Syphilis among U.S.-Bound Refugees, 2009-2013

U.S. immigration regulations require clinical and serologic screening for syphilis for all U.S.-bound refugees 15 years of age and older. We reviewed syphilis screening results for all U.S.-bound refugees from January 1, 2009 through December 31, 2013. We calculated age-adjusted prevalence by region and nationality and assessed factors associated with syphilis seropositivity using multivariable log binomial regression models. 

Among 233,446 refugees, we identified 874 syphilis cases (373 cases per 100,000 refugees). The highest overall age-adjusted prevalence rates of syphilis seropositivity were observed among refugees from Africa (1340 cases per 100,000), followed by East Asia and the Pacific (397 cases per 100,000). In most regions, male sex, increasing age, and living in non-refugee camp settings were associated with syphilis seropositivity. 

Future analysis of test results, stage of infection, and treatment delivery overseas is warranted in order to determine the extent of transmission risk and benefits of the screening program.

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By:  Nyangoma EN1,2, Olson CK3, Painter JA3, Posey DL3, Stauffer WM3,4, Naughton M3, Zhou W3, Kamb M5, Benoit SR3.

• 1Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA. ENyangoma@cdc.gov.
• 2Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, 1600 Clifton Road, NE, MS E-03, Atlanta, GA, USA. ENyangoma@cdc.gov.
• 3Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, 1600 Clifton Road, NE, MS E-03, Atlanta, GA, USA.
• 4Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
• 5Division of Sexually Transmitted Diseases Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
• J Immigr Minor Health. 2016 Mar 18.  

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Are Healthcare Professionals Working in Australia's Immigration Detention Centres Condoning Torture?

Australian immigration detention centres are in secluded locations, some on offshore islands, and are subject to extreme secrecy, comparable with 'black sites' elsewhere. 

There are parallels between healthcare professionals working in immigration detention centres and healthcare professionals involved with or complicit in torture. In both cases, healthcare professionals are conflicted between a duty of care to improve the health of patients and the interests of the government. While this duality of interests has been recognised previously, the full implications for healthcare professionals working in immigration detention have not been addressed. 

The Australian Government maintains that immigration detention is needed for security checks, but the average duration of immigration detention has increased from 10 weeks to 14 months, and detainees are not informed of the progress of their application for refugee status. Long-term immigration detention causes major mental health problems, is illegal in international law and arguably fulfils the recognised definition of torture. 

It is generally accepted that healthcare professionals should not participate in or condone torture. Australian healthcare professionals thus face a major ethical dilemma: patients in immigration detention have pressing mental and physical health needs, but providing healthcare might support or represent complicity in a practice that is unethical. 

Individual healthcare professionals need to decide whether or not to work in immigration detention centres. If they do so, they need to decide for how long and to what extent restrictive contracts and gagging laws will constrain them from advocating for closing detention centres.

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By:   Isaacs D1.

• 1Department of Infectious Diseases & Microbiology, Children's Hospital at Westmead, Sydney, New South Wales, Australia Discipline of Child Health, University of Sydney, Sydney, New South Wales, Australia.  

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Substance Use and Cumulative Exposure to American Society: Findings from Both Sides of the US-Mexico Border Region

OBJECTIVES:

We investigated whether Mexican immigration to the United States exerts transnational effects on substance use in Mexico and the United States.

METHODS:

We performed a cross-sectional survey of 2336 Mexican Americans and 2460 Mexicans in 3 Texas border metropolitan areas and their sister cities in Mexico (the US-Mexico Study on Alcohol and Related Conditions, 2011-2013). We collected prevalence and risk factors for alcohol and drug use; Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, alcohol-use disorders; and 2 symptoms (hazardous use and quit or control) of drug use disorder across a continuum of migration experiences in the Mexican and Mexican American populations.

RESULTS:

Compared with Mexicans with no migrant experience, the adjusted odds ratios for this continuum of migration experiences ranged from 1.10 to 8.85 for 12-month drug use, 1.09 to 5.07 for 12-month alcohol use disorder, and 1.13 to 9.95 for 12-month drug-use disorder. Odds ratios increased with longer exposure to US society. These findings are consistent with those of 3 previous studies.

