina Patone
- Primary Care Epidemiology, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Carol Coupland
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Anthony Harnden
- Primary Care Epidemiology, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Simon J. Griffin
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom,MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Kamlesh Khunti
- Leicester Real World Evidence Unit, Leicester Diabetes Centre, University of Leicester, Leicester, United Kingdom
| | - Hajira Dambha-Miller
- Primary Care Research Centre, University of Southampton, Southampton, United Kingdom
| | - Julia Hippisley-Cox
- Primary Care Epidemiology, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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Who falls between the cracks? Identifying eligible PrEP users among people with Sub-Saharan African migration background living in Antwerp, Belgium. PLoS One 2021; 16:e0256269. [PMID: 34407146 PMCID: PMC8372948 DOI: 10.1371/journal.pone.0256269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 08/03/2021] [Indexed: 12/25/2022] Open
Abstract
Introduction This study produces an estimate of the proportion of eligible PrEP users among people of Sub-Saharan African background based on the Belgian PrEP eligibility criteria and examines associations with socio-economic and demographic characteristics. Methods We performed logistic regression analysis on data of a representative community-based survey conducted among Sub-Saharan African communities (n = 685) living in Antwerp. Results Almost a third (30.3%) of the respondents were eligible to use PrEP. Those who were male, single, lower educated, undocumented, and had experienced forced sex were more likely to be eligible for PrEP use. The findings highlight the importance of taking intra-, interpersonal and structural HIV risk factors into account. Conclusions The study shows high unmet PrEP needs in this population, especially among those with high vulnerability for HIV acquisition. A better understanding of barriers to PrEP use in this population group is needed to allow for equitable access.
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Gogishvili M, Huang TTK, Costa SA, Florez K, Mateu-Gelabert P, Valls MRA, Rivero M, Saumoy M, Samperiz G, Cervero M, Pulido F, Pérez JA. Late HIV diagnosis among immigrants in Spain vs. native-born Spaniards, 2010-15. Eur J Public Health 2021; 31:1123-1128. [PMID: 34405861 DOI: 10.1093/eurpub/ckab089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In 2012, the central government of Spain enacted Royal Decree-Law (RDL) 16/2012 and Royal Decree (RD) 1192/2012, which abolished universal healthcare coverage, thus limiting access to care for undocumented immigrants. Free health care was also no longer granted to anyone who has never been employed. In this context, this study investigated the prevalence of late HIV diagnoses (LHDs) among immigrants living in Spain vs. native-born Spaniards. METHODS Data (n = 5943) from the 2010 to 2015 Cohort of the Spanish AIDs Research Network were used, including HIV-positive and antiretroviral therapy (ART)-naïve patients throughout Spain. Multivariate logistic models were fitted to compare the prevalence of LHD among the groups, adjusting for covariates. RESULTS The prevalence of LHD in the total sample was 39.5%. Compared with native-born Spaniards (n = 4445), immigrants (n = 1488) were more likely to have LHD (37.4% vs. 45.7%, respectively; P < 0.001). Multivariate analysis showed that the prevalence ratio of LHD among immigrants vs. native-born Spaniards was 1.15 [95% confidence interval (CI), 1.02-1.28], after adjusting for covariates. This disparity widened from 2010 to 2011 (APR = 1.14, 95% CI, 1.02-1.29) to 2012-15 (APR = 1.28, 95% CI, 1.17-1.39), although the change was not statistically significant. CONCLUSIONS Immigrants in Spain had a higher risk of LHD compared with native-born counterparts. LHD is an important healthcare marker due to the positive benefits of early HIV diagnosis, including prevention, improvements in health outcomes and decreases in overall cost of treatment. More research is needed on the causes of the disparity and potential social and policy interventions to reduce the prevalence of LHD among immigrants.
