Impact of legal status change on undocumented migrants' health and well-being (Parchemins): protocol of a 4-year, prospective, mixed-methods study

Migrants facing intersectional vulnerability to HIV and AIDS in Switzerland: an exploratory study

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.

Working Conditions and Self-Reported Health Among Undocumented and Newly Regularized Migrants in Geneva: A Cross-Sectional Study

Objectives: Most undocumented migrants are employed in so-called "dirty jobs" or "3D jobs" (dangerous, dirty and degrading) due to their lack of legal status. This study aimed to describe the self-reported health of undocumented and newly regularized migrants in relation to their working conditions. Methods: A cross-sectional study was conducted using data collected during the first phase of the Parchemins study (2017-18), a survey that monitors the socioeconomic and health impact of a regularization scheme for undocumented workers in Geneva, Switzerland. The sample consists of 395 undocumented and newly regularized migrants. Results: Overall, 147 (37.2%) rated their health as very good or excellent. Multivariable regression analysis indicated that work-related factors associated with better self-reported health included higher satisfaction with working conditions, while legal status regularization showed only a borderline association. By contrast, workers performing very demanding tasks and having more difficulties finding a new job were less likely to report very good or excellent health. Conclusion: Findings show that work-related factors had a stronger influence on self-reported health compared to legal status change. Further research is needed to evaluate the long-term impact of regularization on working conditions and self-rated health.

Determinants of life satisfaction among migrants in South Africa: an analysis of the GCRO's quality of life survey (2009-2021)

BACKGROUND

Migrant populations in any country are a vulnerable group, and psycho-demographic research measuring life satisfaction has been used to assess migrants' well-being in developed and developing countries. However, South Africa, with its high influx of migrant populations, has investigated these topical concerns from the perspective of xenophobia, with mixed findings. However, no, or very few studies have examined life satisfaction among migrants in South Africa. This study, therefore, extends previous literature by examining the determinants of life satisfaction among South Africa's internal and international migrant populations.

METHODS

We conducted a cross-sectional study from the 2009 to 2021 Gauteng City-Region Observatory (GCRO) Quality of Life (QoL) surveys among migrant populations in two ways: a full sample and a gender-stratified sample. A sample of male and female migrants ranging from 15 to 49 years of age were recruited into this study. Cantril's Self-Anchoring Ladder Life Satisfaction scale captured their life satisfaction alongside relevant social demographic factors. Descriptive statistics were applied for the data analysis of the demographic factors. Bivariate and multivariate logistics regression analyses were conducted to assess the associations and the predictive factors of life satisfaction among migrants, both internal and international.

RESULTS

The key findings were the gender distribution of life satisfaction, showing that more international (male - 66.0% and female - 67.1%) migrants reported having a thriving life satisfaction than internal migrants (male - 61.7% and female - 61.5%). Findings from the Pearson correlation coefficient revealed a significant association between the individual, household, and community factors by migrant status (ρ < 0.05). However, the probit coefficients revealed that individual factors (age 48+: AOR = 2.18, 95% CI: 1.13, 3.23, and secondary/higher education: AOR = 1.1., 95% CI: 0.01, 1.19) and household factors (two persons living in households (H/H): AOR = 1.05, 95% CI: 0.50, 1.10), and community factors (international migrant status: AOR = 2.12, 95% CI: 0.08, 2.16) significantly increase the prediction of higher odds of life satisfaction by gender among migrants. The ordered logit coefficients also showed that individual factors (middle and high income and having health insurance) and household factors (receiving SASSA social grant) predicted the highest life satisfaction among migrants (internal and international).

CONCLUSION

We found substantial evidence that individual-, household-, and community-level factors were associated with life satisfaction among migrants. In particular, the pattern of life satisfaction varied slightly between male and female migrants, as well as with migrant status in South Africa. These findings collectively may provide helpful information for policymakers and practitioners to optimise interventions for migrant populations to improve their life satisfaction. Evidence from this study also calls on the government of South Africa to begin tracking the life satisfaction of its nationals, whether migrants or not.