CONCLUSIONS:

People of Mexican origin have increased prevalence of substance use and disorders with cumulative exposure to US society. 

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By:  Borges G1, Cherpitel CJ1, Orozco R1, Zemore SE1, Wallisch L1, Medina-Mora ME1, Breslau J1.

• 1Guilherme Borges, Ricardo Orozco, and Maria Elena Medina-Mora are with Instituto Nacional de Psiquiatría, México DF, México. Guilherme Borges is also with the Universidad Autónoma Metropolitana, México DF. Cheryl J. Cherpitel and Sarah E. Zemore are with the National Alcohol Research Center, Public Health Institute, Emeryville, CA. Lynn Wallisch is with the University of Texas, Center for Social Work Research, Austin, TX. Joshua Breslau is with RAND Corporation, Pittsburgh, PA.

 

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HIV Infection in Migrant Populations in the European Union and European Economic Area in 2007-2012: An Epidemic on the Move

Migrants are considered a key group at risk for HIV infection. This study describes the epidemiology of HIV and the distribution of late HIV presentation among migrants within the European Union/European Economic Area during 2007-2012.

HIV cases reported to European Surveillance System (TESSy) were analyzed. Migrants were defined as people whose geographical origin was different than the reporting country. Multiple logistic regression was used to model late HIV presentation.

Overall, 156,817 HIV cases were reported, of which 60,446 (38%) were migrants. Of these, 

• 53% were from Sub-Saharan Africa, 
• 12% from Latin America, 
• 9% from Western Europe, 
• 7% from Central Europe, 
• 5% from South and Southeast Asia, 
• 4% from East Europe, 
• 4% from Caribbean, and 
• 3% from North Africa and Middle East. 

Male and female migrants from Sub-Saharan Africa and Latin America had higher odds of late HIV presentation than native men and women. Migrants accounted for 40% of all HIV notifications in 2007 versus 35% in 2012. HIV cases in women from Sub-Saharan Africa decreased from 3725 in 2007 to 2354 in 2012. The number of HIV cases from Latin America peaked in 2010 to decrease thereafter. HIV diagnoses in migrant men who have sex with men increased from 1927 in 2007 to 2459 in 2012.

Migrants represent two-fifths of the HIV cases reported and had higher late HIV presentation. HIV epidemic in migrant populations in European Union/European Economic Area member states is changing, probably reflecting the global changes in the HIV pandemic, the impact of large-scale ART implementation, and migration fluctuations secondary to the economic crisis in Europe.

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By: Hernando V1, Alvárez-Del Arco D, Alejos B, Monge S, Amato-Gauci AJ, Noori T, Pharris A, Del Amo J.

• 1*Red de Investigación en Sida, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain; †CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; ‡Department of Surgery, Medical and Social Sciences, Universidad Alcalá, Alcalá de Henares, Spain; and §Surveillance and Response Section, European Centre for Disease Prevention and Control, Stockholm, Sweden.  

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“She Mixes Her Business”: HIV Transmission & Acquisition Risks among Female Migrants in Western Kenya

Migration and HIV research in sub-Saharan Africa has focused on HIV risks to male migrants, yet women’s levels of participation in internal migration have met or exceeded those of men in the region. Moreover, studies that have examined HIV risks to female migrants found higher risk behavior and HIV prevalence among migrant compared to non-migrant women. However, little is known about the pathways through which participation in migration leads to higher risk behavior in women. 

This study aimed to characterize the contexts and processes that may facilitate HIV acquisition and transmission among migrant women in the Kisumu area of Nyanza Province, Kenya. We used qualitative methods, including 6 months of participant observation in women’s common migration destinations and in-depth semi-structured interviews conducted with 15 male and 40 female migrants selected from these destinations.

