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Owusu MW, Krankowska DC, Lourida P, Weis N. Late HIV diagnosis among migrant women living in Europe - a systematic review of barriers to HIV testing. IJID REGIONS 2023; 7:206-215. [PMID: 37128290 PMCID: PMC10148112 DOI: 10.1016/j.ijregi.2023.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 05/03/2023]
Abstract
Objectives HIV transmission persists in Europe, with migrants accounting for over two-fifths of new diagnoses. Over half of all women in Europe are diagnosed late - particularly migrant women. Therefore, an updated understanding of migrant women's needs is crucial to inform inclusive and relevant HIV research, services, and policies. Methods A systematic review relating to factors influencing late HIV diagnoses among migrant women living in Europe in 2011-2021 was conducted, based on data from 12 papers relating to 13 European Union (EU) countries and three non-EU countries. Results The studies revealed a range of individual, sociocultural, and structural barriers to HIV diagnosis. Individual barriers included low perceived risk of HIV, lack of knowledge about HIV symptoms and HIV services, lack of trust in healthcare systems, and fear of societal implications of an HIV diagnosis. Sociocultural barriers included language and communication challenges, stigma, and lack of community testing opportunities. Structural factors included poverty, poor living conditions, unclear legal rights, administrative barriers to healthcare access, and lack of testing opportunities. Conclusions Barriers varied according to resident country, healthcare system, and country/region of origin. The studies highlighted the importance of inclusive research and service design and development, to address the needs of migrant women and reduce inequalities, especially given the current climate in Europe and the everchanging patterns of migration.
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Affiliation(s)
| | - Dagny Clea Krankowska
- Department of Infectious and Tropical Diseases and Hepatology, Medical University of Warsaw, Warsaw, Poland
- Hospital for Infectious Diseases, Warsaw, Poland
| | - Panagiota Lourida
- Department of Infectious Diseases and HIV, Evaggelismos General Hospital, Athens, Greece
| | - Nina Weis
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Correspondence to: Prof Nina Weis, PhD, Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Kettegaard Alle 30, 2650 Hvidovre, Denmark, Tel: +45 2636 3881
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Vujcich D, Wangda S, Roberts M, Lobo R, Maycock B, Kulappu Thanthirige C, Reid A. Modes of administering sexual health and blood-borne virus surveys in migrant populations: A scoping review. PLoS One 2020; 15:e0236821. [PMID: 32745106 PMCID: PMC7398552 DOI: 10.1371/journal.pone.0236821] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 07/14/2020] [Indexed: 12/21/2022] Open
Abstract
There has been a growing number of sexual health and blood-borne virus (SHBBV) surveys specifically administered to migrant populations. The purpose of this scoping review is to collate available information about how SHBBV surveys have been administered in migrant populations and the effect that mode of administration has on data quality, reliability and other practical considerations, e.g. response rates (RR) and social desirability bias. A methodological framework for scoping reviews was applied. SHBBV survey studies administered to international migrants published since 2000 were included if they contained some description of mode of administration. Ninety one studies were identified for inclusion from Embase, Medline, Web of Science, Google Scholar and supplementary grey literature. 'Interview only' was the most common mode of administration (n = 48), predominately comprising face-to-face interviews. Thirty six studies reported data from 'self-completed' surveys only, with pen-and-paper being most common (n = 17). Few studies (n = 7) combined interview and self-completed methods of survey administration. Sixty one studies did not report (or only partially reported) RR or the data necessary to calculate RR. Of the studies that reported RR, most were missing other key information including method of recruitment, consent procedures and whether incentives were offered. Strengths and limitations of all administration modes are summarised. Guidelines to inform future SHBBV survey research in migrant populations are presented.