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Affiliation(s)
- Megi Gogishvili
- Center for Systems and Community Design, CUNY Graduate School of Public Health & Health Policy, New York, NY, USA
| | - Terry T-K Huang
- Center for Systems and Community Design, CUNY Graduate School of Public Health & Health Policy, New York, NY, USA
| | - Sergio A Costa
- Center for Systems and Community Design, CUNY Graduate School of Public Health & Health Policy, New York, NY, USA
| | - Karen Florez
- Center for Systems and Community Design, CUNY Graduate School of Public Health & Health Policy, New York, NY, USA
| | - Pedro Mateu-Gelabert
- Institute for Implementation Science in Population Health, CUNY, New York, NY, USA
| | - Maria R A Valls
- University Hospital of Canary Islands, Santa Cruz de Tenerife, Spain
| | | | | | | | | | - Federico Pulido
- University Hospital 12 de Octubre (IMAS12), Complutense University of Madrid (UCM), Madrid, Spain
| | - José A Pérez
- Infectious Diseases Department, University Hospital Ramón y Cajal (IRYCIS), Madrid, Spain
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Manirankunda L, Wallace A, Ddungu C, Nöstlinger C. Stigma Mechanisms and Outcomes among Sub-Saharan African Descendants in Belgium-Contextualizing the HIV Stigma Framework. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168635. [PMID: 34444384 PMCID: PMC8393566 DOI: 10.3390/ijerph18168635] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/29/2021] [Accepted: 08/07/2021] [Indexed: 11/29/2022]
Abstract
HIV-related stigma and discrimination are recognized barriers to HIV prevention, testing and treatment among people of Sub-Saharan African descent (SSA) origin living in Belgium, but insights into HIV related-stigma mechanisms and outcomes are lacking for this population with high HIV prevalence. Guided by Earnshaw and Chaudoir’s stigma framework (2009), we conducted this qualitative study using 10 focus-groups with 76 SSA community members and 20 in-depth interviews with SSA descendants living with HIV to explore specific HIV-stigma mechanisms and outcomes and underlying drivers. Inductive and deductive thematic analysis showed high degrees of stigma among SSA communities driven by fear of HIV acquisition and misconceptions in a migration context, negatively affecting SSA descendants living with HIV. The results allowed for contextualization of the framework: At the community level, prejudices and stereotypes were major stigma mechanisms, while physical distancing, gossips, sexual rejection, violence and increased HIV prevalence emerged as stigma outcomes. Among SSA descendants living with HIV, enacted, anticipated and internalized stigmas were validated as stigma mechanisms, with witnessed stigma as an additional mechanism. Self-isolation, community avoidance and low utilization of non-HIV specialized healthcare were additional outcomes. These results are relevant for tailoring interventions to reduce HIV-related stigma.
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Affiliation(s)
- Lazare Manirankunda
- Institute of Tropical Medicine Antwerp, 2000 Antwerp, Belgium; (C.D.); (C.N.)
- Correspondence:
| | - Aletha Wallace
- Department of Medical Sociology and Health Sciences, Vrije Universiteit Brussel, 1050 Brussels, Belgium;
| | - Charles Ddungu
- Institute of Tropical Medicine Antwerp, 2000 Antwerp, Belgium; (C.D.); (C.N.)
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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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Krabbenborg N, Spijker R, Żakowicz AM, de Moraes M, Heijman T, de Coul EO. Community-based HIV testing in The Netherlands: experiences of lay providers and end users at a rapid HIV test checkpoint. AIDS Res Ther 2021; 18:34. [PMID: 34162401 PMCID: PMC8220118 DOI: 10.1186/s12981-021-00357-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 06/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The AIDS Healthcare Foundation (AHF-Checkpoint) in The Netherlands offers rapid HIV testing for key populations by lay providers. We explored the experiences and needs of lay providers and end users of HIV testing at AHF-Checkpoint, taking into account the WHO 5C-(consent, confidentiality, counselling, correct-results, connection-to-care) criteria for HIV test services. METHODS Qualitative evaluation with 15 semi-structured interviews conducted during 2020 with ten lay providers and five gay or bisexual end users. Recorded interviews were thematically analysed, taking data triangulation into account. RESULTS Four domains were identified: (1) accessibility of HIV testing, (2) quality of test procedures, (3) bridging (transitional care), and (4) future strategies for service delivery. AHF-Checkpoint fills a gap for key populations including LGBTQ and refugees, who experience HIV testing barriers at sexual health centres or general practices. The level of trust between lay providers and end users was highly valued by end users. They appreciated the low threshold to test at no costs, and the absence of waiting lists or triaging. Needs expressed by lay providers included more preparedness for emotionally charged situations, and extra training to improve STI knowledge. End users expressed a need for a full STI test package. Of the 5Cs, consent, counselling, and correct results were realised but confidentiality was sometimes difficult to achieve at pop-up locations, and referral barriers for confirmation testing (connection-to-care) were occasionally experienced by lay providers during weekends. CONCLUSION AHF-Checkpoint was described as a convenient and easily accessible service by end users and lay providers. Of the WHO 5Cs, connection-to-care could be optimised to ensure HIV confirmation and STI testing through a liaison approach with professionals from the regular healthcare sector.