Gendered aspects of the migration process may be linked to the high risks of HIV observed in female migrants— in the circumstances that trigger migration, livelihood strategies available to female migrants, and social features of migration destinations. Migrations were often precipitated by household shocks due to changes in marital status (as when widowhood resulted in disinheritance) and gender-based violence. Many migrants engaged in transactional sex, of varying regularity, from clandestine to overt, to supplement earnings from informal sector trading. 

Migrant women are at high risk of HIV transmission and acquisition: the circumstances that drove migration may have also increased HIV infection risk at origin; and social contexts in destinations facilitate having multiple sexual partners and engaging in transactional sex.

We propose a model for understanding the pathways through which migration contributes to HIV risks in women in high HIV prevalence areas in Africa, highlighting potential opportunities for primary and secondary HIV prevention at origins and destinations, and at key ‘moments of vulnerability’ in the migration process.

Below:  Kenya Counties (2013) and Study Area

Below:  Conceptual framework: Factors linking migration to HIV acquisition and transmission risks among women in high HIV prevalence settings in Africa 

Full article at: http://goo.gl/RPYyKC

By: Carol S. Camlin,1 Zachary A. Kwena,2 Shari L. Dworkin,1 Craig R. Cohen,1 and Elizabeth A. Bukusi3

¹University of California at San Francisco

²Kenya Medical Research Institute

³Kenya Medical Research Institute, University of California at San Francisco and University of Washington

Corresponding Author: Email: ude.fscu@nilmac.lorac (C. Camlin)

  

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Postpartum Contraception: A Comparative Study of Berlin Women with & without Immigration Background

Are there differences in postpartum contraceptive use between women with and without immigration background? Do women more commonly use contraception following a high-risk pregnancy or caesarean section? What role does current breastfeeding play and, amongst immigrants, what is the effect of acculturation level on the frequency of contraceptive use?

Data collection was carried out as part of a larger study in three Berlin delivery units using standardised interviews (questionnaires covering e.g. sociodemographics, immigration history/acculturation and use of antenatal care); telephone interviews comprising 6 questions on postpartum contraception, breastfeeding and postpartum complications were conducted on a sample of the study population six months after delivery.

247 women with, and 358 women without a background of immigration were included in the study (total study population n = 605, response rate 81.1 %). 68 % of 1st generation immigrants, 87 % of 2nd/3rd generation women and 73 % of women without immigration background (non-immigrants) used contraception. In the logistical regression analysis 1st generation immigrants were less likely than non-immigrants to be using contraception six months postpartum, and 1st generation immigrants with low acculturation level were significantly less likely to use contraception than 2nd/3rd generation women with low acculturation level.

In the extended postpartum period there was no major difference in contraceptive use between immigrants in general and non-immigrants. It remains unclear whether the differing contraceptive behaviour of 1st generation immigrants is the result of less access to information, sociocultural factors or differing contraceptive requirements and further targeted, qualitative study is required.

Table 2 Contraception at six months post partum.

		1st generation immigrants	2nd + 3rd generation women	Non-immigrants	Total
* vaginal ring, 3-monthly injection, sterilisation (female, male), coitus interruptus, natural family planning, others
Contraception: yes	n	118	60	261	439
	%	68.2	87.0	73.1	73.3
					missing = 6
Method:	n	117	60	261	438
oral contraceptive	%	29.9	50.0	39.1	38.1
coil (IUD)	%	13.7	16.7	9.2	11.4
condom (+ various [v])	%	47.0	33.3 [v]	45.2	43.8
various*	%	9.4		6.5	6.7

Table 4 Influence of various factors on contraceptive use six months after delivery.