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Affiliation(s)
- Daniel Vujcich
- School of Public Health, Curtin University, Perth, Australia
- * E-mail:
| | | | - Meagan Roberts
- School of Public Health, Curtin University, Perth, Australia
| | - Roanna Lobo
- School of Public Health, Curtin University, Perth, Australia
| | - Bruce Maycock
- College of Medicine & Health, University of Exeter, Exeter, United Kingdom
| | | | - Alison Reid
- School of Public Health, Curtin University, Perth, Australia
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Fakoya I, Logan L, Ssanyu-Sseruma W, Howarth A, Murphy G, Johnson AM, Nardone A, Rodger AJ, Burns F. HIV Testing and Sexual Health Among Black African Men and Women in London, United Kingdom. JAMA Netw Open 2019; 2:e190864. [PMID: 30901043 PMCID: PMC6583286 DOI: 10.1001/jamanetworkopen.2019.0864] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 01/30/2019] [Indexed: 01/12/2023] Open
Abstract
Importance Black African adults are disproportionately affected by HIV in the United Kingdom. Many within this population acquire HIV after migration or are diagnosed late. Data are needed to inform targeted interventions to increase HIV testing and prevention in this population. Objective To inform future HIV prevention strategies by estimating diagnosed and undiagnosed HIV infection and measuring changes in HIV testing rates in black African adults in London, United Kingdom. Design, Setting, and Participants This cross-sectional study used a self-completed survey conducted from September 20 to December 3, 2016. Questionnaires were linked to an optional, anonymous oral fluid HIV test and compared with data from a previous survey (2004). Respondents were recruited from social and commercial venues frequented by black African adults in London. Of 2531 individuals approached in 63 venues, 752 agreed to participate. Data were analyzed initially in March 2017 (as part of internal reporting) and again in August 2018. Main Outcomes and Measures Self-reported HIV testing within the past 5 years; diagnosed and undiagnosed HIV prevalence. Logistic regression examined factors associated with HIV testing by sex. Results In total, 292 women (median [interquartile range] age, 31 [25.0-41.5] years) and 312 men (median [interquartile range] age, 35 [25.0-41.5] years) were included in the analysis. More than half of men (159 [51.0%]) and women (154 [52.7%]) had been tested for HIV in the past 5 years. In multivariable analysis, HIV testing was associated with a range of factors in both sexes, including health service attendance, time in the United Kingdom, and sexually transmitted infection diagnosis. Increases in HIV testing in the past 5 years were observed between 2004 and 2016 for both sexes. In the 2016 sample, 219 of 235 women (93.2%) and 206 of 228 men (90.4%) tested HIV negative. Among those testing positive, 56.3% of women (9 of 16) and 40.9% of men (9 of 22) self-reported as HIV negative or untested, indicating they were living with undiagnosed HIV. A fifth of women (20.7%) and 25.0% of men reported condomless last sex with a partner of different or unknown HIV status in the past year. Conclusions and Relevance Despite efforts to increase HIV testing, uptake in black African communities in London remains modest. This study identified a large fraction of undiagnosed infection-greater than other at-risk populations-suggesting that the prevention and care needs of this group are not adequately met.
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Affiliation(s)
- Ibidun Fakoya
- Institute for Global Health, University College London, London, United Kingdom
| | - Louise Logan
- HIV and STIs Department, Public Health England, London, United Kingdom
| | | | - Alison Howarth
- Institute for Global Health, University College London, London, United Kingdom
| | - Gary Murphy
- HIV and STIs Department, Public Health England, London, United Kingdom
| | - Anne M. Johnson
- Institute for Global Health, University College London, London, United Kingdom
| | - Anthony Nardone
- HIV and STIs Department, Public Health England, London, United Kingdom
| | - Alison J. Rodger
- Institute for Global Health, University College London, London, United Kingdom
- Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Fiona Burns
- Institute for Global Health, University College London, London, United Kingdom
- Royal Free London NHS Foundation Trust, London, United Kingdom
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Fakoya I, Álvarez-Del Arco D, Copas AJ, Teixeira B, Block K, Gennotte AF, Volny-Anne A, Bil JP, Touloumi G, Del Amo J, Burns FM. Factors Associated With Access to HIV Testing and Primary Care Among Migrants Living in Europe: Cross-Sectional Survey. JMIR Public Health Surveill 2017; 3:e84. [PMID: 29109072 PMCID: PMC5696579 DOI: 10.2196/publichealth.7741] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 06/28/2017] [Accepted: 06/28/2017] [Indexed: 12/31/2022] Open
Abstract
Background There is a heavy and disproportionate burden of human immunodeficiency virus (HIV) infection among migrant communities living in Europe. Despite this, the published evidence related to HIV testing, prevention, and treatment needs for migrants is sparse. Objective The aim of this study was to identify the factors associated with access to primary care and HIV testing among migrant groups living in Europe. Methods A Web-based survey (available in 14 languages) was open to all people aged 18 years and older, living outside their country of birth in the World Health Organization (WHO) European area. Community organizations in 9 countries promoted the survey to migrant groups, focusing on those at a higher risk of HIV (sub-Saharan Africans, Latin Americans, gay or bisexual men, and people who inject drugs). Multivariable analysis examined factors associated with access to primary care and previous history of an HIV test. Results In total, 559 women, 395 heterosexual men, and 674 gay or bisexual men were included in the analysis, and 68.1% (359/527) of