Social Support, Sexual Violence, and Transactional Sex among Female Transnational Migrants to South Africa

OBJECTIVES:

To examine the relationship between sexual violence and transactional sex and assess the impact of social support on this relationship among female transnational migrants in Cape Town, South Africa.

METHODS:

In 2012 we administered a behavioral risk factor survey using respondent-driven sampling to transnational migrant women aged between 16 and 39 years, born outside South Africa, living in Cape Town, and speaking English, Shona, Swahili, Lingala, Kirundi, Kinyarwanda, French, or Somali.

RESULTS:

Controlling for study covariates, travel-phase sexual violence was positively associated with engagement in transactional sex (adjusted prevalence ratio [APR] = 1.38; 95% confidence interval [CI] = 1.07, 1.77), and social support was shown to be a protective factor (APR = 0.84; 95% CI = 0.75, 0.95). The interaction of experienced sexual violence during migration and social support score was APR = 0.85 (95% CI = 0.66, 1.10). In the stratified analysis, we found an increased risk of transactional sex among the low social support group (APR = 1.56; 95% CI = 1.22, 2.00). This relationship was not statistically significant among the moderate or high social support group (APR = 1.04; 95% CI = 0.58, 1.87).

CONCLUSIONS:

Programs designed to strengthen social support may reduce transactional sex among migrant women after they have settled in their receiving communities. 

Purchase full article at:   http://goo.gl/uB7VNO

By:  Giorgio M1, Townsend L1, Zembe Y1, Guttmacher S1, Kapadia F1, Cheyip M1, Mathews C1.

• 1At the time of this study, Margaret Giorgio, Sally Guttmacher, and Farzana Kapadia were with the Department of Nutrition, New York University, New York, NY. Loraine Townsend, Yanga Zembe, and Catherine Mathews are with the Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa. Mireille Cheyip is with the Centers for Disease Control and Prevention, Pretoria, South Africa. 
• Am J Public Health. 2016 Apr 14:e1-e7

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Point of Care HIV Testing with Oral Fluid among Returnee Migrants in a Rural Area of Bangladesh

Objectives

To determine HIV prevalence and assess the acceptability of HIV testing using oral fluid as a point of care (PoC) test method among returnee migrants in a rural area of Bangladesh.

Design

A cross-sectional study.

Methods

Matlab is a rural area southeast of Dhaka where icddr,b hosts a health and demographic surveillance system covering 225 826 people of whom 934 are returnee migrants. The sample size of 304 was proportionately distributed among randomly selected households. HIV antibodies in oral fluid were tested using OraQuick Rapid HIV 1/2 antibody test. To understand reasons of acceptability a short questionnaire was applied and 32 in-depth interviews were conducted.

Results

Of 304 returnee migrants approached, 97.4% accepted the test. The prevalence of HIV was 0.3% without a confirmatory blood test. Reasons for acceptance included easy accessibility of the test at the door-step which saved resources (i.e., time and money), comfortable test-procedure without any pain and fear, and receiving quick results with confidentiality. Some described knowing HIV status as a way to ‘get certified’ (of sexual fidelity) and to confront a prevailing silent stigma against migrants. Acceptability was moreover found to be grounded in icddr,b's institutional reputation and its close relationship with the local community.

Conclusions

The PoC oral fluid test for HIV has shown for the first time that assessment of HIV prevalence in rural-based returnee migrants is possible. Findings also suggest that PoC oral fluid test has the potential of increasing accessibility to HIV testing as it was found to be highly acceptable.

Objectives

To determine HIV prevalence and assess the acceptability of HIV testing using oral fluid as a point of care (PoC) test method among returnee migrants in a rural area of Bangladesh.

Design

A cross-sectional study.

Methods

Matlab is a rural area southeast of Dhaka where icddr,b hosts a health and demographic surveillance system covering 225 826 people of whom 934 are returnee migrants. The sample size of 304 was proportionately distributed among randomly selected households. HIV antibodies in oral fluid were tested using OraQuick Rapid HIV 1/2 antibody test. To understand reasons of acceptability a short questionnaire was applied and 32 in-depth interviews were conducted.

