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Wirtz AL, Stevenson M, Guillén JR, Ortiz J, Barriga Talero MÁ, Page KR, López JJ, Ramirez Correa JF, Martínez Porras D, Luque Núñez R, Fernández-Niño JA, Spiegel PB. Persistent Food Insecurity and Material Hardships: A Latent Class Analysis of Experiences among Venezuelan Refugees and Migrants in Urban Colombia. Nutrients 2024; 16:1060. [PMID: 38613093 PMCID: PMC11013044 DOI: 10.3390/nu16071060] [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: 02/28/2024] [Revised: 03/28/2024] [Accepted: 03/28/2024] [Indexed: 04/14/2024] Open
Abstract
The causes and conditions of displacement often increase the vulnerability of migrant and refugee populations to food insecurity, alongside other material hardships. We aimed to examine the multidimensional aspects and patterns of food insecurity and other material hardships in a cross-sectional sample of 6221 Venezuelan refugees and migrants in urban Colombia using a latent class analysis. Using multinomial and logistic regression models, we investigated the demographic and migratory experiences associated with identified classes and how class membership is associated with multiple health outcomes among Venezuelan refugees and migrants, respectively. Approximately two thirds of the sample was comprised cisgender women, and the participants had a median age of 32 years (IQR: 26-41). Four heterogeneous classes of food insecurity and material hardships emerged: Class 1-low food insecurity and material hardship; Class 2-high food insecurity and material hardship; Class 3-high income hardship with insufficient food intake; and Class 4-income hardship with food affordability challenges. Class 2 reflected the most severe food insecurity and material hardships and had the highest class membership; Venezuelans with an irregular migration status were almost 1.5 times more likely to belong to this class. Food insecurity and material hardship class membership was independently associated with self-rated health, mental health symptoms, and recent violence victimization and marginally associated with infectious disease outcomes (laboratory-confirmed HIV and/or syphilis infection). Social safety nets, social protection, and other interventions that reduce and prevent material hardships and food insecurity among refugees and migrants, alongside the host community, may improve public health, support development, and reduce healthcare costs. In the long term, regularization and social policies for migrants aimed at enhancing refugees' and migrants' social and economic inclusion may contribute to improving food security in this population.
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Affiliation(s)
- Andrea L. Wirtz
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA; (M.S.); (K.R.P.)
- Department of International Health, Center for Humanitarian Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA;
| | - Megan Stevenson
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA; (M.S.); (K.R.P.)
| | - José Rafael Guillén
- Red Somos, Bogotá 111321, Colombia; (J.R.G.); (J.O.); (M.Á.B.T.); (J.J.L.); (J.F.R.C.); (D.M.P.)
| | - Jennifer Ortiz
- Red Somos, Bogotá 111321, Colombia; (J.R.G.); (J.O.); (M.Á.B.T.); (J.J.L.); (J.F.R.C.); (D.M.P.)
| | | | - Kathleen R. Page
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA; (M.S.); (K.R.P.)
- Department of International Health, Center for Humanitarian Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA;
- Department of Infectious Disease, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
| | - Jhon Jairo López
- Red Somos, Bogotá 111321, Colombia; (J.R.G.); (J.O.); (M.Á.B.T.); (J.J.L.); (J.F.R.C.); (D.M.P.)
| | | | - Damary Martínez Porras
- Red Somos, Bogotá 111321, Colombia; (J.R.G.); (J.O.); (M.Á.B.T.); (J.J.L.); (J.F.R.C.); (D.M.P.)
| | | | | | - Paul B. Spiegel
- Department of International Health, Center for Humanitarian Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA;
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Gomez W, Fernández-Niño JA, Guillén JR, Stevenson M, Ortíz J, Barriga Talero MÁ, López JJ, Núñez RL, Spiegel P, Page KR, Ramirez Correa JF, Porras DM, Wirtz AL. The impact of policy and policy communication on COVID-19 vaccination inequalities among Venezuelan refugees and migrants in Colombia: a comparative cross-sectional interrupted time-series analysis. BMJ Glob Health 2024; 9:e014464. [PMID: 38453517 PMCID: PMC10921509 DOI: 10.1136/bmjgh-2023-014464] [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: 11/07/2023] [Accepted: 01/06/2024] [Indexed: 03/09/2024] Open
Abstract
INTRODUCTION Equitable access to vaccines for migrants and refugees is necessary to ensure their right to health and to achieve public health goals of reducing vaccine-preventable illness. Public health policies require regulatory frameworks and communication to effect uptake of effective vaccines among the target population. In Colombia, the National COVID-19 Vaccination Plan implicitly included Venezuelan refugees and migrants; however, initial communication of the policy indicated that vaccine availability was restricted to people with regular migration status. We estimated the impact of a public announcement, which clarified access for refugees and migrants, on vaccination coverage among Venezuelans living in Colombia. METHODS Between 30 July 2021 and 5 February 2022, 6221 adult Venezuelans participated in a cross-sectional, population-based health survey. We used a comparative cross-sectional time-series analysis to estimate the effect of the October 2021 announcement on the average biweekly change in COVID-19 vaccine coverage of Venezuelans with regular and irregular migration status. RESULTS 71% of Venezuelans had an irregular status. The baseline (preannouncement) vaccine coverage was lower among people with an irregular status but increased at similar rates as those with a regular status. After the announcement, there was a level change of 14.49% (95% CI: 1.57 to 27.42, p=0.03) in vaccination rates among individuals with irregular migration status with a 4.61% increase in vaccination rate per biweekly period (95% CI: 1.71 to 7.51, p=0.004). By February 2022, there was a 26.2% relative increase in vaccinations among individuals with irregular migration status compared with what was expected without the announcement. CONCLUSION While there was no policy change, communication clarifying the policy drastically reduced vaccination inequalities across migration status. Lessons can be translated from the COVID-19 pandemic into more effective global, regional and local public health emergency preparedness and response to displacement.