women, 59.5% (220/371) of heterosexual men, and 89.6% (596/664) of gay or bisexual men had tested for HIV. Low perceived risk was the reason given for not testing by 62.3% (43/69) of gay or bisexual men and 83.3% (140/168) of women and heterosexual men who reported never having tested for HIV. Access to primary care was >60% in all groups. Access to primary care was strongly positively associated with living in Northern Europe compared with Southern Europe (women: adjusted odds ratio, aOR 34.56 [95% CI 11.58-101]; heterosexual men: aOR 6.93 [95% CI 2.49-19.35], and gay or bisexual men: aOR 2.53 [95% CI 1.23-5.19]), whereas those with temporary residency permits were less likely to have access to primary care (women: aOR 0.41 [95% CI 0.21-0.80] and heterosexual men: aOR 0.24 [95% CI 0.10-0.54] only). Women who had experience of forced sex (aOR 3.53 [95% CI 1.39-9.00]) or postmigration antenatal care (aOR 3.07 [95% CI 1.55-6.07]) were more likely to have tested for HIV as were heterosexual men who had access to primary care (aOR 3.13 [95% CI 1.58-6.13]) or reported “Good” health status (aOR 2.94 [95% CI 1.41-5.88]). Conclusions Access to primary care is limited by structural determinants such as immigration and health care policy, which varies across Europe. For those migrants who can access primary care and other health services, missed opportunities for HIV testing remain a barrier to earlier testing and diagnosis for migrants in Europe. Clinicians should be aware of these potential structural barriers to HIV testing as well as low perception of HIV risk in migrant groups.
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Affiliation(s)
- Ibidun Fakoya
- Centre for Sexual Health and HIV Research, Research Department of Infection and Population Health, University College London, London, United Kingdom
| | - Débora Álvarez-Del Arco
- National Centre of Epidemiology, Instituto de Salud Carlos III, Madrid, Spain.,Biomedical Research Network on Epidemiology and Public Health, Faculty of Political Science and Sociology, Universidad Complutense de Madrid, Madrid, Spain
| | - Andrew J Copas
- Centre for Sexual Health and HIV Research, Research Department of Infection and Population Health, University College London, London, United Kingdom
| | | | - Koen Block
- European AIDS Treatment Group, Brussels, Belgium
| | - Anne-Francoise Gennotte
- Department of Infectious Diseases, Centre Hospitalier Universitaire Saint-Pierre, Brussels, Belgium
| | | | - Janneke P Bil
- Department of Infectious Diseases Research and Prevention, Public Health Service of Amsterdam, Amsterdam, Netherlands.,Department of Internal Medicine, Division of Infectious Diseases, Center for Infection and Immunology Amsterdam, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Giota Touloumi
- Department of Hygiene, Epidemiology, and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Julia Del Amo
- National Centre of Epidemiology, Instituto de Salud Carlos III, Madrid, Spain.,Biomedical Research Network on Epidemiology and Public Health, Faculty of Political Science and Sociology, Universidad Complutense de Madrid, Madrid, Spain
| | - Fiona M Burns
- Centre for Sexual Health and HIV Research, Research Department of Infection and Population Health, University College London, London, United Kingdom.,Royal Free London National Health Service Foundation Trust, London, United Kingdom
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Abdissa HG, Lemu YK, Nigussie DT. HIV preventive behavior and associated factors among mining workers in Sali traditional gold mining site Bench Maji zone, Southwest Ethiopia: a cross sectional study. BMC Public Health 2014; 14:1003. [PMID: 25256947 PMCID: PMC4182769 DOI: 10.1186/1471-2458-14-1003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 09/22/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prevalence of HIV and other STI is high among migrant mining workers due to factors such as dangerous working conditions, only masculine identities existence, living away from families, desolate and in hospitable place. This makes them known to be HIV and STI vulnerable group in different part of the world. But, in Ethiopia they were not thought as at risk group yet. So the aim of this study is to assess magnitude of HIV preventive behaviours and associated factors among gold miners in Sali traditional gold mining site. METHODS A cross sectional study was conducted to assess HIV preventive behavior of the mining worker. The data were collected using interviewer administered structured questionnaire adapted from other related behavioural studies. The data was entered using EPI data version 3.1 and analyzed using SPSS version 17. Multiple logistic regression was used to assess relationship of HIV preventive behavior with constructs of health belief model. RESULTS A total of 393 respondents with response rate of 93.12% were participated. All of the study participants were male 393(100%), the mean age of the participant was 24.0 (± 5.13SD). Less than half of the respondents 187(47.6%) were engaged in HIV preventive behavior. Less than half (45.3%) of them have high perceived susceptibility to HIV/AIDS; majority (62.8%) of them has high perceived severity to HIV/AIDS. HIV preventive behavior is negatively associated with being in middle, higher and highest income [OR = 0.54, 95% CI: 0.21, 0.74], [OR = 0.40, 95% CI: 0.30, 0.98] and [OR = 0.39, 95% CI: 0.20, 0.77] respectively and positively associated with Completing secondary, tertiary school and self efficacy [OR = 2.66, 95% CI: 1.11, 6.41], [OR = 5.40, 95% CI: 1.54, 19] and [OR = 1.88, 95% CI: 1.18, 2.94] respectively. CONCLUSIONS The HIV preventive behavior of the mining worker was low. Being engaged in sexual intercourse with one sexual partner is very low, Consistent condom use among these mining workers was low. Income, educational status and self efficacy have significant effect on the HIV preventive behavior of mining workers. Thus this population group should be understood as at risk population at national level.