Results

Of 304 returnee migrants approached, 97.4% accepted the test. The prevalence of HIV was 0.3% without a confirmatory blood test. Reasons for acceptance included easy accessibility of the test at the door-step which saved resources (i.e., time and money), comfortable test-procedure without any pain and fear, and receiving quick results with confidentiality. Some described knowing HIV status as a way to ‘get certified’ (of sexual fidelity) and to confront a prevailing silent stigma against migrants. Acceptability was moreover found to be grounded in icddr,b's institutional reputation and its close relationship with the local community.

Conclusions

The PoC oral fluid test for HIV has shown for the first time that assessment of HIV prevalence in rural-based returnee migrants is possible. Findings also suggest that PoC oral fluid test has the potential of increasing accessibility to HIV testing as it was found to be highly acceptable.

Reasons for accepting the point of care oral fluid test for HIV

Reasons for accepting the testa	N = 296, % (95% CI)
Home-based test	75.3 (70.1–79.9)
Easy and rapid test	69.7 (64.2–74.7)
Pain-free test	65.9 (60.3–71.1)
Free of cost	57.1 (51.4–62.6)
Confidential test	22.3 (17.9–27.4)
Test result of icddr,b is acceptable	12.8 (9.5–17.2)
Confidence on the test result	10.8 (7.7–14.9)

CI, confidence interval.

aRefers to multiple responses.

Full article at:   http://goo.gl/CNqU3j

By:  Md Shah Alam,a Sharful I. Khan,a Masud Reza,a Ahmed Shahriar,b Md Safiullah Sarker,a Anisur Rahman,a Mustafizur Rahman,a and Tasnim Azima

^aInternational Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)

^bSave the Children in Bangladesh, Dhaka, Bangladesh

Correspondence to Tasnim Azim, Centre for HIV and AIDS, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka-1212, Bangladesh. Tel: +880 1713090403

Curr Opin HIV AIDS. 2016 Mar; 11(Suppl 1): S52–S58.

Published online 2016 Mar 10. doi:  10.1097/COH.0000000000000267

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

TOGETHER Project to Increase Understanding of the HIV Epidemic among Sub-Saharan African Migrants: Protocol of Community-Based Participatory Mixed-Method Studies

BACKGROUND:

Sub-Saharan African Migrants (SAM) are the second largest group affected by HIV/AIDS in Belgium and the rest of Western Europe. Increasing evidence shows that, more than previously thought, SAM are acquiring HIV in their host countries. This calls for a renewed focus on primary prevention. Yet, knowledge on the magnitude of the HIV epidemic among SAM (HIV prevalence estimates and proportions of undiagnosed HIV infections) and underlying drivers are scarce and limit the development of such interventions.

OBJECTIVE:

By applying a community-based participatory and mixed-methods approach, the TOGETHER project aims to deepen our understanding of HIV transmission dynamics, as well as inform future primary prevention interventions for this target group.

METHODS:

The TOGETHER project consists of a cross-sectional study to assess HIV prevalence and risk factors among SAM visiting community settings in Antwerp city, Belgium, and links an anonymous electronic self-reported questionnaire to oral fluid samples. Three formative studies informed this method: (1) a social mapping of community settings using an adaptation of the PLACE method; (2) a multiple case study aiming to identify factors that increase risk and vulnerability for HIV infection by triangulating data from life history interviews, lifelines, and patient files; and (3) an acceptability and feasibility study of oral fluid sampling in community settings using participant observations.

RESULTS:

Results have been obtained from 4 interlinked studies and will be described in future research.

CONCLUSIONS:

Combining empirically tested and innovative epidemiological and social science methods, this project provides the first HIV prevalence estimates for a representative sample of SAM residing in a West European city. By triangulating qualitative and quantitative insights, the project will generate an in-depth understanding of the factors that increase risk and vulnerability for HIV infection among SAM. Based on this knowledge, the project will identify priority subgroups within SAM communities and places for HIV prevention. Adopting a community-based participatory approach throughout the full research process should increase community ownership, investment, and mobilization for HIV prevention.

Below:  Outline of the TOGETHER project

Full article at: http://goo.gl/89hDSQ

By:  Loos J1, Vuylsteke B, Manirankunda L, Deblonde J, Kint I, Namanya F, Fransen K, Colebunders R, Laga M, Adobea D, Nöstlinger C.