Chagas disease prevalence among migrants from El Salvador in Milan: a cross- sectional study of an often-overlooked population

BACKGROUND

Chagas disease (CD) is considered to be highly endemic in El Salvador, where its prevalence is estimated to be 1.3-3.7%. Although more than 40,000 migrants from El Salvador are currently living in Europe (particularly in Spain and Italy), there are few data regarding the prevalence of CD in this population. The aim of this study was to evaluate the prevalence of CD among Salvadorans living in Italy.

METHODS

A cross-sectional serological survey of CD among Salvadorans living in the metropolitan area of Milan was carried out between October 2017 and December 2019. The participants' blood samples were tested for Trypanosoma cruzi antibodies using two different serological assays. The collected demographic data included their biological sex, province of origin, the type of housing in their country of origin, and family history of CD.

RESULTS

Of the 384 subjects who voluntarily participated in the study, five (1.3%, most coming from La Paz) were positive to both serological assays and therefore conclusively diagnosed as having CD. Five other subjects had discrepant serological results but were not positive to a third assay. Three of the five subjects with a diagnosis of CD completed medical staging, one of whom had chronic disease (digestive and cardiac involvement).

CONCLUSIONS

The prevalence of CD among Salvadorans living in Milan is similar to that estimated by the WHO in 2010. Although they are often overlooked in CD surveys, Salvadoran migrants should be included in CD control programs in countries in which the disease is not endemic.

Impact of legal status regularization on undocumented migrants’ self-reported and mental health in Switzerland

Undocumented migrants face cumulative difficulties like precarious living and working conditions or exclusion from health services that might negatively influence their health. Little is known about the evolution of undocumented migrants' self-reported health (SRH) and mental health after they get documented. This study aims to observe the effect of legal status regularization on SRH and mental health in a cohort of migrants undergoing regularization in Geneva, Switzerland. We evaluate SRH with the first item of the Short Form Survey (SF12) and depression as a proxy of mental health with the PHQ-9 questionnaire over four years among 387 undocumented and newly documented migrants. Using hybrid linear models, our data show that regularization has no direct effect on SRH, but has direct positive effects on mental health in a longitudinal perspective, even when controlling for competing factors. The arrival of the pandemic did not alter these effects. Migrants tend to evaluate their subjective health status more positively than the prevalence of screened depression shows. Those findings point towards better targeted policies that could reduce the burden of depression among undocumented migrants.

Association Between Residence Status Regularization and Access to Healthcare for Undocumented Migrants in Switzerland: A Panel Study

Background

Switzerland has a universal healthcare system. Yet, undocumented migrants face barriers at different levels that hinder their access to healthcare services. The aim of this study is to assess whether undocumented migrants' healthcare utilization improves with residence status regularization.

Methods

We used two-wave panel data from the Parchemins study, a study exploring the impact of regularization on undocumented migrants' health in Geneva, Switzerland. First wave data were collected between 2017 and 2018, second wave data between 2019 and 2020. At baseline, the sample consisted of 309 undocumented migrants, recruited after the implementation of a temporary regularization policy in Geneva. We distributed them into two groups according to their residence status 12 months before the second data collection [regularized vs. undocumented (controls)]. Using as dependent variable the number of medical consultations within two distinct 12-months periods (the first before regularization, the second after regularization), we conducted multivariable regression analyses applying hurdle specification to identify factors enhancing healthcare utilization. Then, we estimated first-difference panel models to assess change in healthcare utilization along regularization. Models were adjusted for demographic, economic and health-related factors.