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Fernández-Balbuena S, de la Fuente L, Hoyos J, Rosales-Statkus ME, Barrio G, Belza MJ. Highly visible street-based HIV rapid testing: is it an attractive option for a previously untested population? A cross-sectional study. Sex Transm Infect 2013; 90:112-8. [PMID: 24234073 DOI: 10.1136/sextrans-2013-051234] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Given the shortage of community-based HIV testing initiatives in resource-rich countries not targeting most-at-risk populations, we aimed to evaluate whether a highly visible mobile programme promoting and offering rapid HIV testing in the street can attract persons at risk for infection who have never been tested. METHODS Between 2008 and 2011, the programme served 7552 persons in various Spanish cities who answered a brief questionnaire while awaiting their results. The factors associated with being tested for the first time were analysed using two logistic regression models, one for men who have sex with men (MSM) and the other for only heterosexual men (MSW) and women. RESULTS 3517 participants (47%) were first-time testers (24% of MSM, 56% of MSW and 60% of women). Among them, 22 undiagnosed HIV infections were detected with a global prevalence of 0.6% and 3.1% in MSM. Undergoing a first HIV test was independently associated with age <30, being from Spain or another developed country, lack of university education, having fewer partners, having had unprotected sex with casual partners and not having been diagnosed with a sexually transmitted infection. In heterosexuals, also with never injected drugs, and in MSM, with not being involved in the gay community. Among those tested for the first time, 22% had never thought of being tested and 62% decided to be tested when they passed by and noticed the programme, regardless of their previous intentions. CONCLUSIONS This community programme attracted a substantial number of persons previously untested and particularly hard to reach, such as those with low education and MSM who were least involved in the gay community. Programme visibility was a decisive factor for almost two of every three persons who had never been tested.
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Abstract
SUMMARYWe examined the uptake of HIV testing in black Africans living in England before the introduction of national testing guidelines. Analyses were conducted using data from an anonymous self-completed questionnaire linked to oral fluid samples to establish HIV status in black Africans attending community venues in England in 2004. Of 946 participants, 44% had ever been tested for HIV and 29% had been tested in the previous 24 months. Of those with undiagnosed HIV, 45% had previously had a negative HIV test. Almost a third of people tested in the UK had been at general practice. Uptake of HIV testing was not associated with perceived risk of HIV. These findings highlight the need for the implementation of national HIV testing guidelines in the UK, including the promotion of testing in general practice. Regular testing in black Africans living in the UK should be promoted regardless of their HIV test history.
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Kaai S, Bullock S, Burchell AN, Major C. Factors that affect HIV testing and counseling services among heterosexuals in Canada and the United Kingdom: an integrated review. PATIENT EDUCATION AND COUNSELING 2012; 88:4-15. [PMID: 22196985 DOI: 10.1016/j.pec.2011.11.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Revised: 10/01/2011] [Accepted: 11/26/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To examine factors that affect the utilization of HIV testing and counseling (HTC) services among heterosexual populations in Canada and the U.K. METHODS We conducted an integrated review of published and unpublished literature (1996-September 2010) using Scopus, OVID-EMBASE, CSA illumina, CINHAL, PROQuest, Web of Science, and Google. RESULTS Twenty-seven studies met the inclusion criteria. We identified and categorized the key factors into three broad categories depending on their source. Personal-related factors included socio-demographic characteristics, risk perception, illness, HIV-related stigma, level of HIV and testing knowledge, and culture. Provider-related factors included provider-recommended HIV testing, provision of culturally and linguistically appropriate services, and doctor-patient relationship. System-related factors included integrating HIV testing with other health care services, anonymity of testing services, suitability of testing venues, technical aspects of HIV testing, and funding for immigrant health services. CONCLUSION The findings from our review indicate that HTC behaviors of heterosexuals in the Canada and the U.K. are likely influenced by several unchangeable (socio-demographic characteristics) and amenable factors. There is need to step-up research to confirm whether these associations are causal using stronger research designs. PRACTICAL IMPLICATION: We have made several recommendations that could be used to improve existing services in Canada.
