Social construction of risk and prevention practices related to Aedes mosquito-borne disease in an endemic municipality in Colombia.

INTRODUCTION: This article analyzes risk discourses around dengue, zika and chikungunya constructed by lay people, community leaders and disease control experts from the fields of medical anthropology, medical sociology, and public health. METHODS: A qualitative ethnographic study was conducted in a municipality in Colombia (December 2016 and January 2018) with semistructured and open-ended interviews, informal dialogues, and fieldwork journal observations. RESULTS: This study found a mismatch in risk discourse about vector-borne diseases among health officials, lay people, and community leaders. These discourses are linked to the sociocultural contexts in which people live, and offer particular ways of giving meaning and acting in the face of disease prevention. CONCLUSION: The findings show a multisituated risk that refers to the inside and outside of homes; and the prevention practices mentioned by different actors, in which a continuity of tensions between lay people, leaders and government officials can be observed.

Venezuelan migrants and access to contraception in Colombia: A mixed research approach towards understanding patterns of inequality.

BACKGROUND: Migration should not put at risk the achievements of SDG 3: Universal Access to Sexual and Reproductive Healthcare, particularly access to contraceptive methods for Venezuelan migrants in receiving countries such as Colombia. Each year, more than 2 million men and women have access to modern contraceptive methods in Colombia. However, amid the pandemic, disruptions in supply chains, the interruption of essential services for sexual and reproductive health, and social inequalities may jeopardize these gains in contraception among Venezuelan migrants and refugees. The measurement of inequalities focuses on identifying the epicenter of inequity that is particularly relevant within the humanitarian response under strain. The objective of this article is to identify inequalities in access to contraception services among the migrant and refugee populations in six cities that concentrate 70% of the Venezuelan migration into Colombia and to discuss the challenges they represent for future emergencies. METHODS AND FINDINGS: We used a cross-sectional, descriptive study that included a mixed research approach (quantitative and qualitative analyses) based on three activities: i) analysis of contraceptive care records for the period 2018-2019; ii) measurement of inequalities in access to contraceptive services, and iii) design and implementation of twelve focus groups among Venezuelan migrants and refugees for discussion. RESULTS: Despite the evidence of a 70% increase in the use of contraceptive services among Venezuelan migrants between 2018 and 2019, there are absolute and relative inequalities in access to contraceptive methods both in the migrant and refugee populations versus the host population. The inequalities are mainly explained by the demographic dependency rate and the lack of job opportunities. CONCLUSIONS: The provision of essential sexual and reproductive health services to migrant and host populations must be regular, continuous, and shielded so that under no circumstances is it interrupted neither for infectious disease outbreaks to climate change emergencies in the future.

Uso de servicios de salud y enfermedades transmisibles de la población migrante y refugiada venezolana / Use of health services and communicable diseases of the Venezuelan migrant and refugee population

Resumen Introducción: Colombia es el principal país receptor de población migrante venezolana. Esto ha implicado identificar las necesidades en salud de esta población, como la atención y tratamiento de enfermedades infecciosas. Objetivo: Analizar el uso de servicios de salud relacionados con VIH/SIDA, malaria y hepatitis virales en migrantes y refugiados venezolanos en Colombia durante 2018 y 2019. Metodología: Estudio de investigación mixto. Se desarrollaron 12 grupos focales con mujeres y hombres venezolanos y se realizó un análisis del uso de servicios de salud por diagnósticos de VIH/SIDA, malaria y hepatitis virales, durante 2018 y 2019, en seis ciudades con un alto flujo de migración: Barranquilla, Bogotá, Cartagena, Cúcuta, Santa Marta y Riohacha. Resultados: El uso de servicios de salud por enfermedades infecciosas en migrantes venezolanos aumentó de 2018 (n=1,519) a 2019 (n=3,988). Los hombres fueron los que más usaron los servicios de salud por estas enfermedades. Aun así, la situación irregular migratoria, deficiencias en la atención primaria y acceso limitado a protección y detección temprana de enfermedades transmisibles, constituyen las principales barreras para migrantes y refugiados respecto a la atención en salud. Conclusiones: La migración expone a las personas al riesgo de contraer enfermedades infecciosas, así como a desigualdades y exclusión social en el acceso a servicios de salud para el control y tratamiento de estas enfermedades. Por ello, en contextos de migración se debe fortalecer la equidad en los servicios de salud con el fin de asegurar el acceso de las personas a la atención primaria, insumos, pruebas diagnósticas y tratamiento de enfermedades infecciosas.

Abstract Introduction: Colombia is the main receiving country of the Venezuelan migrant population. This has involved identifying the health needs of this population, such as the care and treatment of infectious diseases. Objective: To analyze the use of health services related to HIV/AIDS, malaria and viral hepatitis in Venezuelan migrants and refugees in Colombia during 2018 and 2019. Methodology: Mixed research study. Twelve focus groups were held with Venezuelan women and men and an analysis was made of the use of health services for HIV/AIDS, malaria, and viral hepatitis diagnoses during 2018 and 2019 in six cities with a high migration flow: Barranquilla, Bogotá, Cartagena, Cúcuta, Santa Marta, and Riohacha. Results: The use of health services for infectious diseases among Venezuelan migrants increased from 2018 (n=1.519) to 2019 (n=3.988). Men were the greatest users of health services for these diseases. Even so, irregular migration status, deficiencies in primary care, and limited access to protection and early detection of communicable diseases are the main barriers to health care for migrants and refugees. Conclusions: Migration exposes people to the risk of infectious diseases, as well as to inequalities and social exclusion in access to health services for the control and treatment of these diseases. Therefore, in migration contexts, equity in health services should be strengthened by ensuring people's access to primary care, inputs, diagnostic tests and treatment of infectious diseases.