Discutir saúde e imigração no contexto atual de intensa mobilidade humana

Association between in-country migration and HIV infection among transgender women from northeastern Brazil: a respondent-driven sampling survey

BACKGROUND

Migration is common among transgender women (TGW), often driven by the desire to escape stigma, find acceptance, establish new connections, access body modifications, or enter new avenues of sex work. Given the heightened mobility of TGW, they are mostly vulnerable to human immunodeficiency virus (HIV) due to migration. This study aimed to evaluate the association between in-country migration and HIV infection among TGW in Northeast Brazil.

METHODS

The DIVAS was a cross-sectional, multicity study investigating risk behaviors and sexually transmitted infections (STI) among TGW in 2016-2017. A total of 864 TGW were recruited through respondent-driven sampling from three capital cities in Northeast Brazil. Logistic regression estimating odds ratios (OR) and 95% confidence intervals (CI) was used to assess the relationship between in-country migration and HIV infection.

RESULTS

The prevalence of HIV among TGW was 24.5%, 21.4% among those aged 18-34 and 36.1% among those ≥ 35 years old. In-country migration increased the odds of HIV infection among TGW aged 18-34 years (OR = 1.84; 95%CI:1.04-3.27) and even higher among those aged ≥ 35y old (OR = 3.08; 95%CI:1.18-8.04).

CONCLUSIONS

These data reinforce the pressing need for public health policies that provide comprehensive access and strategies for demand creation for HIV/AIDS prevention and care for TGW who are already highly vulnerable to infection.

Social support networks and life cycle stage of Venezuelan immigrant families

OBJECTIVE

To understand the structures of social networks of interiorized Venezuelan immigrant families and the life cycle stage they are in.

METHODS

Qualitative multiple-case study with families from the Interiorization Program residing in the Greater Florianópolis, Brazil. Screening occurred through social networks and key informants. For data collection, the photovoice technique and semi-structured interviews were used, categorized with the help of the Atlas.ti software. Genograms and ecomaps were elaborated.

RESULTS

Of the 4 families interviewed, totaling 7 members with young children, the nuclear family was identified as the main informal support network. Formal networks included schools, churches, and civil society.

CONCLUSION

Families rely heavily on their nuclear structure for support, with formal institutions acting as secondary resources. The predominant life cycle stage is focused on families with young children. More efforts are needed to strengthen formal support networks.

Health condition, income loss, food insecurity and other social inequities among migrants and refugees during the COVID-19 pandemic in Brazil

BACKGROUND

Brazil is the destination of many international migrants and refugees and, given the circumstances of their entry into the country, many face difficulties due to the absence of targeted policies. Thus, the objective of this study was to survey the social impact of COVID-19 on international migrants and refugees regarding income loss, food insecurity and other social inequities, and to identify explanatory factors on these aspects.

METHODS

This is a cross-sectional, analytical study. We used a validated instrument applied by trained interviewers. Descriptive analysis and binary logistic regression were performed to identify factors associated with income loss and food insecurity.

RESULTS

A total of 360 individuals from sub-Saharan African and South American countries participated in the study. Individuals who were white, black/brown, yellow, had an occupation/employment, and earned less than one minimum wage were more likely to lose income. Those who reported no income, received less than one minimum wage, and were diagnosed with COVID-19 were more likely to be food insecure.

CONCLUSIONS

The study advances knowledge by identifying factors associated with income loss, food insecurity, and individuals' difficulty in accessing health services and social support measures in Brazil.

[The covid-19 pandemic and international mobility in Brazil: challenges for the health and social protection of international migrants in times of uncertainty]

The relationship between health and migration was severely affected during the covid-19 pandemic. This article discusses the literature on health and migration, including the deteriorating levels of social and economic vulnerability of international migrants to Brazil in 2020 and 2021. The analysis was based on a review of articles published in the national and international press addressing the impacts of covid-19 on contemporary processes of human mobility and its consequences for stigmatized populations. The results point to the possibility of understanding the pandemic as a key moment for rethinking nationality and borders.

Migration and medical screening for tuberculosis

Vulnerable populations, such as migrants and refugees, have an increased risk of tuberculosis disease, especially in the first years after arrival in the host country. The presence of migrants and refugees in Brazil exponentially grew over the period between 2011 and 2020, and approximately 1.3 million migrants from the Global South were estimated to be residing in Brazil, most of whom from Venezuela and Haiti. Tuberculosis control programs for migrants can be divided into pre- and post-migration screening strategies. Pre-migration screening aims to identify cases of tuberculosis infection (TBI) and can be carried out in the country of origin (pre-entry) or in the destination country (at entry). Pre-migration screening can also detect migrants at an increased risk of developing tuberculosis in the future. High-risk migrants are then followed up in post-migration screening. In Brazil, migrants are considered a priority group for the active search for tuberculosis cases. However, there is no recommendation or plan regarding screening for TBI in migrants and refugees. Ensuring prevention, diagnosis, and treatment for TBI and tuberculosis disease in migrant populations is an important aspect of tuberculosis control and elimination. In this review article, we address epidemiological aspects and access to health care for migrants in Brazil. In addition, the migration medical screening for tuberculosis was reviewed.