• 1HIV and Sexual Health Unit, Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium. jloos@itg.be.

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

HIV Prevalence & Risk Factors among Left-Behind Women in High HIV Epidemic Rural Areas of Yunnan Province

OBJECTIVE:

To understand the status of HIV infection and risk factors among those left-behind women (LBW) in high HIV epidemic rural areas.

METHODS:

A cross-sectional investigation was conducted between March and May, 2015 in Dehong and Lincang prefectures, Yunnan province, where HIV appeared highly epidemic. Probability Proportion to Size (PPS) sampling method was used, and 500 cases were involved and tested for HIV antibody.

RESULTS:

The total rate of HIV infection among LBW was 8.2% (41/500). The rate of HIV infection among LBWs whose husbands were on medication was 22.7% (30/132). Data from Multi-factor logistic regression analysis showed that the risk factors of HIV infection were: being minorities, education background lower than junior high school, widowed, living in Lincang prefecture, husband infected with HIV but did not consistently use condoms,etc. The rate of HIV infection among other LBWs was 2.8% (10/363). Data from Multi-factor logistic regression analysis showed that the risk factors of HIV infection would include: aged between 30-40 years, being minorities, education background lower than junior high school, divorced, living in Dehong prefecture, having had multiple-sex partners, husband coming home less than once a year,etc. The rate of HIV infection among drug users whose husbands did not take HIV medication was 20.0% (1/5).

CONCLUSION:

HIV prevalence among LBWs in highly HIV epidemic areas was high, and the major risk factors related to their husbands were: being drug users or with HIV infected. Further effort should be made on consistently use of anti-HIV drugs and prevention of inter-marital sexual transmission. Comprehensive intervention should be carried out for LBWs who were having lower education background, being minority and having multiple-sex partners.

Purchase full article [Article in Chinese] at:  http://goo.gl/o8w1q7

By:  Zhang ZY1, Xiao MY2, Niu J2, Li XH2, Song LJ2, Mei JY2, Luo HB2, Jia MH2.

• 1School of Public Health, Kunming Medical University, Kunming, 650500, China.
• 2Center for AIDS/STDs Prevention Control, Yunnan Provincial Center for Disease Control and Prevention, Kunming, 650022, China. 
• Zhonghua Liu Xing Bing Xue Za Zhi. 2016 Feb 10;37(2):192-6. doi: 10.3760/cma.j.issn.0254-6450.2016.02.008.

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Provider-Initiated HIV Testing for Migrants in Spain: A Qualitative Study with Health Care Workers and Foreign-Born Sexual Minorities

Introduction

Provider-initiated HIV testing (PITC) is increasingly adopted in Europe. The success of the approach at identifying new HIV cases relies on its effectiveness at testing individuals most at risk. However, its suitability to reach populations facing overlapping vulnerabilities is under researched. This qualitative study examined HIV testing experiences and perceptions amongst Latin-American migrant men who have sex with men and transgender females in Spain, as well as health professionals’ experiences offering HIV tests to migrants in Barcelona and Madrid.

Methods

We conducted 32 in-depth interviews and 8 discussion groups with 38 Latin-American migrants and 21 health professionals. We imported verbatim transcripts and detailed field work notes into the qualitative software package Nvivo-10 and applied to all data a coding framework to examine systematically different HIV testing dimensions and modalities. The dimensions analysed were based on the World Health Organization “5 Cs” principles: Consent, Counselling, Connection to treatment, Correctness of results and Confidentiality.

Results

Health professionals reported that PITC was conceptually acceptable for them, although their perceived inability to adequately communicate HIV+ results and resulting bottle necks in the flow of care were recurrent concerns. Endorsement and adherence to the principles underpinning the rights-based response to HIV varied widely across health settings. The offer of an HIV test during routine consultations was generally appreciated by users as a way of avoiding the embarrassment of asking for it. Several participants deemed compulsory testing as acceptable on public health grounds. In spite of—and sometimes because of—partial endorsement of rights-based approaches, PITC was acceptable in a population with high levels of internalised stigma.

Conclusion

PITC is a promising approach to reach sexual minority migrants who hold high levels of internalised stigma but explicit extra efforts are needed to safeguard the rights of the most vulnerable.