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Affiliation(s)
- Susan Kaai
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada.
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Lo YC, Wu PY, Hsieh CY, Chen MY, Sheng WH, Hsieh SM, Sun HY, Liu WC, Hung CC, Chang SC. Late Diagnosis of Human Immunodeficiency Virus Infection in the Era of Highly Active Antiretroviral Therapy: Role of Socio-behavioral Factors and Medical Encounters. J Formos Med Assoc 2011; 110:306-15. [DOI: 10.1016/s0929-6646(11)60046-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2009] [Revised: 02/17/2010] [Accepted: 05/16/2010] [Indexed: 11/25/2022] Open
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Griffiths C, Johnson AM, Fenton KA, Erens B, Hart GJ, Wellings K, Mercer CH. Attitudes and first heterosexual experiences among Indians and Pakistanis in Britain: evidence from a national probability survey. Int J STD AIDS 2011; 22:131-9. [PMID: 21464449 DOI: 10.1258/ijsa.2009.009496] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We compare attitudes, experiences of learning about sex and first intercourse among Indians (n = 393) and Pakistanis (n = 365) using a probability survey of Britain's general population aged 16-44 years conducted during 1999-2001 (n = 12,110). Higher proportions of Pakistanis (64.6%) and Indians (28.1%) reported religion as 'very important' versus 6.2% of other ethnicities. Pakistanis were more conservative in their attitudes, e.g. reporting premarital sex as wrong (adjusted odds ratios [AORs] for sociodemographic differences, 4.71 [men] and 6.59 [women]). Pakistanis were more likely to be married at first sex (AORs 6.2 [men] and 9.53 [women]), yet men were more likely than women to be in non-marital relationships at this time (69.4% versus 25.2%). Pakistani men and women and Indian women were more likely to report not using reliable contraception at first sex relative to others (AORs 2.33, 3.16 and 1.90, respectively). Pakistani and Indian women were more likely than others to report school lessons as their main source of sex education (AORs 2.23 and 1.77) and not discussing sex with their parents during adolescence (AORs 2.04 and 2.62). These unique data have implications for ensuring that sex and relationship education and health promotion messages are appropriately planned, targeted and delivered to benefit Pakistanis and Indians.
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Affiliation(s)
- C Griffiths
- Research Department of Infection and Population Health, University College London, London, UK.
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Factors associated with HIV testing among immigrants in Portugal. Int J Public Health 2010; 56:559-66. [DOI: 10.1007/s00038-010-0215-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2010] [Revised: 10/20/2010] [Accepted: 10/21/2010] [Indexed: 11/30/2022] Open
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Rocha CMF, Dias SF, Gama AF. Conhecimentos sobre o uso de contraceptivos e prevenção de DST: a percepção de mulheres imigrantes. CAD SAUDE PUBLICA 2010; 26:1003-12. [DOI: 10.1590/s0102-311x2010000500022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2009] [Accepted: 03/18/2010] [Indexed: 11/21/2022] Open
Abstract
A saúde sexual e reprodutiva representa uma das principais preocupações da Saúde Pública, pois afeta a saúde e o bem-estar dos indivíduos e compromete o nível social e econômico das sociedades. Muitos problemas relacionados à saúde sexual e reprodutiva são acentuados em grupos socialmente desfavorecidos, como os imigrantes. Esta investigação aprofunda o conhecimento de alguns aspectos sobre a saúde sexual e reprodutiva de imigrantes brasileiras e africanas em Portugal, particularmente em relação ao uso de métodos contraceptivos, infecções sexualmente transmissíveis e uso do preservativo. A coleta de dados se deu a partir da realização de grupos focais com mulheres imigrantes, em idade fértil, residentes em Portugal e provenientes do Brasil ou de Países Africanos de Língua Oficial Portuguesa. Os resultados permitem compreender as percepções e conhecimentos das participantes em relação às temáticas abordadas e determinar os aspectos a serem levados em conta para melhor atender suas necessidades de saúde sexual e reprodutiva.