			Contraception “yes” in % (n)
			1st generation immigrants	2nd + 3rd generation women	Non-immigrants
Fisherʼs Exact Tests: Ref. = Referenz, ** p < 0.01, n. s. = nicht signifikant
Acculturation level	low		67.4 (58)**	96.3 (26) Ref.	–
	high		70.5 (55) n. s.	78.4 (29) Ref.	–
	low	oral contraceptive	34.5 (20)	53.9 (14)	–
		condom	39.7 (23)	30.8 (11)	–
		other	25.9 (15)	15.4 (4)	–
	high	oral contraceptive	23.6 (13)	46.7 (14)	–
		condom	58.2 (32)	33.3 (10)	–
		other	18.2 (10)	20.0 (6)	–
Mode of delivery	vaginal		70.9 (83) n. s.	87.5 (42) n. s.	75.4 (147) Ref.
	Caesarean section		62.5 (35) n. s.	85.7 (18) n. s.	70.4 (114) Ref.
	vaginal	oral contraceptive	28.9 (24)	47.6 (20)	39.9 (59)
		condom	43.4 (36)	33.3 (14)	49.3 (73)
		other	27.7 (23)	19.1 (8)	10.8 (16)
	Caesarean section	oral contraceptive	31.4 (11)	52.6 (10)	37.4 (43)
		condom	54.3 (19)	26.3 (5)	40.0 (46)
		other	14.3 (5)	21.1 (4)	22.6 (26)
High risk pregnancy	no		71.4 (85) n. s.	87.2 (41) n. s.	74.5 (180) Ref.
	yes		60.4 (32) n. s.	86.4 (19) n. s.	69.8 (81) Ref.
	no	oral contraceptive	28.2 (24)	48.8 (20)	42.9 (78)
		condom	49.4 (42)	36.6 (15)	45.6 (83)
		other	22.4 (19)	14.6 (6)	11.5 (21)
	yes	oral contraceptive	31.3 (10)	50.0 (10)	29.6 (24)
		condom	40.6 (13)	20.0 (4)	44.4 (36)
		other	28.1 (9)	30.0 (6)	25.9 (21)
Midwifery postpartum care	no		71.4 (50) n. s.	89.2 (33) n. s.	69.8 (44) Ref.
	yes		66.0 (68) n. s.	84.4 (27) n. s.	73.8 (217) Ref.
	no	oral contraceptive	40.0 (20)	41.2 (14)	47.8 (22)
		condom	30.0 (15)	35.3 (12)	37.0 (17)
		other	30.0 (15)	23.5 (8)	15.2 (7)
	yes	oral contraceptive	22.1 (15)	59.3 (16)	36.9 (80)
		condom	58.8 (40)	25.9 (7)	47.0 (102)
		other	19.1 (13)	14.8 (4)	16.1 (35)
Current breastfeeding	no		66.2 (51) n. s.	89.4 (47) n. s.	77.2 (129) Ref.
	yes		69.8 (67) n. s.	81.8 (22) n. s.	69.5 (132) Ref.
	no	oral contraceptive	37.3 (19)	51.2 (22)	50.0 (65)
		condom	43.1 (22)	25.6 (11)	32.3 (42)
		other	19.6 10)	23.3 (10)	17.7 (23)
	yes	oral contraceptive	23.9 (16)	44.4 (8)	27.8 (37)
		condom	49.3 (33)	44.4 (8)	57.9 (77)
		other	26.9 (18)	11.1 (2)	14.3 (19)
All
Religion	Christian			74.5 (164)
	none/other			67.0 (140)
	Muslim			79.4 (135)
	Christian	oral contraceptive		35.8 (59)
		condom		52.7 (87)
		other		11.5 (19)
	none/other	oral contraceptive		34.8 (49)
		condom		45.4 (64)
		other		19.9 (28)
	Muslim	oral contraceptive		43.4 (59)
		condom		30.9 (42)
		other		25.7 (35)

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By: M. David, S. Brenne, J. Breckenkamp, O. Razum, and T. Borde

¹Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Klinik für Gynäkologie, Berlin

²Alice Salomon Hochschule Berlin, Berlin

³Universität Bielefeld, Fakultät für Gesundheitswissenschaften, AG Epidemiologie und International Public Health, Bielefeld

Correspondence Prof. Dr. med. Matthias David Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Klinik für Gynäkologie, Augustenburger Platz 1, 13353 Berlin, ; Email: ed.etirahc@divad.saihttam

  

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