Full article at:   http://goo.gl/Xg3Hnk

By:  Navaza B1, Abarca B1, Bisoffi F1, Pool R2, Roura M1.

• 1ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.
• 2Centre for Social Science and Global Health, University of Amsterdam, Amsterdam, The Netherlands. 
• PLoS One. 2016 Feb 25;11(2):e0150223. doi: 10.1371/journal.pone.0150223.

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

High Prevalence and Incidence of HIV and HCV among New Injecting Drug Users with a Large Proportion of Migrants - Is Prevention Failing?

OBJECTIVES:

The aim of this study was to assess differences in the prevalence of HIV and HCV infection and associated risk factors between new (injecting for ≤5 years) and long-term injectors and to estimate HIV/HCV incidence among new injectors.

METHODS:

Cross-sectional study among people who inject drugs (PWID) who attended harm reduction centers in Catalonia in 2010-11. Anonymous questionnaires and oral fluid samples were collected. Poisson regression models were applied to determine the association between HIV/HCV infection and risk factors.

RESULTS:

Of the 761 participants, 21.4% were new injectors. New injectors were younger than long-term injectors (mean age = 31.6 vs. 37.8) and were more likely to be immigrants (59.0% vs. 33.4%). HIV and HCV prevalence was 20.6% and 59.4% among new injectors, and estimated HIV and HCV incidence 8.7 and 25.1 /100 person-years, respectively. Among new injectors, HIV infection was associated with homelessness and reporting a previous sexually transmitted infection. Reporting front/backloading and daily injection were risk-factors for HCV infection. For long-term injectors, HIV risk factors were: having shared syringes, having injected cocaine, reporting front/backloading and ever having been in prison.

CONCLUSION:

A large proportion of PWID in Catalonia are new injectors, a subgroup with a high level of both sexual and parenteral exposure and a high incidence rate of HIV/ HCV infections. It is important to improve early diagnosis of these infections among this group, in particular among migrants. To identify and address risk factors for homelessness PWID should be a priority.

Purchase full article at:   http://goo.gl/Bq4jHF

By:  Folch C1,2,3, Casabona J1,2,3,4, Espelt A2,5,6, Majó X7, Meroño M8, Gonzalez V1,2,9, Wiessing L10, Colom J7, Brugal MT2,5; REDAN Study Group.

• 1a Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Agéncia de Salut Pública de Catalunya (ASPC), Generalitat de Catalunya , Badalona , Spain.
• 2b CIBER Epidemiología y Salud Pública (CIBERESP) , Spain.
• 3c Fundació Institut d'Investigació Germans Trias i Pujol (IGTP) , Badalona , Spain.
• 4d Departament de Pediatria, d'Obstetrícia i Ginecologia i de Medicina Preventiva i de Salut Pública, Facultat de Medicina, Universitat Autònoma de Barcelona , Bellaterra (Cerdanyola del Vallés) , Spain.
• 5e Agéncia de Salut Pública de Barcelona , Spain.
• 6f Departament de Psicologia i Metodologia de les Ciéncies de la Salut, Universitat Autònoma de Barcelona , Bellaterra (Cerdanyola del Vallés) , Spain.
• 7g Subdirecció General de Drogodependéncies, Agéncia Salut Pública de Catalunya (ASPC), Departament de Salut de la Generalitat de Catalunya.
• 8h Ámbit Prevenció , Barcelona , Spain.
• 9i Microbiology Service, Hospital Universitari Germans Trias i Pujol , Badalona , Spain.
• 10j European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) , Lisbon , Portugal.
• Subst Use Misuse. 2016 Jan 28:1-11. 

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Multiple Abortions and Sexually Transmitted Infections among Young Migrant Women Working in Entertainment Venues in China

We conducted a survey of 358 young migrant women working in entertainment venues in China to explore the prevalence of and factors associated with two indicators of sexual and reproductive health: (1) multiple abortions and (2) the dual risk of sexually transmitted infections (STI) and abortion history. 

One quarter (25.4 percent) of the women in this sample had multiple abortions during their lifetime and, of those with any abortion history, 18.3 percent had had an abortion outside of a regulated health clinic. 

One-third (33.0 percent) of the sample had had an STI during the past year, and approximately one-fourth (23.7 percent) of those women did not receive STI treatment in a public hospital. 