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Affiliation(s)
- Wilson Gomez
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Julián A Fernández-Niño
- Center for Humanitarian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Megan Stevenson
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | | | - Ricardo Luque Núñez
- Government of Colombia Ministry of Health and Social Protection, Bogotá, Colombia
| | - Paul Spiegel
- Center for Humanitarian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kathleen R Page
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Center for Humanitarian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Medicine, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | - Andrea L Wirtz
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Center for Humanitarian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Stevenson M, Guillén J, Ortíz J, Ramírez Correa JF, Page KR, Barriga Talero MÁ, López JJ, Fernández-Niño JA, Núñez RL, Spiegel P, Wirtz AL. Syphilis prevalence and correlates of infection among Venezuelan refugees and migrants in Colombia: findings of a cross-sectional biobehavioral survey. LANCET REGIONAL HEALTH. AMERICAS 2024; 30:100669. [PMID: 38298201 PMCID: PMC10827575 DOI: 10.1016/j.lana.2023.100669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 12/22/2023] [Accepted: 12/26/2023] [Indexed: 02/02/2024]
Abstract
Background Population-based estimates of syphilis prevalence are critical to informing public health response. We aimed to measure syphilis prevalence among Venezuelan refugees and migrants in Colombia to inform public health programming. Methods Between July 2021 and February 2022, we surveyed 6221 adult Venezuelan refugees and migrants in four cities in Colombia using respondent-driven sampling (RDS). Participants completed a survey and dual-rapid HIV/treponemal syphilis screening. Confirmatory laboratory-based rapid plasma reagin testing was conducted on whole blood samples. Active syphilis infection was defined as RPR titer ≥ 1:8 and no self-reported syphilis treatment. We used multivariable regression models to identify associations with active syphilis infection among subgroups by gender and history of pregnancy (cisgender men n = 2123, cisgender women n = 4044, transgender/nonbinary people n = 47, pregnant women n = 150). Findings Population (RDS-weighted) prevalence of laboratory-confirmed syphilis was 5.1% (95% CI: 4.6-5.6). Syphilis prevalence was 5.8% (weighted) among men; lifetime sexually transmitted infections (STI) diagnosis, same-sex relationships, HIV infection, and partner number were independently associated with syphilis infection. Syphilis prevalence was 4.6% (weighted) in women; correlates of infection included: lifetime STI diagnosis, food insecurity, current engagement in sex work, current pregnancy, any unsafe night in Colombia, irregular migration status, and no healthcare utilization in Colombia. 14.9% (unweighted) of transgender participants had syphilis infection; correlates of infection included partner number and HIV infection. The prevalence of syphilis was 9.0% (weighted) among pregnant women, which was associated with lifetime STI diagnosis. Interpretation Syphilis among Venezuelans in Colombia is high. Correlates of infection are distinct among demographic groups, spanning sexual and social vulnerabilities, suggesting tailored public health strategies. Funding US President's Emergency Plan for AIDS Relief through the U.S. Centers for Disease Control and Prevention.