Hepatitis B and C in Immigrants and Refugees in Central Brazil: Prevalence, Associated Factors, and Immunization

Introduction: Eliminating hepatitis B and C in immigrant and refugee populations is a significant challenge worldwide. Given the lack of information in Brazil, this study aimed to estimate the prevalence of infections caused by hepatitis B and C viruses and factors associated with hepatitis B in immigrants and refugees residing in central Brazil. Methods: An observational, cross-sectional, and analytical study was conducted from July 2019 to January 2020 with 365 immigrants and refugees. Hepatitis B was detected by a rapid immunochromatographic test, enzyme immunoassay, and chemiluminescence, and hepatitis C by rapid immunochromatographic test. Multiple analysis was used to assess factors associated with hepatitis B infection. Results: Of the participants, 57.8% were from Haiti and 35.6% were from Venezuela. Most had been in Brazil for less than 2 years (71.2%). The prevalence of HBV infection and exposure was 6.6% (95% CI: 4.5-9.6%) and 27.9% (95% CI: 23.6-2.8%), respectively, and 34% had isolated anti-HBs positivity. Reporting a sexually transmitted infection was statistically associated with HBV infection (OR: 7.8; 95% CI: 2.3-26.4). No participant with positive anti-HCV serology was found. Conclusions: The study showed that participants were outside the reach of prevention and control actions for hepatitis B. Therefore, public health strategies must be designed to reach, inform, and vaccinate this group.

A (In)visibilidade do Outro: Reflexões sobre Refúgio e Migração

Resumo O artigo explora a problemática do refúgio e da migração a partir de coordenadas teóricas de caráter interdisciplinar, complementares no aprofundamento do tema. Destaca-se, neste ensaio teórico, a invisibilidade imposta ao sujeito da diáspora mediante a negativa de reconhecer as violentas e dramáticas condições de seu entorno (crise social, crise política, crise econômica etc.), seja ele migrante ou refugiado. Por meio das proposições do psicanalista Sándor Ferenczi sobre o conceito de desmentido e das considerações do filósofo sul-coreano Byung-Chul Han sobre os mecanismos contemporâneos de proliferação do idêntico, desenvolve-se uma reflexão a respeito de diferentes práticas de indiferença ilustradas no silenciamento e invisibilização da subjetividade migrante. Essa linha argumentativa permite vislumbrar a premência de reconhecer práticas de desumanização ao se deixar à margem o direito de migrantes e refugiados à existência digna. Considera-se essencial para a ruptura com a invisibilidade imposta aos protagonistas das diásporas dar legitimidade a suas narrativas. Conclui-se, portanto, que esse movimento de ruptura por parte do migrante e do refugiado, devido à violência imposta, não decorre do assistencialismo ou da filantropia que lhes são dirigidos; por isso, é imperativo, no campo alteritário, ter reconhecido o legítimo direito a ser acolhido, com hospitalidade e humanidade, pela sociedade da qual faz parte.

Low-wage migrant workers during coronavirus disease 2019: a social determinants analysis

The severe acute respiratory syndrome coronavirus 2 pandemic has had disproportionate effects on economically and socially marginalized people. We explore the effects on low-wage migrant workers (migrant workers) in three countries: Singapore, South Korea and Brazil, through the lens of the social determinants of health. Our analysis shows that governments missed key opportunities to mitigate pandemic risks for migrant workers. Government measures demonstrate potential for effective and sustainable policy reform, including universal and equitable access to healthcare, social safety nets and labour rights for migrant workers-key concerns of the Global Compact for Migration. A whole-of-society and a whole-of-government approach with Health in All Policies, and migrant worker frameworks developed by the World Health Organization could be instrumental. The current situation indicates a need to frame public health crisis responses and policies in ways that recognize social determinants as fundamental to health.

Vulnerability and health promotion of Haitian immigrants: reflections based on Paulo Freire's dialogic práxis

OBJECTIVE

To understand the perceptions of Haitian immigrants about the possibilities to promote health, in the face of the vulnerabilities they experience.