Approximately one-fourth (23.5 percent) of the sample reported both a history of abortion and an STI during the past year. Women with a history of multiple abortions had significantly lower income levels, were more likely to have sex with clients and with husbands, and tended more to use alcohol before sex. 

Women who experienced both abortion and STI risks were more likely to report having had unprotected sex, genitourinary tract infections symptoms, anxiety, illicit drug use, and suicidal ideation. 

Enhanced efforts are needed to improve reproductive and sexual health for female migrants in urban China, particularly those working in entertainment venues.

Purchase full article at:   http://goo.gl/qxr6xB

By:  Dong Y1, Zhang H, Wang Y, Tao H, Xu S, Xia J, Huang W, He H, Zaller N, Operario D.

• 1 Department of Adolescent Health and Maternal and Child Health, School of Public Health , Anhui Medical University , Hefei , Anhui Province , China. 

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

What The Eye Does Not See: A Critical Interpretive Synthesis of European Union Policies Addressing Sexual Violence in Vulnerable Migrants

Abstract

In Europe, refugees, asylum seekers and undocumented migrants are more vulnerable to sexual victimisation than European citizens. They face more challenges when seeking care. This literature review examines how legal and policy frameworks at national, European and international levels condition the prevention of and response to sexual violence affecting these vulnerable migrant communities living in the European Union (EU). 

Applying the Critical Interpretive Synthesis method, we reviewed 187 legal and policy documents and 80 peer-reviewed articles on migrant sexual health for elements on sexual violence and further analysed the 37 legal and 12 peer-reviewed articles among them that specifically focused on sexual violence in vulnerable migrants in the EU-27 States. 

Legal and policy documents dealing with sexual violence, particularly but not exclusively in vulnerable migrants, apply ‘tunnel vision’. They ignore: 

1. frequently occurring types of sexual violence, 
2. victimisation rates across genders and 
3. specific risk factors within the EU such as migrants’ legal status, gender orientation and living conditions. 

The current EU policy-making paradigm relegates sexual violence in vulnerable migrants as an ‘outsider’ and ‘female only’ issue while EU migration and asylum policies reinforce its invisibility. Effective response must be guided by participatory rights- and evidence-based policies and a public health approach, acknowledging the occurrence and multiplicity of sexual victimisation of vulnerable migrants of all genders within EU borders.

Résumé

En Europe, les réfugiés, les demandeurs d’asile et les migrants sans papiers sont plus vulnérables à la victimisation sexuelle que les citoyens européens. Ils rencontrent davantage d’obstacles pour obtenir des soins. Cet examen des publications analyse comment les cadres juridiques et politiques aux niveaux national, européen et international conditionnent la prévention et le traitement de la violence sexuelle touchant ces communautés migrantes vulnérables qui vivent dans l’Union européenne (UE). À l’aide de la méthode de synthèse interprétative critique, nous avons recherché des éléments sur la violence sexuelle dans 187 documents juridiques et politiques et 80 articles publiés dans des revues à comité de lecture sur la santé sexuelle des migrants. Parmi ces documents, nous avons également analysé les 37 articles juridiques et 12 articles de revues à comité de lecture qui traitaient spécifiquement de la violence sexuelle chez les migrants vulnérables dans les 27 pays de l’UE. Les documents politiques et juridiques abordant la violence sexuelle, en particulier, mais pas exclusivement chez les migrants vulnérables, appliquent une « vision étroite ». Ils ignorent : a) les types fréquents de violence sexuelle ; b) les taux de victimisation entre sexes ; et c) les facteurs spécifiques de risque au sein de l’UE, comme la situation juridique des migrants, leur orientation sexuelle et leurs conditions de vie. Actuellement, le paradigme politique de l’UE confine la violence sexuelle chez les migrants vulnérables à une question « extérieure » et « uniquement féminine », alors que les politiques de l’UE en matière de migrations et d’asile renforcent son invisibilité. Pour être opérante, la riposte doit être guidée par des politiques participatives à base factuelle et fondées sur les droits, et par une approche de santé publique, et elle doit reconnaître la réalité et la multiplicité de la victimisation sexuelle des migrants vulnérables de tous les sexes au sein des frontières de l’UE.