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Affiliation(s)
- Megan Stevenson
- Bloomberg School of Public Health, Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins University, Baltimore, MD, USA
| | | | | | | | - Kathleen R. Page
- Bloomberg School of Public Health, Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins University, Baltimore, MD, USA
- Bloomberg School of Public Health, Department of International Health, Center for Humanitarian Health, Johns Hopkins University, Baltimore, MD, USA
- Department of Infectious Disease, Johns Hopkins School of Medicine, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | | | | - Paul Spiegel
- Bloomberg School of Public Health, Department of International Health, Center for Humanitarian Health, Johns Hopkins University, Baltimore, MD, USA
| | - Andrea L. Wirtz
- Bloomberg School of Public Health, Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins University, Baltimore, MD, USA
- Bloomberg School of Public Health, Department of International Health, Center for Humanitarian Health, Johns Hopkins University, Baltimore, MD, USA
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Wirtz AL, Guillén JR, Stevenson M, Ortiz J, Talero MÁB, Page KR, López JJ, Porras DM, Correa JFR, Núñez RL, Fernández-Niño JA, Spiegel PB. HIV infection and engagement in the care continuum among migrants and refugees from Venezuela in Colombia: a cross-sectional, biobehavioural survey. Lancet HIV 2023; 10:e461-e471. [PMID: 37302399 PMCID: PMC10336726 DOI: 10.1016/s2352-3018(23)00085-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 03/26/2023] [Accepted: 04/13/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Venezuela has experienced substantial human displacement since 2015. To inform HIV programmes and treatment distribution, we aimed to estimate HIV prevalence and associated indicators among migrants and refugees from Venezuela residing in Colombia, the largest receiving country. METHODS We conducted a biobehavioural, cross-sectional survey using respondent-driven sampling among Venezuelan people aged 18 years or older who had arrived in Colombia since 2015 and resided in four cities (ie, Bogotá, Soacha, Soledad, and Barranquilla). Participants completed sociobehavioural questionnaires and rapid HIV and syphilis screening with laboratory-based confirmatory testing, CD4 cell counts, and viral load quantification. Policies related to migration status affect access to insurance and HIV services in Colombia, as in many receiving countries, so we provided legal assistance and navigation support to participants with HIV for sustained access to treatment. Population-based estimates were weighted for the complex sampling design. Penalised multivariable logistic regression analysis was used to identify correlates of viral suppression (HIV-1 RNA <1000 copies per mL). FINDINGS Between July 30, 2021, and Feb 5, 2022, 6506 participants were recruited through respondent-driven sampling, of whom 6221 were enrolled. 4046 (65·1%) of 6217 were cisgender women, 2124 (34·2%) of 6217 were cisgender men, and 47 (0·8%) of 6217 were transgender or non-binary people. 71 (1·1%) of all 6221 participants had laboratory-confirmed HIV infection, resulting in a weighted population HIV prevalence of 0·9% (95% CI 0·6-1·4). Among participants living with HIV, 34 (47·9%) of 71 had been previously diagnosed with HIV and 25 (35·7%) of 70 had viral suppression. Individuals with irregular migration status compared with individuals with regular migration status (adjusted odds ratio 0·3, 95% CI 0·1-0·9) and with a most recent HIV test in Colombia compared with a most recent test in Venezuela (0·2, 0·1-0·8) were less likely to have suppressed viral loads. INTERPRETATION HIV prevalence among migrants and refugees from Venezuela in Colombia suggests the HIV epidemic is close to being generalised, which could be addressed by the inclusion of migrants and refugees from Venezuela in local HIV services, improved access to and navigation support for HIV testing and care, and coordination with humanitarian programmes. There is an association between migration status and viral suppression, conferring both clinical and epidemiological implications. Therefore, legal support and access to insurance might lead to early detection of HIV and timely treatment for people with irregular migration status. FUNDING US President's Emergency Plan for AIDS Relief through the US Centers for Disease Control and Prevention. TRANSLATION For the Spanish translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Andrea L Wirtz
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins University, Baltimore, MD, USA; Bloomberg School of Public Health, Department of International Health, Center for Humanitarian Health, Johns Hopkins University, Baltimore, MD, USA.
| | | | - Megan Stevenson
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins University, Baltimore, MD, USA
| | | | | | - Kathleen R Page
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins University, Baltimore, MD, USA; Bloomberg School of Public Health, Department of International Health, Center for Humanitarian Health, Johns Hopkins University, Baltimore, MD, USA; Department of Infectious Disease, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | | | | | | | | | | | - Paul B Spiegel
- Bloomberg School of Public Health, Department of International Health, Center for Humanitarian Health, Johns Hopkins University, Baltimore, MD, USA
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Qualitative assessment of the impacts of the COVID-19 pandemic on migration, access to healthcare, and social wellbeing among Venezuelan migrants and refugees in Colombia. J Migr Health 2023; 7:100187. [PMID: 37007283 PMCID: PMC10039780 DOI: 10.1016/j.jmh.2023.100187] [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] [Received: 10/18/2022] [Revised: 02/12/2023] [Accepted: 03/16/2023] [Indexed: 03/28/2023] Open
Abstract
Background Colombia hosts a large number of Venezuelan migrants and refugees who are uniquely vulnerable and have been markedly impacted by the COVID-19 pandemic. It is necessary to understand their experiences to inform future policy decisions both in Colombia and during disease outbreaks in other humanitarian contexts in the future. As part of a larger study focused on HIV among Venezuelans residing in Colombia, qualitative interviews were conducted to understand this population's experiences and access to healthcare. Methods Interviews were conducted with Venezuelan migrants and refugees as well as stakeholders such as care providers, humanitarian workers, and government officials. Interviews were recorded, transcribed, and coded using thematic content analysis. Select quotes were translated and edited for length and/or clarity. Results Venezuelan migrants and refugees reported high levels of housing instability, job instability, increased barriers to accessing healthcare, and complications in engaging in the HIV care continuum, among other impacts of the COVID-19 pandemic. Stakeholders reported complications in provision of care and obtaining medicines, difficulty maintaining contact with patients, increased discrimination and xenophobia targeting Venezuelan migrants and refugees, increased housing instability among Venezuelan migrants and refugees, and other impacts as a result of the COVID-19 pandemic. Conclusions This study demonstrates the unique impacts of the COVID-19 pandemic among Venezuelans residing in Colombia by both compounding extant vulnerabilities and introducing new challenges, such as high rates of eviction. Colombia has enacted increasingly inclusive migration policies for Venezuelan refugees and migrants within the country; findings from this study underscore the necessity for such policies both in and outside of the Colombian context.