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Manirankunda L, Loos J, Alou TA, Colebunders R, Nöstlinger C. "It's better not to know": perceived barriers to HIV voluntary counseling and testing among sub-Saharan African migrants in Belgium. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2009; 21:582-593. [PMID: 20030501 DOI: 10.1521/aeap.2009.21.6.582] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
This study explored perceptions, needs, and barriers of sub-Saharan African migrants in relation to HIV voluntary counseling and testing (VCT). Using an inductive qualitative methodological approach, data were obtained from focus group discussions. Results showed that participants were in principle in favor of VCT. However, they indicated that barriers outweighed advantages. Such barriers included fear of positive test results and its related personal and social consequences, lack of information, lack of preventive health behavior, denial of HIV risk, and missed opportunities. Limited financial resources were only a concern for some subgroups like young people, asylum seekers, and recent migrants. This study identified multiple and intertwined barriers to VCT from a community perspective. In order to promote VCT, interventions such as raising awareness through culturally sensitive education should be adopted at community level. At level of service provision, provider initiated HIV testing including target group tailored counseling should be promoted.
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Adler A, Mounier-Jack S, Coker R. Late diagnosis of HIV in Europe: definitional and public health challenges. AIDS Care 2009; 21:284-93. [DOI: 10.1080/09540120802183537] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- A. Adler
- a Department of Public Health and Policy , London School of Hygiene and Tropical Medicine , London , UK
| | - S. Mounier-Jack
- a Department of Public Health and Policy , London School of Hygiene and Tropical Medicine , London , UK
| | - R.J. Coker
- a Department of Public Health and Policy , London School of Hygiene and Tropical Medicine , London , UK
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Abstract
The number of new diagnoses of HIV in the UK is increasing, with most new diagnoses reported in men who have sex with men (MSM) and black African heterosexuals the later of whom usually acquire their infection abroad. Around 31 % of people infected with HIV in the UK are unaware of their diagnosis, and one in three are diagnosed for the first time with a CD4 count <200 cells/mm3 or with AIDS. Late diagnosis is the most important factor that explains most HIV-related causes of death in the UK. Strategies to increase HIV-testing include universal approaches in antenatal and STD clinics (known as genitourinary [GU] medicine clinics), but other opportunities for prompt diagnosis are often missed during secondary and primary consultations - even when patients present with HIV-related illnesses. Furthermore, a significant proportion of people with undiagnosed HIV who attend GU medicine clinics leave without being offered an HIV test or a diagnosis of HIV. Universal offer (opt-out testing) policies seem to work well - such as in the successful antenatal testing programme - but local strategies to increase HIV-testing and prompt diagnosis, such as training courses and rapid HIV-testing initiatives have met with varied success. New national guidelines for the UK have been published and, if successfully implemented, should help to address some of these issues.
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Affiliation(s)
- M Fisher
- Brighton and Sussex University Hospitals, Eastern Road, Brighton BN2 5BE, UK
| | - V Delpech
- Consultant Epidemiologist and Head of National HIV Surveillance Centre for Infections, Health Protection Agency, UK
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Vermeer W, Bos AER, Mbwambo J, Kaaya S, Schaalma HP. Social and cognitive variables predicting voluntary HIV counseling and testing among Tanzanian medical students. PATIENT EDUCATION AND COUNSELING 2009; 75:135-140. [PMID: 18951747 DOI: 10.1016/j.pec.2008.08.022] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2008] [Revised: 08/19/2008] [Accepted: 08/30/2008] [Indexed: 05/27/2023]
Abstract
OBJECTIVE The present study aimed to predict Tanzanian medical students' Voluntary Counseling and Testing (VCT) participation intention using the Health Belief Model (HBM) as a theoretical framework. Further, differences between respondents who had previously participated in VCT and respondents who had not were assessed. METHODS Cross-sectional data were gathered from 186 Tanzanian medical students using a self-administered questionnaire. RESULTS Almost half of the respondents (43.3%) reported having been tested for HIV. A prediction model containing HBM and demographic variables explained 31% of the variance in VCT-participation intention. Self-efficacy, fear of being HIV-positive, and perceived susceptibility contributed significantly to the final regression model. In addition, respondents who had previously participated in VCT expressed less fear of being stigmatized and being HIV-positive than respondents who had not. CONCLUSION Fear of being HIV-positive, self-efficacy, perceived susceptibility and fear of being stigmatized were associated with either VCT-participation intention or previous participation. Further, the HBM accounted for a limited proportion of the explained variance in Tanzanian students' intention to participate in VCT. This suggests that the validity of the HBM in explaining HIV-preventive behavior in Sub-Saharan Africa should be questioned. PRACTICE IMPLICATIONS Interventions promoting VCT should incorporate program elements targeting self-efficacy, fear of being HIV-positive, perceived susceptibility and fear of being stigmatized.