Resumen

En Europa, refugiados, solicitantes de asilo y migrantes indocumentados son más vulnerables a la persecución sexual que la ciudadanía europea. Enfrentan más retos cuando buscan atención médica. Esta revisión de la literatura examina cómo los marcos jurídicos y políticos a nivel nacional, europeo e internacional condicionan la prevención de y respuesta a la violencia sexual que afecta a estas comunidades de migrantes vulnerables que viven en la Unión Europea (UE). Aplicando el método de Síntesis Interpretativa Crítica, revisamos 187 documentos jurídicos y políticos y 80 artículos revisados por pares sobre la salud sexual de migrantes, en busca de elementos de violencia sexual; de estos, analizamos los 37 artículos jurídicos y 12 artículos revisados por pares enfocados específicamente en violencia sexual contra migrantes vulnerables en la UE-27 Estados. Los documentos jurídicos y políticos que tratan sobre violencia sexual, particular pero no exclusivamente en migrantes vulnerables, aplican la ‘visión de túnel’. Hacen caso omiso de: a) los tipos de violencia sexual que ocurren con frecuencia, b) las tasas de persecución de todos los géneros c) factores de riesgo específicos en la UE, tales como el estatus legal, orientación de género y condiciones de vida de cada migrante. El paradigma de formulación de políticas de la UE relega la violencia sexual en migrantes vulnerables como un asunto de ‘extranjeros’ y ‘mujeres únicamente’, mientras que las políticas de migración y asilo de la UE reafirman su invisibilidad. Una respuesta eficaz debe ser guiada por políticas participativas basadas en derechos y evidencia y un enfoque en salud pública, reconociendo la ocurrencia y multiplicidad de la persecución sexual de migrantes vulnerables de todos los géneros dentro de las fronteras de la UE.

  

Full article at:    http://goo.gl/JRNwgS

By:   

Ines Keygnaert, 

 Aurore Guieu

International Centre for Reproductive Health (ICRH)

Ghent University

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

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.

Purchase full article at:   http://goo.gl/fAyLXk

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.  

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Complex Routes into HIV Care for Migrant Workers: A Qualitative Study from North India

Migrant workers are designated a bridge population in the spread of HIV and therefore if infected, should be diagnosed and treated early. This study examined pathways to HIV diagnosis and access to care for rural-to-urban circular migrant workers and partners of migrants in northern India, identifying structural, social and individual level factors that shaped their journeys into care. 

We conducted a qualitative study using in-depth interviews with HIV-positive men (n = 20) and women (n = 13) with a history of circular migration, recruited from an antiretroviral therapy centre in one district of Uttar Pradesh, north India. Migrants and partners of migrants faced a complex series of obstacles to accessing HIV testing and care. Employment insecurity, lack of entitlement to sick pay or subsidised healthcare at destination and the household's economic reliance on their migration-based livelihood led many men to continue working until they became incapacitated by HIV-related morbidity. 

During periods of deteriorating health they often exhausted their savings on private treatments focused on symptom management, and sought HIV testing and treatment at a public hospital only following a medical or financial emergency. Wives of migrants had generally been diagnosed following their husbands' diagnosis or death, with access to testing and treatment mediated via family members. For some, a delay in disclosure of husband's HIV status led to delays in their own testing. Diagnosing and treating HIV infection early is important in slowing down the spread of the epidemic and targeting those at greatest risk should be a priority. 

However, despite targeted campaigns, circumstances associated with migration may prevent migrant workers and their partners from accessing testing and treatment until they become sick. The insecurity of migrant work, the dominance of private healthcare and gender differences in health-seeking behaviour delay early diagnosis and treatment initiation.

Below:  Routes to HIV diagnosis for migrant men and wives of migrant men. (a) Dominant pathway to testing for migrant men. (b) Dominant pathway to testing for wives of migrant men.

Below:  The structural, social and individual factors delaying HIV diagnosis and access to care for HIV-positive migrant workers and their partners.

Full article at:   http://goo.gl/hCnj5x

By:   Rai T¹, Lambert HS², Ward H¹.

¹a School of Public Health , Imperial College London , London , UK.

²b School of Social and Community Medicine , University of Bristol , Bristol , UK.

 

More at:  https://twitter.com/hiv_insight

And: http://twitter.com/Prison_Health