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Gogishvili M, Costa SA, Flórez K, Huang TT. Policy implementation analysis on access to healthcare among undocumented immigrants in seven autonomous communities of Spain, 2012-2018. BMJ Open 2021; 11:e045626. [PMID: 34155072 PMCID: PMC8217913 DOI: 10.1136/bmjopen-2020-045626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND In 2012, the Government of Spain enacted Royal Decree-Law (RDL) 16/2012 and Royal Decree (RD) 1192/2012 excluding undocumented immigrants from publicly funded healthcare services. We conducted a policy implementation analysis to describe and evaluate the legal and regulatory actions taken at the autonomous community (AC) level after enactment of 2012 RDL and RD and their impact on access to general healthcare and HIV services among undocumented immigrants. METHODS We reviewed documents published by the governments of seven ACs (Andalucía, Aragón, Euskadi (Basque Country), Castilla-La Mancha, Galicia, Madrid, Valencia) from April 2012 to July 2018, describing circumstances under which undocumented immigrants would be able to access free healthcare services. We developed indicators according to the main systemic barriers presented in official documents to analyse access to free healthcare across the participating ACs. ACs were grouped under five access categories: high, medium-high, medium, medium-low and low. RESULTS Andalucía provided the highest access to free healthcare for undocumented immigrants in both general care and HIV treatment. Medium-high access was provided by Euskadi and medium access by Aragón, Madrid and Valencia. Castilla-La Mancha provided medium-low access. Galicia had low access. Only Madrid and Galicia provided different and higher level of access to undocumented migrants in HIV care compared with general healthcare. CONCLUSIONS Implementation of 2012 RDL and RD across the ACs varied significantly, in part due to the decentralisation of the Spanish healthcare system. The challenge of healthcare access among undocumented immigrants included persistent systemic restrictions, frequent and unclear rule changes, and the need to navigate differences across ACs of Spain.
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Affiliation(s)
- Megi Gogishvili
- Center of Systems and Community Design, City University of New York School of Public Health, New York, New York, USA
| | - Sergio A Costa
- Center of Systems and Community Design, City University of New York School of Public Health, New York, New York, USA
| | - Karen Flórez
- Center of Systems and Community Design, City University of New York School of Public Health, New York, New York, USA
| | - Terry T Huang
- Center of Systems and Community Design, City University of New York School of Public Health, New York, New York, USA
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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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Park H, Brenner B, Ibanescu RI, Cox J, Weiss K, Klein MB, Hardy I, Narasiah L, Roger M, Kronfli N. Phylogenetic Clustering among Asylum Seekers with New HIV-1 Diagnoses in Montreal, QC, Canada. Viruses 2021; 13:v13040601. [PMID: 33915869 PMCID: PMC8066823 DOI: 10.3390/v13040601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/22/2021] [Accepted: 03/30/2021] [Indexed: 01/08/2023] Open
Abstract
Migrants are at an increased risk of HIV acquisition. We aimed to use phylogenetics to characterize transmission clusters among newly-diagnosed asylum seekers and to understand the role of networks in local HIV transmission. Retrospective chart reviews of asylum seekers linked to HIV care between 1 June 2017 and 31 December 2018 at the McGill University Health Centre and the Jewish General Hospital in Montreal were performed. HIV-1 partial pol sequences were analyzed among study participants and individuals in the provincial genotyping database. Trees were reconstructed using MEGA10 neighbor-joining analysis. Clustering of linked viral sequences was based on a strong bootstrap support (>97%) and a short genetic distance (<0.01). Overall, 10,645 provincial sequences and 105 asylum seekers were included. A total of 13/105 participant sequences (12%; n = 7 males) formed part of eight clusters. Four clusters (two to three people) included only study participants (n = 9) and four clusters (two to three people) included four study participants clustered with six individuals from the provincial genotyping database. Six (75%) clusters were HIV subtype B. We identified the presence of HIV-1 phylogenetic clusters among asylum seekers and at a population-level. Our findings highlight the complementary role of cohort data and population-level genotypic surveillance to better characterize transmission clusters in Quebec.
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Affiliation(s)
- Hyejin Park
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC H4A 3J1, Canada; (H.P.); (J.C.); (M.B.K.)
| | - Bluma Brenner
- McGill AIDS Centre, Lady Davis Institute, Jewish General Hospital, Montreal, QC H3T 1E2, Canada; (B.B.); (R.-I.I.)
| | - Ruxandra-Ilinca Ibanescu
- McGill AIDS Centre, Lady Davis Institute, Jewish General Hospital, Montreal, QC H3T 1E2, Canada; (B.B.); (R.-I.I.)
| | - Joseph Cox
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC H4A 3J1, Canada; (H.P.); (J.C.); (M.B.K.)