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Prácticas sexuales de chicos y chicas españoles de 14-24 años de edad. GACETA SANITARIA 2008; 22:511-9; discussion 519. [DOI: 10.1016/s0213-9111(08)75347-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Missed opportunities for earlier HIV diagnosis within primary and secondary healthcare settings in the UK. AIDS 2008; 22:115-22. [PMID: 18090399 DOI: 10.1097/qad.0b013e3282f1d4b6] [Citation(s) in RCA: 137] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To identify opportunities for earlier HIV diagnosis within primary and secondary care settings in the UK in Africans with newly diagnosed HIV infection. METHODS A survey of newly diagnosed HIV-positive Africans attending 15 HIV treatment centres across London was conducted between April 2004 and February 2006. The survey consisted of a confidential self-completed questionnaire linked to clinician-completed clinical records. RESULTS A total of 263 questionnaires were completed, representing an uptake rate of 79.5% of patients approached and 49.8% (131/263) of participants presented with advanced HIV disease (CD4 cell count < 200 cells/mul at diagnosis). In the year prior to HIV diagnosis 76.4% (181/237) had seen their GP, 38.3% (98/256) had attended outpatient services, and 15.2% (39/257) inpatient services, representing missed opportunities for earlier HIV diagnosis. Of those attending GP services the issue of HIV and/or HIV testing was raised for 17.6% (31/176) and 37.1% (78/210) had a previous negative HIV test, 32.5% of these within the UK. Medical attention was sought for wide ranging reasons, often not obviously connected to underlying HIV status. Despite the population predominantly coming from countries of high HIV prevalence personal appreciation of risk was comparatively low and knowledge of benefits of testing lacking. CONCLUSION Africans are accessing health services but clinicians are failing to use these opportunities effectively for preventive and diagnostic purposes with regards to HIV infection. Comparatively low appreciation of personal risk and lack of perceived ill health within this community means clinicians need to be more proactive in addressing HIV.
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Sadler KE, McGarrigle CA, Elam G, Ssanyu-Sseruma W, Davidson O, Nichols T, Mercey D, Parry JV, Fenton KA. Sexual behaviour and HIV infection in black-Africans in England: results from the Mayisha II survey of sexual attitudes and lifestyles. Sex Transm Infect 2007; 83:523-9. [PMID: 17932129 PMCID: PMC2598650 DOI: 10.1136/sti.2007.027128] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2007] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To estimate HIV prevalence and the distribution of high risk sexual behaviours, sexual health service use, and HIV testing among black Africans aged 16 years or over in England. To determine demographic, behavioural and service use factors associated with HIV prevalence. METHODS A cross-sectional community-based survey (Mayisha II) in London, Luton and the West Midlands. A short (24-item) anonymous self-completion questionnaire with linked voluntary anonymous oral fluid sampling, using an Orasure device for HIV testing. RESULTS A total of 1359 eligible black African men (51.9%) and women (48.1%) were recruited, of whom 74% (1006) provided a sufficient oral fluid sample for HIV testing. 42.9% of men and 50.9% of women reported ever having had an HIV test. Overall, 14.0% (141, 95% CI 11.9 to 16.3) of respondents tested HIV positive (13.1% of men and 15.0% of women); 9.2% (93) had undiagnosed HIV infection, while 4.8% (48) had a diagnosed HIV infection. HIV prevalence was significantly higher in men: born in East Africa; who had had a previous STI diagnosis; or who were recruited in bars and clubs; and in women: born in East or Southern Africa; aged 25 years and over; who had had two new sexual partners in the past 12 months; or who had had a previous STI diagnosis. CONCLUSIONS Despite about half the sample having had an HIV test at some time in the past, 9.2% of respondents had an undiagnosed HIV infection. This study supports current policy efforts to further promote HIV testing and serostatus awareness.
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Affiliation(s)
- K E Sadler
- Health Protection Agency Centre for Infections, London, UK.
