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HIV and population movements Short & Long term migration and travelling

HIV and population movements Short & Long term migration and travelling. Eleni Kakalou , MD, MSc Athens, January 2012. Moving away from established links. Loss of cultural norms, taboos, societal control Loss of family & social support Social vulnerability to the host environment

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HIV and population movements Short & Long term migration and travelling

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  1. HIV and population movementsShort & Long term migration and travelling EleniKakalou, MD, MSc Athens, January 2012

  2. Moving away from established links • Loss of cultural norms, taboos, societal control • Loss of family & social support • Social vulnerability to the host environment • Loss of steady sexual partners • Access to preventive & care services (cultural, legal, financial & perception barriers) • Perception of risk & ‘’bargaining’’ safer sex capacity • Internal migration, travelling to visit friends- family, expatriates, military personnel, sex tourism, sexual industry all play a pivotal role in the dynamics of the HIV epidemic • Prevalence rates may reflect the risk up-taking in the host country rather than that of origin (both ways South-North direction)

  3. Access to diagnosis & care • 87% of black men, 85% of Whites and 84% of Carribbean origin with known HIV infection receive ARTs • In France foreign born pregnant women showed similar up take of HIV testing and showed the same results once in clinical care • 40-70% of MTCT cases in EU27 are found among babies born to non native mothers

  4. Late diagnosis

  5. Gender issues & sexual concurrency • Migrant women disproportionately affected by HIV • Gender imbalances, inability to bargain safer sex • Sexual concurrency and its contribution to HIV spread (in Norway concurrent sexual contacts were 16.5% among migrants vs 9% among natives)

  6. Reasons for no uptake of testing & care services • Legal (no papers, fear of expulsion) • Social (marginalized, lower social status) • Cultural (cultural insensitivity, institutional racism) • Poor Communication (linguistic & cultural issues) • Risk perception • Gender issues • Knowledge, attitudes & health seeking behavior

  7. The host environment • 25-35% of heterosexual migrants LWHA* have acquired HIV infection in UK • 50% of MSM migrants LWHA* have acquired HIV infection in UK • 77% of LWHA* migrants in Italy have acquired HIV infection in the host country • 40-70% of MTCT** occurs among babies born to migrant women (sentinel event) • 30% of expats (US Peace Corps, 1080 participants) reported using condom with local partner in high prevalence countries • 25% of German expats reported condom use with local partners *LWHA=Living With HIV & AIDS **MTCT=Mother to Child Transmission

  8. Tailored approaches to various needs Not all migrants are the same • Ethnicity • Gender • Age • Sexual orientation • Substance abuse • Education • Degree of integration • Legal and work status

  9. Approaches for various sub-groups • Provider initiated testing (opt-out) • Counseling, education and testing outside health care setting (POC* testing) • Culturally sensitive, non-judgmental attitudes • Community involvement & empowerment • NGO involvement • Cultural mediation • Social support services • Clinical care at community settings * POC=Point of Care

  10. Special needs when in care • Perception of risk, vulnerability and life expectations • Socio-economic context • Substance abuse patterns • Parenthood expectations • Ethical and emotional considerations • Sexual practices & taboos • Social & self-stigmatization • Attitudes to health and clinical care services • Misconceptions and disbeliefs • Use of alternative medicine approaches

  11. Sources Suligoi B., Guliani M. Le Malattie Sessualmente Trasmesse e l’infezione da HIV. In Il Medico ed il Paziente Immigrato (a cura di Pasini W.), 1996: 113-122 Moore J., Beeker C., Harrison J.S., Eng T.R., Doll L.S. HIV risk behaviour among Peace Corps Volunteers. AIDS, 1995; 9: 795-9 HouwelingH, De Grave A, Smits SP, et al. HIV infections, needles, ticks and sexual behavior among Deutch expatriates in subSaharan Africa. In: Lobel HO, Steffen R, Kozarsky PE, eds. Travel medicine 2. Proceedings of the Second Conference on International Travel Medicine, Atlanta, GA, May 12-19, 1991. International Society of Travel Medicine, 1992: 204-206. BonneauxL, van der Suyft P, Tallman H et al. Risk factors for HIV infections among Europeans expatriates in Africa. BMJ 1988; 297:581-584. HPA. Migrant health Infectious diseases in non-UK populations in the UK. An update to the baseline report-2011 FRA. Fundamental Rights of migrants in irregular situations in the European Union ECDC TECHNICAL REPORT. Migrant health: Access to HIV prevention, treatment and care for migrant populations in EU/EEA countries-2009 MG van Veen. Concurrent sexual partenerships & and risk taking among African and Carribean migrants. Int J STD & AIDS

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