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC H3A 0G4, Canada
| | - Karl Weiss
- Department of Medicine, Division of Infectious Diseases and Medical Microbiology, Jewish General Hospital, Montreal, QC H3T 1E2, Canada;
| | - Marina B. Klein
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC H4A 3J1, Canada; (H.P.); (J.C.); (M.B.K.)
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
| | - Isabelle Hardy
- Department of Microbiology, Infectiology and Immunology, Université de Montréal, Montréal, QC H3T 1J4, Canada; (I.H.); (M.R.)
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montréal, QC H2X 0A9, Canada
| | - Lavanya Narasiah
- Direction Régionale de Santé Publique, CIUSSS Centre-Sud-de-l’Île-de-Montréal, Montréal, QC H2L 1M3, Canada;
- Clinique des Réfugiés, CISSS Montérégie Centre, Brossard, QC J4Z 1A5, Canada
| | - Michel Roger
- Department of Microbiology, Infectiology and Immunology, Université de Montréal, Montréal, QC H3T 1J4, Canada; (I.H.); (M.R.)
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montréal, QC H2X 0A9, Canada
| | - Nadine Kronfli
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC H4A 3J1, Canada; (H.P.); (J.C.); (M.B.K.)
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
- Correspondence: ; Tel.: +1-514-934-1934; Fax: +1-514-843-2092
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Gogishvili M, Flórez KR, Costa SA, Huang TTK. A qualitative study on mixed experiences of discrimination and healthcare access among HIV-positive immigrants in Spain. BMC Public Health 2021; 21:385. [PMID: 33607960 PMCID: PMC7893723 DOI: 10.1186/s12889-021-10388-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 02/04/2021] [Indexed: 11/16/2022] Open
Abstract
Background Immigrants are disproportionally impacted by HIV infection in Europe and in Spain. Immigrants are also identified as a vulnerable population during economic crises. Various socioeconomic barriers hinder HIV-positive immigrants from accessing healthcare services in the host country. As a result of the 2008 financial crisis, Spain has implemented multiple austerity measures, one of which was the enactments of Royal Decree Law (RDL) 16/2012 and Royal Decree (RD) 1192/2012 which abolished universal healthcare coverage. In this context, this study examined: 1) Participants’ mixed experiences in accessing health care after the enactment of 2012 RDL and RD, and 2) Distress felt by the participants and their experiences as HIV-positive immigrants living in Spain. Methods Participants were recruited through a nongovernmental organization (NGO) during routine visits at the center. A total of 12 participants were interviewed to reach data saturation. Participants were HIV-positive immigrants living in Spain for 1 or more years, allowing for substantial experience with navigating the healthcare system. Thematic analysis was performed to identify common themes in participants’ experiences living as HIV-positive individuals in Spain and in accessing healthcare. Results Four primary themes were identified. The primary systemic barrier to accessing health care encountered by participants was the inability to fulfill the requirement of having proof of registration in an Autonomous Community for the required time period, thus not being able to apply for a public health insurance card and utilize free care services. Participants identified a positive impact of third party (NGO, social worker, friend/family member) guidance on their experience of applying for a public health insurance card. Participants expressed experiencing emotional or physical (eg, side effects of medication) distress in adapting to life as HIV-positive individuals. Participants also identified experiencing discrimination while living as HIV-positive immigrants in Spain. Conclusions HIV-positive immigrants are underserved in Spain. They encounter systemic barriers while accessing healthcare services, and experience fear and/or discrimination. The study underscores the role of NGOs in helping HIV-positive immigrants navigate the healthcare system. More research is needed on comprehensive approaches to address healthcare needs of HIV-positive immigrants in Spain.
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Affiliation(s)
- Megi Gogishvili
- Center for Systems and Community Design, Graduate School of Public Health and Health Policy, City University of New York, 55 West 125 Street, New York, NY, 10027, USA
| | - Karen R Flórez
- Center for Systems and Community Design, Graduate School of Public Health and Health Policy, City University of New York, 55 West 125 Street, New York, NY, 10027, USA
| | - Sergio A Costa
- Center for Systems and Community Design, Graduate School of Public Health and Health Policy, City University of New York, 55 West 125 Street, New York, NY, 10027, USA
| | - Terry T-K Huang
- Center for Systems and Community Design, Graduate School of Public Health and Health Policy, City University of New York, 55 West 125 Street, New York, NY, 10027, USA.
