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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

HIV and population movementsShort & Long term migration and travelling

EleniKakalou, MD, MSc

Athens, January 2012

moving away from established links
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)
access to diagnosis care
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
gender issues sexual concurrency
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)
reasons for no uptake of testing care services
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
the host environment
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

tailored approaches to various needs
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
approaches for various sub groups
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

special needs when in care
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
sources
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