Results

Of the 309 participants, 68 (22%) were regularized. For the 12 months before regularization, these migrants did not significantly differ in their healthcare utilization from the controls. At this stage, factors increasing the odds of having consulted at least once included being a female (aOR: 2.70; 95% CI: 1.37–5.30) and having access to a general practitioner (aOR: 3.15; 95% CI: 1.62–6.13). The factors associated with the number of consultations apart from underlying health conditions were the equivalent disposable income (aIRR per additional CHF 100.-: 0.98; 95% CI: 0.97–1.00) and having access to a general practitioner (aIRR: 1.45; 95% CI: 1.09–1.92). For the 12 months after regularization, being regularized was not associated with higher odds of having consulted at least once. However, among participants who consulted at least once, regularized ones reported higher counts of medical consultations than controls (3.7 vs. 2.6, p = 0.02), suggesting a positive impact of regularization. Results from the first-difference panel models confirmed that residence status regularization might have driven migrants' healthcare utilization (aβ: 0.90; 95% CI: 0.31-1.77).

Conclusions

This study supports the hypothesis that residence status regularization is associated with improved healthcare utilization among undocumented migrants. Future research is needed to understand the mechanisms through which regularization improves undocumented migrants' use of healthcare services.

Health-Care Utilization of Refugees: Evidence from Austria

European countries have experienced significant inflows of migrants in the past decade, including many refugees from regions engaged in armed conflicts. Although previous research on migrant health has largely focused on economic migration, empirical evidence on refugee health is sparse. This article uses administrative data from Austria to differentiate between economic migrants and refugees and to analyze both groups’ health-care expenditures in comparison to natives. We contribute to the literature on migrant health in several dimensions. First, we follow economic migrants and refugees over the first five years after arrival and show different health-care expenditure patterns among migration groups. In contrast to patterns for economic migrants, we find substantially higher health-care expenditures for refugees compared to natives, especially in the first year after arrival. This difference is not explained by specific diseases or individual refugee groups, indicating refugees’ generally inferior health status in the first years of settlement. Second, we focus on the health effects of granting asylum and find that the expenditure differences decrease after a positive asylum decision. In the last part, by using refugees’ quasi-random placement as a natural experiment, we show that the local health-care sector's characteristics do not have a significant effect on expenditure levels. The findings highlight the importance of distinguishing between migrant groups in the analysis of health-care utilization and show that the time spent in the host country, as well as legal status, have a substantial impact on migrants’ health-care utilization.

The well-being of newly regularized migrant workers: Determinants of their satisfaction with life as compared to undocumented migrant workers and regular local residents

Subjective assessments of well-being are becoming routine indicators, considering that material resources are insufficient to capture people's satisfaction with life. Examining the unique situation of undocumented migrant workers, driven by aspirations for a better life but constrained by their limited rights in the country of destination, we assess their satisfaction with life and the factors that matter in their evaluations. Data were collected in Geneva (Switzerland), in a study comparing those who have just received a residency permit or about to obtaining it after submitting a regularization request (n = 195) with those who were still undocumented and/or had not submitted a regularization request at the time of our study (n = 231). In addition, comparisons were made with a sample of regular local residents (n = 175). Data obtained through standardized questionnaires include a range of material and non-material determinants, some unique to migrants and others common to the three populations. Satisfaction with life is significantly lower among undocumented migrant workers while those who are regularized and regular local residents report similar levels of well-being. Social participation, self-reported health and discrimination are associated to satisfaction with life among undocumented migrant workers. Among those being regularized, having been longer in the country of destination is associated with lower well-being. Among regular local residents, the only significant factor for a better satisfaction with life is having a partner. Material determinants, while distributed in vastly different levels, do not influence satisfaction with life. Despite the high satisfaction expressed by those who have recently been regularized, policy intervention still have to pay attention to their persisting difficult socioeconomic circumstances amidst a context of overall affluence.

The Health of Children in Immigrant Families: Key Drivers and Research Gaps Through an Equity Lens

OBJECTIVE

The United States benefits economically and socially from the diverse skill-set and innovative contributions of immigrants. By applying a socioecological framework with an equity lens, we aim to provide an overview of the health of children in immigrant families (CIF) in the United States, identify gaps in related research, and suggest future areas of focus to advance health equity.