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Intersections of Immigration and Sexual/Reproductive Health: An Umbrella Literature Review with a Focus on Health Equity. SOCIAL SCIENCES 2021. [DOI: 10.3390/socsci10020063] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Identifying the opportunities and barriers of promoting and fulfilling the sexual health rights of migrants remains a challenge that requires systematic assessment. Such an assessment would include estimating the influence of acculturation processes on sexual and reproductive health, and mapping intersectional inequities that influence migrants’ sexual and reproductive health in comparison with the native population. The aim of this research was to locate, select, and critically assess/summarize scientific evidence regarding the social, cultural, and structural factors influencing migrants’ sexual and reproductive health outcomes in comparison with native population. An umbrella review of systematic reviews and/or meta-analyses, following preferred reporting items for systematic reviews and meta-analysis (PRISMA) standards was undertaken. Medline, Scopus, Web of Science, and the Cochrane Database of Systematic Reviews were searched from their start date until June 2019. The quality of the included articles was determined using the assessment of multiple systematic reviews tool (AMSTAR 2). From the 36 selected studies, only 12 compared migrant with native populations. Overall, the findings indicated that migrants tend to underuse maternal health services and have an increased risk of poor sexual and reproductive health outcomes. Specific intersectional inequities were identified and discussed.
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A Review of Cultural Influences on Risk for HIV and Culturally-Responsive Risk Mitigation Strategies Among African Immigrants in the US. J Immigr Minor Health 2021; 23:1280-1292. [PMID: 33428074 DOI: 10.1007/s10903-020-01138-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2020] [Indexed: 10/22/2022]
Abstract
There is a paucity of research on HIV risk factors and risk reduction among African immigrants living in the US. This is despite the fact that the literature on HIV prevention and treatment continues to grow. We conducted a focused review to identify cultural factors contributing to the high incidence of HIV among African immigrants and best practices to increase engagement in HIV prevention services in this population. We conducted a search for empirical research published between 2009 and 2019, yielding 17 relevant studies with 16 unique samples. Inadequate knowledge about HIV transmission, low HIV risk perception, and stigma may be barriers to engaging in HIV prevention. Targeted interventions included bundled HIV testing, flexible scheduling, and involvement of community leaders in intervention planning and implementation. Implications for practice and directions for future research among this population are discussed.
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Nkulu-Kalengayi FK, Jonzon R, Deogan C, Hurtig AK. Evidence and gaps in the literature on HIV/STI prevention interventions targeting migrants in receiving countries: a scoping review. Glob Health Action 2021; 14:1962039. [PMID: 34404337 PMCID: PMC8381899 DOI: 10.1080/16549716.2021.1962039] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 07/21/2021] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Evidence suggests that migration increases vulnerability to human immunodeficiency virus (HIV) and other sexually transmitted infections (STI). However, there is limited knowledge about what has been done or needs to be done to address migrants' vulnerability in receiving countries. OBJECTIVES A scoping review was carried out to map the existing literature in this field, describe its characteristics, identify gaps in knowledge and determine whether a Sexual and Reproductive Health and Rights (SRHR)-perspective was applied. METHODS We used the Arksey and O'Malley framework and the Joanna Briggs Institute guidelines for scoping reviews and subsequent enhancements proposed by other authors. We searched three databases and grey literature to identify relevant publications. RESULTS A total of 1,147 records were found across the three electronic databases and compiled. Of these, only 29 papers that met the inclusion criteria were included. The review shows that research in this field is dominated by studies from the USA that mostly include behavioural interventions for HIV and HBV prevention among migrants from Latin America and Asian countries, respectively. None of the interventions integrated an SRHR perspective. The intervention effects varied across studies and measured outcomes. The observed effects on knowledge, attitudes, perceptions, behavioural intentions and skills were largely positive, but reported effects on testing and sexual risk behaviours were inconsistent. CONCLUSIONS There is a need for good quality research, particularly in parts of the world other than the USA that will address all STIs and specifically target the most vulnerable subgroups of migrants. Further research requires greater scope and depth, including the need to apply an SRHR perspective and incorporate biomedical and structural interventions to address the interacting causes of migrants' vulnerability to HIV/STIs.