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Prost A, Sseruma WS, Fakoya I, Arthur G, Taegtmeyer M, Njeri A, Fakoya A, Imrie J. HIV voluntary counselling and testing for African communities in London: learning from experiences in Kenya. Sex Transm Infect 2007; 83:547-51. [PMID: 17911136 PMCID: PMC2598659 DOI: 10.1136/sti.2007.027110] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2007] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To explore the feasibility and acceptability of translating a successful voluntary counselling and testing (VCT) service model from Kenya to African communities in London. METHODS Qualitative study with focus group discussions and a structured workshop with key informants. Five focus group discussions were conducted in London with 42 participants from 14 African countries between August 2006 and January 2007. A workshop was held with 28 key informants. Transcripts from the group discussions and workshop were analysed for recurrent themes. RESULTS Participants indicated that a community-based HIV VCT service would be acceptable to African communities in London, but also identified barriers to uptake: HIV-related stigma, concerns about confidentiality, and doubts about the ability of community-based services to maintain professional standards of care. Workshop participants highlighted three key requirements to ensure feasibility: (a) efficient referrals to sexual health services for the newly diagnosed; (b) a locally appropriate testing algorithm and quality assurance scheme; (c) a training programme for VCT counsellors. CONCLUSIONS Offering community-based VCT with rapid HIV tests appears feasible within a UK context and acceptable to African communities in London, provided that clients' confidentiality is ensured and appropriate support is given to the newly diagnosed. However, the persistence of concerns related to HIV-related stigma among African communities suggests that routine opt-out testing in healthcare settings may also constitute an effective approach to reducing the proportion of late diagnoses in this group. HIV service models and programmes from Africa constitute a valuable knowledge base for innovative interventions in other settings, including developed countries.
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Affiliation(s)
- A Prost
- MRC Social & Public Health Sciences Unit, Glasgow, Scotland, UK.
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Abstract
There have been major efforts to improve the application of statistical methods in medical research, although some errors and misconceptions persist. In this paper I will review some of the topics which most often cause problems: a) comparison of two methods of clinical measurement; b) comparison of baseline values between arms of a randomized trial; c) absence of evidence as opposed to evidence of absence; and d) regression to the mean. I will also revisit a statistical error in one of my own publications. I review some causes of the continuing misuse of statistics, and make some suggestions for modifying the education of statistical and non-statistical medical researchers in order to alleviate this.
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Burns FM, Imrie JY, Nazroo J, Johnson AM, Fenton KA. Why the(y) wait? Key informant understandings of factors contributing to late presentation and poor utilization of HIV health and social care services by African migrants in Britain. AIDS Care 2007; 19:102-8. [PMID: 17129864 DOI: 10.1080/09540120600908440] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The majority of new HIV diagnoses in the UK occur in people with heterosexually acquired HIV infection, the majority of whom are migrant Africans. In the UK HIV positive Africans access HIV services at a later stage of disease than non-Africans (Burns et al., 2001; Sinka et al., 2003). Employing purposive sampling techniques, semi-structured interviews were conducted with key informants to identify the key issues affecting utilization of HIV services for Africans in Britain. Considerable agreement about the major issues influencing uptake of HIV services existed amongst the key informants. Respondents felt there was high HIV awareness but this did not translate into perception of individual risk. Home country experience and community mobilization was highly influential on HIV awareness, appreciation of risk, and attitudes to health services. Institutional barriers to care exist; these include lack of cultural understanding, lack of open access or community clinics, failure to integrate care with support organizations, and the inability of many General Practitioners to address HIV effectively. Community involvement should include input to ensure there is: better cultural understanding within the health care system; normalization of the HIV testing process; and a clear message on the effectiveness of therapy.
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Affiliation(s)
- F M Burns
- Centre for Sexual Health and HIV Research, University College London.
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Abstract
In the UK, substantial numbers of new HIV diagnoses are within migrant communities, especially African communities. Current surveillance shows that despite health promotion efforts and advances in therapy these communities are accessing HIV care late. This paper explores the issues influencing the access and uptake of HIV care by migrant Africans in Britain. Using Kleinman's model of health care systems (Kleinman, 1980) as a theoretical framework, we highlight the importance of placing health within its broader context if we are to make significant improvement to the health of HIV-infected Africans in Britain.
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Affiliation(s)
- Fiona Burns
- Centre for Sexual Health & HIV Research, Departments of Primary Care and Population Sciences, Royal Free and University College Medical School, Mortimer Market Centre, London, UK.
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