METHODS

The literature review consisted of identifying academic and gray literature using a MeSH Database, Clinical Queries, and relevant keywords in 3 electronic databases (PubMed, Web of Science, and BrowZine). Search terms were selected with goals of: 1) conceptualizing a model of key drivers of health for CIF; 2) describing and classifying key drivers of health for CIF; and 3) identifying knowledge gaps.

RESULTS

The initial search produced 1120 results which were screened for relevance using a meta-narrative approach. Of these, 224 papers were selected, categorized by topic, and reviewed in collaboration with the authors. Key topic areas included patient and family outcomes, institutional and community environments, the impact of public policy, and opportunities for research. Key inequities were identified in health outcomes; access to quality health care, housing, education, employment opportunities; immigration policies; and inclusion in and funding for research. Important resiliency factors for CIF included strong family connections and social networks.

CONCLUSIONS

Broad structural inequities contribute to poor health outcomes among immigrant families. While resiliency factors exist, research on the impact of certain important drivers of health, such as structural and cultural racism, is missing regarding this population. More work is needed to inform the development and optimization of programs and policies aimed at improving outcomes for CIF. However, research should incorporate expertise from within immigrant communities. Finally, interventions to improve outcomes for CIF should be considered in the context of the socioecological model which informs the upstream and downstream drivers of health outcomes.

Self-rated health among undocumented and newly regularized migrants in Geneva: a cross-sectional study

Background

In Europe, knowledge about the social determinants of health among undocumented migrants is scarce. The canton of Geneva, Switzerland, implemented in 2017–2018 a pilot public policy aiming at regularizing undocumented migrants. We sought to test for associations between self-rated health, proven eligibility for residence status regularization and social and economic integration.

Methods

This paper reports data from the first wave of the Parchemins Study, a prospective study whose aim is to investigate the effect of residence status regularization on undocumented migrants’ living conditions and health. The convenience sample included undocumented migrants living in Geneva for at least 3 years. We categorized them into those who were in the process of receiving or had just been granted a residence permit (eligible or newly regularized) and those who had not applied or were ineligible for regularization (undocumented). We conducted multivariate regression analyses to determine factors associated with better self-rated health, i.e., with excellent/very good vs. good/fair/poor self-rated health. Among these factors, measures of integration, social support and economic resources were included.

Results

Of the 437 participants, 202 (46%) belonged to the eligible or newly regularized group. This group reported better health more frequently than the undocumented group (44.6% versus 28.9%, p-value < .001), but the association was no longer significant after adjustment for social support and economic factors (odds ratio (OR): 1.12; 95% confidence interval (CI): 0.67–1.87). Overall, better health was associated with larger social networks (OR: 1.66; 95% CI: 1.04–2.64). This association remained significant even after adjusting for health-related variables.

Conclusion

At the onset of the regularization program, access to regularization was not associated with better self-rated health. Policies aiming at favouring undocumented migrants’ inclusion and engagement in social networks may promote better health. Future research should investigate long-term effects of residence status regularization on self-rated health.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11239-0.

Access to Health Care by Migrants with Precarious Status During a Health Crisis: Some Insights from Portugal

In March 2020, the Portuguese Government issued a remarkable regulation by which irregular migrants who had previously started the regularization procedure were temporarily regularized and thus allowed full access to all social benefits, including healthcare. The Portuguese constitutional and legal framework is particularly generous regarding the right to healthcare to irregular migrants. Nevertheless, until now, several practical barriers prevented full access to healthcare services provided by the national health service, even in situations in which it was legally granted. This decision is not only remarkable in light of the fulfilling of migrants' rights to health, as imposed by international commitments assumed by, but also in view of the fight against COVID-19. The decision is grounded both on human rights and in public health reasons. The paper is divided in two main parts. In the first one, it analyzes national State obligations with regard to healthcare provision to migrants in irregular situation. In the second part, it analyzes the Portuguese solution, using this case study to discuss the possible mechanisms to comply with such obligations.