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Affiliation(s)
| | - Robert Jonzon
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
- Department of Sexual Health and HIV Prevention, The Public Health Agency of Sweden, Stockholm, Sweden
| | - Charlotte Deogan
- Department of Sexual Health and HIV Prevention, The Public Health Agency of Sweden, Stockholm, Sweden
| | - Anna-Karin Hurtig
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
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Blondell SJ, Debattista J, Griffin MP, Durham J. 'I think they might just go to the doctor': qualitatively examining the (un)acceptability of newer HIV testing approaches among Vietnamese-born migrants in greater-Brisbane, Queensland, Australia. Sex Health 2021; 18:50-57. [PMID: 33573716 DOI: 10.1071/sh20064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 07/07/2020] [Indexed: 11/23/2022]
Abstract
Background In high-income countries (HICs), migrants often have higher rates of late diagnosis of HIV than the host population. Timely HIV testing has significant implications for HIV prevention and management. Newer HIV testing approaches, namely provider-initiated testing and counselling (PITC), HIV rapid testing (HIV RT) and HIV self-testing (HIV ST), aim to reach those populations most at risk and, particularly, those who have not previously tested for HIV. METHODS This study used semi-structured interviews to examine the (un)acceptability, barriers and facilitators to newer HIV testing approaches (i.e. PITC, HIV RT and HIV ST) among Vietnamese-born migrants (n = 10) in greater-Brisbane, Queensland, Australia. RESULTS Vietnamese-born migrants had mixed perspectives on the (un)acceptability of newer HIV testing approaches. PITC was largely viewed by participants as a facilitator to HIV testing for Vietnamese-born migrants. Likewise, HIV RT (undertaken by a doctor in a medical setting, as opposed to a trained community member in a community setting) was generally considered to facilitate HIV testing. HIV ST was largely not considered acceptable to Vietnamese-born migrants and they would prefer to go to a doctor for HIV testing. Several factors were identified that either facilitate or act as barriers to newer HIV testing approaches, including privacy; cost of (accessing) HIV testing; comfort and convenience; healthcare provider relationship; risk perception; symptoms; and technical and emotional support. CONCLUSIONS There is a need to understand migrants' HIV testing preferences if poorer HIV-related outcomes are to be overcome. The findings from this study show a preference for doctor-centred HIV testing, due to enhanced privacy, accuracy and support.
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Affiliation(s)
- Sarah J Blondell
- The University of Queensland, School of Public Health, Brisbane, Qld 4006 Australia; and Corresponding author.
| | - Joseph Debattista
- Metro North Public Health Unit, Metro North Hospital and Health Service, Brisbane, Qld 4029, Australia
| | - Mark P Griffin
- The University of Queensland, School of Public Health, Brisbane, Qld 4006 Australia; and Insight Research Services Associated, Brisbane, Qld 4109, Australia
| | - Jo Durham
- The University of Queensland, School of Public Health, Brisbane, Qld 4006 Australia; and Queensland University of Technology, School of Public Health and Social Work, Brisbane, Qld 4059, Australia
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Health assessment for migrants and asylum seekers upon arrival and while hosted in reception centres: Italian guidelines. Health Policy 2020; 125:393-405. [PMID: 33461797 DOI: 10.1016/j.healthpol.2020.12.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 12/15/2020] [Accepted: 12/17/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND During 2016-17, national guidelines were developed in order to provide evidence-based recommendations on health assessments for migrants and asylum seekers upon their arrival in Italy. METHODS Scientific literature published between 2005 and 2016 was searched in different databases. A free search was also performed on international organizations' websites in order to identify additional relevant documents. A multidisciplinary panel discussed the resulting evidence and formulated recommendations. RESULTS Evidence-based recommendations were formulated: signs and symptoms of specific diseases should to be actively searched for active TB, malaria, STI, intestinal parasites, diabetes, anaemia. In case of other health conditions (latent TB, HIV, HBV, HCV, STI, strongyloides, schistosoma, diabetes), testing should be offered to asymptomatic subjects coming from endemic areas or exposed to risk factors. Mass screening is recommended for anaemia and hypertension; a pregnancy test should be considered, while inclusion in cervical cancer screening and vaccination programs is recommended. A modulated, progressive approach was developed, covering an initial evaluation during rescue operations, a full medical examination at first line reception stage and the referral to national health services during second line reception. CONCLUSIONS It is important to produce and periodically update guidelines on these issues and local peculiarities should be taken into account in their design and implementation. Guidelines can not only support economic sustainability, but also counteract stigmatization dynamics.