METHOD

This is a qualitative, participatory action study, based on Paulo Freire's Research Itinerary, which has three phases: thematic investigation; encoding and decoding; critical unveiling. Ten Haitian immigrants, students of a public university in Brazil, participated in the Culture Circle.

RESULTS

In the face of vulnerabilities, Haitian immigrants expressed the need to participate in university social groups, to have moments of integration with Brazilians, to know their rights, to master the Portuguese language, to adapt socially and culturally and to the food, to engage in the promotion of mental health and quality of life through physical activities and leisure.

CONCLUSION

The discussions led to a process of action-reflection-action, in which immigrants reframed their reality, looking for strategies to promote health and empowering themselves in the search for a healthier life.

Saúde e migrações: a pandemia de Covid-19 e os trabalhadores imigrantes nos frigoríficos do Sul do Brasil

Resumo Com base na relação saúde e migrações, o artigo analisa as condições sociais e de saúde de imigrantes que trabalham nos frigoríficos de carnes e derivados, nos municípios do interior do Rio Grande do Sul e de Santa Catarina, no contexto da pandemia de Covid-19. As dificuldades de acesso à saúde e aos direitos básicos (como a biossegurança), a discriminação racial, a xenofobia e as vulnerabilidades socioeconômicas são fatores que marcam as condições de trabalho desses migrantes nos frigoríficos do Sul do país. As conclusões apontam a necessidade de implementar políticas públicas de saúde que incorporem novas formas de interdependência entre os sistemas produtivos e os indivíduos e grupos sociais, oriundos de processos migratórios, e a mitigação das vulnerabilidades sociais e iniquidades em saúde às quais esses trabalhadores estão expostos para o enfrentamento à pandemia.

[Healthcare experiences of primary care workers with Bengalese immigrants in Paraná State, Brazil]

The aim of this study was to analyze the experiences of primary care workers with Bengalese immigrants in Paraná State, Brazil. This was a qualitative study in a primary care unit with approximately 700 Bengalese immigrants living in its coverage area. The study was conducted in a medium-sized city in northern Paraná State. Data were obtained through semi-structured interviews with the health workers. The data were analyzed adopting proper compliance with all ethical aspects. The results showed that the immigrants' physical appearance and language affected the way the health workers treated them. It was thus possible to identify a series of implications in the actions and services offered to this immigrant population: adherence to a protocol, even though it did not take the immigrants' specific needs into account; presumption of the immigrant population's reasons and needs for seeking the health services; and the omission of some specific health interventions. The Bengalese immigrant population thus accesses the primary healthcare services much more through their adaptive skills than by the health workers' capacity to offer care according to the patients' needs. It is thus necessary to take a special look at the health workers in this situation and design forms of support that can be offered to healthcare teams that deal with immigrant populations on a daily basis.

Sexual Health of Haitian Immigrants in Southern Brazil: A Cross-Sectional Study

Background

Some specific groups, such as immigrants, are considered at significantly high risk of developing poor sexual health (SH), specifically in relation to sexually transmitted infections (STIs). However, despite the high number of Haitian immigrants living in southern Brazil, a study that assessed the SH of these immigrants has not been conducted yet.

Objective

This study aimed to assess the sexual health of Haitian immigrants in southern Brazil.

Methods

This was a cross-sectional study conducted in 201 adult Haitian immigrants of both sexes, living in southern Brazil. A self-applied questionnaire containing sociodemographic questions and SH and behaviors was used to collect data. Data were collected on paper or through online form.

Findings

Of the 201 immigrants included in the study, the majority were men (58.06%). There was no difference in the mean age (30 years) between both sexes. More than half were married with a partner (a) (53.29%), and 69.89% had an average educational level. Although an association between the reported STIs and the variables considered as risk factors or behaviors for STIs was not reported, women reported a frequency of 33.80% for self-declared active STIs and a frequency of 66.20% for lifelong STIs; these frequencies are highly superior in women compared to men. Additionally, 55.33% of women also reported not using a condom in their last sexual intercourse, and 35.10% reported changing their sexual behaviors after immigrating.

Conclusions

The high frequency of STIs reported by Haitian immigrant women indicates the need to implement STI tracking strategies in that population. This study can assist in the development of comprehensive healthcare policies for Haitian immigrants.

