Wanting to or having to - a qualitative study of experiences and attitudes towards migrant screening for tuberculosis in Norway.

BACKGROUND: This study assesses how tuberculosis (TB) screening is perceived by immigrants in Norway. Screening is mandatory for people arriving from high incidence countries. To attend screening, immigrants have to contact the health system after receiving an invitation by letter. The proportion of non-attenders is not known, and there are no sanctions for not attending. Generally, only persons who test positive receive test results. The study explores users' experiences, attitudes and motivations for attending or not attending TB screening, and perceived barriers and enablers. METHODS: We conducted six focus group discussions and three individual interviews with 34 people from 16 countries in Africa, Asia and Europe. Interviews were recorded and transcribed, and data was coded following a general inductive approach: All transcribed text data was closely read through, salient themes were identified and categories were created and labelled. The data was read through several times and the category system was subsequently revised. RESULTS: Most appreciated the opportunity to be tested for a severe disease and were generally positive towards the healthcare system. At the same time, many were uncomfortable with screening, particularly due to the fear and stigma attached to TB. All experienced practical problems related to language, information, and accessing facilities. Having to ask others for help made them feel dependent and vulnerable. Positive and negative attitudes simultaneously created ambivalence. Many wanted "structuring measures" like sanctions to help attendance. Many said that not receiving results left them feeling anxious. CONCLUSIONS: In order to adapt the system and improve trust and patient uptake, all aspects of the screening should be taken into account. Ambivalence towards screening probably has a negative impact on screening uptake and should be sought reduced. A combination of ambivalence and a wish for "structuring measures" leads the authors to conclude that mandatory screening is a reasonable measure. However, since mandatory screening negatively impacts patient autonomy, and because of fear, stigma and practical problems, the health system should empower users by improving communication and access to services. In addition, it is recommended that negative test results are also communicated to the users.

[How to combat HIV, tuberculosis and malaria?]. / Hvordan bekjempe hiv, tuberkulose og malaria?

BACKGROUND: In year 2 000, the United Nations (UN) agreed on eight millennium development goals (MDGs). Goal number 6 is to combat HIV/AIDS, malaria and other communicable diseases, including tuberculosis. The aim of this paper is to provide an overview of current status and prognosis for this MDG, and to discuss strategies that need to be implemented to reach the goal. MATERIAL AND METHODS: The article is mainly based on publications from the UN or WHO-affiliated organizations. RESULTS: The global HIV prevalence rate has remained at 0.8 % for the last ten years, but the total infected population is still increasing. Access to treatment has increased considerably, but only 28 % of those in need of treatment (and living in developing countries), received it in 2007. Global tuberculosis incidence and prevalence rates of tuberculosis are falling, but not in Europe and Africa. For malaria, there is more uncertainty, but there seems to be a declining incidence in many countries. INTERPRETATION: The MDG for HIV/AIDS cannot be reached by treatment alone, continued emphasis on prevention and more specific prevention strategies is necessary. The global targets for tuberculosis can be reached, but probably not in Africa; in addition, multi-resistant tuberculosis is increasing. Modern combination treatment, impregnated bednets and indoor residual spraying has led to a substantial reduction in the prevalence of malaria during few years in African countries.

[The HIV-pandemic in the third world--worse than anticipated?]. / Hivepidemien i den tredje verden--verre enn forventet?

BACKGROUND: The first AIDS cases were discovered 25 years ago in the United States. We describe how the epidemic evolved in the Third World, with emphasis on the current situation and on the African continent, which is most affected. METHODS: The present review article is based on a literature review and own working experience. RESULTS AND INTERPRETATION: In 2005, more than 90 % of HIV-infected persons lived in Third World countries, mainly Africa and Asia. Transmission in Africa is mainly heterosexual and approximately 60 % of the infected are women. Asia has epidemics among intravenous drug users and men who have sex with men, and among sex workers and their customers. Several Asian countries now have generalized epidemics. Urban populations are more affected than rural ones in all geographical areas of the world, with only a few exceptions. Modern HIV treatment saves many lives, but only an increase of preventive measures can reverse the current trends. To obtain a reversal, it is adamant with broad mobilization of affected populations, clear political leadership and prioritisation and a considerable increase in help from developed countries.