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Kovalenko G, Yakovleva A, Smyrnov P, Redlinger M, Tymets O, Korobchuk A, Kolodiazieva A, Podolina A, Cherniavska S, Skaathun B, Smith LR, Strathdee SA, Wertheim JO, Friedman SR, Bortz E, Goodfellow I, Meredith L, Vasylyeva TI. Phylodynamics and migration data help describe HIV transmission dynamics in internally displaced people who inject drugs in Ukraine. PNAS NEXUS 2023; 2:pgad008. [PMID: 36896134 PMCID: PMC9991454 DOI: 10.1093/pnasnexus/pgad008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 01/03/2023] [Accepted: 01/04/2023] [Indexed: 01/21/2023]
Abstract
Internally displaced persons are often excluded from HIV molecular epidemiology surveillance due to structural, behavioral, and social barriers in access to treatment. We test a field-based molecular epidemiology framework to study HIV transmission dynamics in a hard-to-reach and highly stigmatized group, internally displaced people who inject drugs (IDPWIDs). We inform the framework by Nanopore generated HIV pol sequences and IDPWID migration history. In June-September 2020, we recruited 164 IDPWID in Odesa, Ukraine, and obtained 34 HIV sequences from HIV-infected participants. We aligned them to publicly available sequences (N = 359) from Odesa and IDPWID regions of origin and identified 7 phylogenetic clusters with at least 1 IDPWID. Using times to the most recent common ancestors of the identified clusters and times of IDPWID relocation to Odesa, we infer potential post-displacement transmission window when infections likely to happen to be between 10 and 21 months, not exceeding 4 years. Phylogeographic analysis of the sequence data shows that local people in Odesa disproportionally transmit HIV to the IDPWID community. Rapid transmissions post-displacement in the IDPWID community might be associated with slow progression along the HIV continuum of care: only 63% of IDPWID were aware of their status, 40% of those were in antiviral treatment, and 43% of those were virally suppressed. Such HIV molecular epidemiology investigations are feasible in transient and hard-to-reach communities and can help indicate best times for HIV preventive interventions. Our findings highlight the need to rapidly integrate Ukrainian IDPWID into prevention and treatment services following the dramatic escalation of the war in 2022.
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Affiliation(s)
- Ganna Kovalenko
- Division of Virology, Department of Pathology, University of Cambridge, Cambridge CB2 0QN, UK
- Department of Biological Sciences, University of Alaska, Anchorage, AK 99508, USA
| | - Anna Yakovleva
- Medical Sciences Division, University of Oxford, Oxford OX3 9DU, UK
| | | | - Matthew Redlinger
- Department of Biological Sciences, University of Alaska, Anchorage, AK 99508, USA
| | - Olga Tymets
- Alliance for Public Health, Kyiv 01601, Ukraine
| | | | | | - Anna Podolina
- Odesa Regional Virology Laboratory, Odesa 65000, Ukraine
| | | | - Britt Skaathun
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA 92093-0507, USA
| | - Laramie R Smith
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA 92093-0507, USA
| | - Steffanie A Strathdee
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA 92093-0507, USA
| | - Joel O Wertheim
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA 92093-0507, USA
| | - Samuel R Friedman
- Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Eric Bortz
- Department of Biological Sciences, University of Alaska, Anchorage, AK 99508, USA
| | - Ian Goodfellow
- Division of Virology, Department of Pathology, University of Cambridge, Cambridge CB2 0QN, UK
| | - Luke Meredith
- Division of Virology, Department of Pathology, University of Cambridge, Cambridge CB2 0QN, UK
| | - Tetyana I Vasylyeva
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA 92093-0507, USA
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