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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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Sacks-Davis R, Chibo D, Peach E, Aleksic E, Crowe SM, El Hayek C, Marukutira T, Higgins N, Stoove M, Hellard M. Phylogenetic clustering networks among heterosexual migrants with new HIV diagnoses post-migration in Australia. PLoS One 2020; 15:e0237469. [PMID: 32870911 PMCID: PMC7462279 DOI: 10.1371/journal.pone.0237469] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/27/2020] [Indexed: 01/28/2023] Open
Abstract
Background It is estimated that approximately half of new HIV diagnoses among heterosexual migrants in Victoria, Australia, were acquired post-migration. We investigated the characteristics of phylogenetic clusters in notified cases of HIV among heterosexual migrants. Methods Partial HIV pol sequences obtained from routine clinical genotype tests were linked to Victorian HIV notifications with the following exposures listed on the notification form: heterosexual sexual contact, injecting drug use, bisexual sexual contact, male-to male sexual contact or heterosexual sexual contact in combination with injecting drug use, unknown exposure. Those with heterosexual sexual contact as the only exposure were the focus of this study, with the other exposures included to better understand transmission networks. Additional reference sequences were extracted from the Los Alamos database. Maximum likelihood methods were used to infer the phylogeny and the robustness of the resulting tree was assessed using bootstrap analysis. Phylogenetic clusters were defined on the basis of bootstrap and genetic distance. Results HIV pol sequences were available for 332 of 445 HIV notifications attributed to only heterosexual sexual contact in Victoria from 2005–2014. Forty-three phylogenetic clusters containing at least one heterosexual migrant were detected, 30 (70%) of which were pairs. The characteristics of these phylogenetic clusters varied considerably by cluster size. Pairs were more likely to be composed of people living with HIV from a single country of birth (p = 0.032). Larger clusters (n≥3) were more likely to contain people born in Australian/New Zealand (p = 0.002), migrants from more than one country of birth (p = 0.013) and viral subtype-B, the most common subtype in Australia (p = 0.006). Pairs were significantly more likely to contain females (p = 0.037) and less likely to include HIV diagnoses with male-to-male sexual contact reported as a possible exposure (p<0.001) compared to larger clusters (n≥3). Conclusion Migrants appear to be at elevated risk of HIV acquisition, in part due to intimate relationships between migrants from the same country of origin, and in part due to risks associated with the broader Australian HIV epidemic. However, there was no evidence of large transmission clusters driven by heterosexual transmission between migrants. A multipronged approach to prevention of HIV among migrants is warranted.
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Affiliation(s)
- Rachel Sacks-Davis
- Burnet Institute, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- * E-mail:
| | - Doris Chibo
- Victorian Infectious Disease Reference Laboratory, Peter Doherty Institute, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Eman Aleksic
- Burnet Institute, Melbourne, Victoria, Australia
| | - Suzanne M. Crowe
- Burnet Institute, Melbourne, Victoria, Australia
- Department of Infectious Diseases, Monash University, Melbourne, Victoria, Australia
| | - Carol El Hayek
- Burnet Institute, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Tafireyi Marukutira
- Burnet Institute, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Nasra Higgins
- Department of Health and Human Services, Melbourne, Victoria, Australia
| | - Mark Stoove
- Burnet Institute, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Margaret Hellard
- Burnet Institute, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Hepatitis Services, Department of Infectious Diseases, The Alfred Hospital, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
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Shakya P, Sawada T, Zhang H, Kitajima T. Factors associated with access to HIV testing among international students in Japanese language schools in Tokyo. PLoS One 2020; 15:e0235659. [PMID: 32614904 PMCID: PMC7332052 DOI: 10.1371/journal.pone.0235659] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 06/20/2020] [Indexed: 11/26/2022] Open
Abstract
Japan has been recognized for its excellent universal health coverage system. However, the migrant population faces many barriers in accessing health services in Japan. Japan hosts around 260,000 international students, mostly from developing countries. Among them, language school students tripled from 2011 to 2017, against the backdrop of labor shortage in Japan. Most of these students are also engaged as cheap laborers and are vulnerable populations with poor access to health services. Several socio-economic and behavioral factors may increase their vulnerability to HIV and prevent them from accessing HIV testing in Japan. We examined the factors associated with access to HIV testing among international students in language schools in Tokyo. We conducted a cross-sectional study among international students studying in Japanese language schools in Tokyo. We collected data from 769 Chinese, Vietnamese, and Nepalese students using a self-administered questionnaire. We measured their access to HIV testing through questions on their knowledge of where to receive HIV testing and utilization of HIV testing. Bivariate and multivariable logistic regression models were used to analyze the data. Nepalese students were less likely to know where to receive HIV testing in Japan than Chinese students (AOR = 0.12, 95% CI 0.01–0.96). Students who did not need Japanese language interpreters during visits to health facilities were more likely to know where to receive HIV testing (AOR = 1.93, 95% CI 1.14–3.25). Students who did not have knowledge of free and anonymous HIV testing in Japan were also less likely to know where to receive HIV testing in Japan (AOR = 0.18, 95% CI 0.08–0.42). Students who did not have knowledge of free and anonymous HIV testing (OR = 0.05, 95% CI 0.02–0.10) and who had not utilized HIV testing in their home country (OR = 0.12, 95% CI 0.06–0.27) were less likely to utilize HIV testing in Japan. Factors associated with access to HIV testing among Japanese language school students in Tokyo are nationality, need for Japanese language interpreters, perceived access to doctors/health workers, utilization of HIV testing in the home country, and knowledge of free and anonymous HIV testing. These findings may help to design interventions for improving access to HIV testing among international students in Japan.