Mental health of undocumented migrants and migrants undergoing regularization in Switzerland: a cross-sectional study

BACKGROUND

Undocumented migrants live and work in precarious conditions. Few studies have explored the mental health consequences of such environment. The objective of this study is to describe the mental health of migrants at different stages of a regularization program.

METHODS

This cross-sectional study included migrants undocumented or in the process of regularization. We screened for symptoms of anxiety, depression and sleep disturbance using validated tools. We created a composite outcome of altered mental health including these components plus self-report of a recent diagnosis of mental health condition by a health professional.

RESULTS

We enrolled 456 participants of whom 246 (53.9%) were undocumented. They were predominantly women (71.9%) with a median age of 43.3 (interquartile range: 15.5) years, from Latin America (63.6%) or Asia (20.2%) who had lived in Switzerland for 12 (IQR: 7) years. Overall, 57.2% presented symptoms of altered mental health. Prevalence of symptoms of anxiety, depression and sleep disturbance were 36% (95% confidence interval: 31.6-40.6%), 45.4% (95% CI: 40.8-50.1%) and 23% (95% CI: 19.2-27.2), respectively. Younger age (adjusted odd ratio: 0.7; 95% CI: 0.5-0.9 for each additional decade), social isolation (aOR: 2.4; 95% CI: 1.4-4.2), exposure to abuse (aOR: 1.9; 95% CI: 1.1-3.5), financial instability (aOR: 2.2; 95% CI: 1.4-3.7) and multi-morbidity (aOR: 3.2; 95% CI: 1.7-6.5) were associated with increased risk of having altered mental health while being in the early stages of the process of regularization had no effect (aOR: 1.3: 95% CI: 0.8-2.2).

CONCLUSIONS

This study highlights the need for multi-pronged social and health interventions addressing the various domains of undocumented migrants living difficulties as complement to legal status regularization policies. Protection against unfair working conditions and abuse, access to adequate housing, promoting social integration and preventive interventions to tackle the early occurrence of chronic diseases may all contribute to reduce the burden of altered mental health in this group. More research is needed to assess the long-term impact of legal status regularization on mental health.

The Impact of the Covid-19 Pandemic and the Lockdown on the Health and Living Conditions of Undocumented Migrants and Migrants Undergoing Legal Status Regularization

Introduction: Undocumented migrants are at high risk of adverse consequences during crises because of a lack of access to essential securities and sources of support. This study aims to describe the impact of the COVID-19 crisis on the health and living circumstances of precarious migrants in Switzerland and to assess whether those undergoing legal status regularization fared better than undocumented migrants.

Materials and methods: This cross-sectional mixed methods study was conducted during the COVID-19 lockdown in April–May 2020. Undocumented and recently regularized migrants taking part in an ongoing cohort study were asked to respond to an online questionnaire. A subsample was selected to undergo semi-directed phone interviews.

Results: Overall, 117 of the 379 (30.9%) cohort study participants responded to the questionnaire. Seventeen interviews were conducted. Migrants faced cumulative and rapidly progressive difficulties in essential life domains. As a consequence, they showed high prevalence of exposure to COVID-19, poor mental health along with frequent avoidance of health care. Moreover, the loss of working hours and the related income overlapped with frequent food and housing insecurity. Around one participant in four had experienced hunger. Despite these unmet needs, half of the participants had not sought external assistance for reasons that differ by legal status. Both groups felt that seeking assistance might represent a threat for the renewal or a future application for a residency permit. While documented migrants were less severely affected in some domains by having accumulated more reserves previously, they also frequently renounced to sources of support.

Conclusions: The cumulated difficulties faced by migrants in this period of crisis and their limited search for assistance highlight the need to implement trust-building strategies to bridge the access gap to sources of support along with policies protecting them against the rapid loss of income, the risk of losing their residency permit and the exposure to multi-fold insecurities.