Discourse of nurses and doctors on the use of the emergency service by immigrants

Abstract Objective: To describe the discourse of nurses and physicians on the use of emergency services by immigrants. Method: Descriptive and exploratory study, with qualitative approach, carried out inan emergency public unit located at the north of Paraná. Sixteen health professionals were interviewed through a semi-structured questions. The interviews were audio-taped and their contents, after transcription, submitted to French discourse analysis. Results: It was identified, according to professionals, that immigrants seek emergency services mainly due to work-related problems, because they are unaware on how the Brazilian health system works and because they have difficulties to access other services. In addition, communication, cultural, professional, socioeconomic, and prejudice barriers were highlighted as influencing the care for the immigrant population. Conclusion and implications for practice: Given such findings, it is imperative to develop orientation and preparation activities for the immigrant population on the Brazilian culture and health system and health professionals regarding the cultural and socio-sanitary profile of the immigrant population, thus enhancing the adequate search of the users and the qualified care.

Bibliometric analysis of global migration health research in peer-reviewed literature (2000-2016)

BACKGROUND

The health of migrants has become an important issue in global health and foreign policy. Assessing the current status of research activity and identifying gaps in global migration health (GMH) is an important step in mapping the evidence-base and on advocating health needs of migrants and mobile populations. The aim of this study was to analyze globally published peer-reviewed literature in GMH.

METHODS

A bibliometric analysis methodology was used. The Scopus database was used to retrieve documents in peer-reviewed journals in GMH for the study period from 2000 to 2016. A group of experts in GMH developed the needed keywords and validated the final search strategy.

RESULTS

The number of retrieved documents was 21,457. Approximately one third (6878; 32.1%) of the retrieved documents were published in the last three years of the study period. In total, 5451 (25.4%) documents were about refugees and asylum seekers, while 1328 (6.2%) were about migrant workers, 440 (2.1%) were about international students, 679 (3.2%) were about victims of human trafficking/smuggling, 26 (0.1%) were about patients' mobility across international borders, and the remaining documents were about unspecified categories of migrants. The majority of the retrieved documents (10,086; 47.0%) were in psychosocial and mental health domain, while 2945 (13.7%) documents were in infectious diseases, 6819 (31.8%) documents were in health policy and systems, 2759 (12.8%) documents were in maternal and reproductive health, and 1918 (8.9%) were in non-communicable diseases. The contribution of authors and institutions in Asian countries, Latin America, Africa, Middle East, and Eastern European countries was low. Literature in GMH represents the perspectives of high-income migrant destination countries.

CONCLUSION

Our heat map of research output shows that despite the ever-growing prominence of human mobility across the globe, and Sustainable Development Goals of leaving no one behind, research output on migrants' health is not consistent with the global migration pattern. A stronger evidence base is needed to enable authorities to make evidence-informed decisions on migration health policy and practice. Research collaboration and networks should be encouraged to prioritize research in GMH.

Prenatal follow-up of Haitian and Brazilian women in Mato Grosso

Abstract Objectives: to analyze the prenatal follow-up performed by pregnant women in Haiti and Brazil in the state of Mato Grosso. Methods: a cross-sectional study of secondary database, with analysis of SINASC birth records in Mato Grosso between 2013 and 2015, of Brazilian children, born from both Brazilian and Haitian mothers. Variables related to the identification of the newborn and the woman, maternal data on gestational history, including information on prenatal follow-up of the last gestation were evaluated, besides the birth characteristics. Results: 167,820 live births were registered in the state in the period, of which 139 (0.08%) were children of Haitian women. Haitian mothers were older, however with lower schooling when compared to Brazilian mothers. The proportion of mothers of Haitian nationality who had at least 6 prenatal consultations was lower, and the proportion of vaginal births was higher, when compared to Brazilian women. The prevalence of low birth weight among live births of Haitian mothers was also higher. Conclusions: the results of this study point to the need to understand these differences, since some indicators have distanced from those advocated by WHO. These findings may contribute to the public policies development aimed at this population.

Imigração, refúgio e saúde: perspectivas de análise sociocultural

Resumo Os recentes processos migratórios internacionais ocorridos no Brasil se apresentam como um campo de estudo para as ciências sociais e humanas em saúde. Este artigo tem como objetivo refletir sobre os processos de inclusão de imigrantes e refugiados pelas instituições de saúde, considerando o campo de debates das ciências sociais e humanas em Saúde e o comprometimento dessa área com os direitos humanos. Inicialmente, são apresentadas características contemporâneas das migrações internacionais, incluindo a situação brasileira. Em seguida, são descritas algumas pesquisas e práticas sobre concepções de saúde, doenças e cuidados com imigrantes e, por fim, propomos um debate acerca de alguns conceitos antropológicos que podem contribuir para uma abordagem menos estereotipada dos processos de inclusão nas instituições de saúde nacionais. Pretendemos apresentar uma perspectiva das ciências sociais e humanas em saúde em um horizonte teórico articulado com práticas em saúde que, de certa forma, podem contribuir para a formulação de conceitos, explicações e orientações no plano das políticas públicas com essas populações.