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Affiliation(s)
- Prakash Shakya
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Graduate School of International Co-operation Studies, Kyorin University, Tokyo, Japan
- * E-mail:
| | - Takashi Sawada
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Minatomachi Medical Centre, Yokohama, Japan
| | - Hong Zhang
- Graduate School of International Co-operation Studies, Kyorin University, Tokyo, Japan
| | - Tsutomu Kitajima
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Graduate School of International Co-operation Studies, Kyorin University, Tokyo, Japan
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Boga JA, Casado L, Fernández-Suarez J, Moran N, Rodríguez-Perez M, Martínez-Sela M, Pérez A, Garcia-Perez A, Menendez C, Santos S, Rodriguez-Guardado A. Screening Program for Imported Diseases in Immigrant Women: Analysis and Implications from a Gender-Oriented Perspective. Am J Trop Med Hyg 2020; 103:480-484. [PMID: 32342844 PMCID: PMC7356466 DOI: 10.4269/ajtmh.19-0687] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 03/18/2020] [Indexed: 01/05/2023] Open
Abstract
The female immigrant population is especially vulnerable to imported diseases. We describe the results of a prospective screening program for imported diseases performed in immigrant female patients. The protocol included tests for HIV, hepatitis B virus (HBV), hepatitis C virus (HCV), Treponema pallidum, Trypanosoma cruzi, Strongyloides stercoralis and Schistosoma spp., intestinal parasites, malaria, and the detection of microfilaremia, according to the patient's origin. Six hundred eleven patients were studied. The most frequent imported diseases were intestinal parasitosis (39.4%), followed by syphilis (14.6%), HIV infection (9%), chronic HCV (5%), and HBV (3.3%). Most of the cases of HIV (78%) and HBV (85%) were diagnosed in patients aged between 16 and 45 years. Hepatitis C virus appeared mostly in patients in the 46- to 65-year range (P = 0.001; odds ratio [OD]: 3.667 [1.741-7.724]) or older than 65 years (P = 0.0001; OR: 26.350 [7.509-92.463]). Syphilis was diagnosed more frequently in patients older than 46 years (P = 0.0001; OR: 4.273 [2.649-6.893]). Multivariate analysis confirmed a greater presence of HCV infection (P = 0.049) and syphilis (P = 0.0001) in patients aged between 46 and 65 years. In 15.4% of patients, screening did not find any pathology. These data show a high prevalence of imported diseases in the female immigrant population, which may have serious consequences in terms of morbimortality and vertical transmission. Our results encourage the establishment of policies of active screening both in women of childbearing age and within the specific pregnancy screening programs.
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Affiliation(s)
- José A. Boga
- Microbiology Unit, Hospital Universitario Central de Asturias, Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Luis Casado
- Internal Medicine, Hospital de Cruz Roja, Gijón, Spain
| | - Jonathan Fernández-Suarez
- Microbiology Unit, Hospital Universitario Central de Asturias, Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Noelia Moran
- Internal Medicine, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Mercedes Rodríguez-Perez
- Microbiology Unit, Hospital Universitario Central de Asturias, Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - María Martínez-Sela
- Internal Medicine, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Ana Pérez
- Microbiology Unit, Hospital Universitario Central de Asturias, Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | | | - Candela Menendez
- Department of Internal Medicine, Fundación Hospital de Aviles, Aviles, Spain
| | - Sagrario Santos
- Infectious Diseases Unit, Hospital Universitario de Cabueñes, Gijón, Spain
| | - Azucena Rodriguez-Guardado
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
- Infectious Diseases Unit, Hospital Universitario de Cabueñes, Gijón, Spain
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