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1.
AIDS Behav ; 23(9): 2514-2521, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31520239

RESUMO

To inform the development of interventions to increase uptake and adherence to antiretroviral therapy (ART), we explored perceptions of ART in semi-structured interviews with 52 men and women from UK black African and black Caribbean communities. Verbatim transcripts were analyzed using framework analysis. Perceptions of ART could be grouped into two categories: doubts about the personal necessity for ART and concerns about potential adverse effects. Doubts about necessity stemmed from feeling well, doubts about the efficacy of ART, religious beliefs and the belief that treatment was futile because it could not cure HIV. Concerns about adverse effects included the fear that attending HIV services and taking treatment would lead to disclosure of HIV, feeling overwhelmed at the prospect of starting treatment soon after diagnosis, fears about side effects and potential long-term effects, and physical repulsion. The findings will facilitate the development of interventions to increase uptake and adherence to ART.


Assuntos
Grupo com Ancestrais do Continente Africano/psicologia , Medo , Infecções por HIV/tratamento farmacológico , Adesão à Medicação/psicologia , Adulto , África ao Sul do Saara/etnologia , Grupo com Ancestrais do Continente Africano/etnologia , Região do Caribe/etnologia , Estudos Transversais , Revelação , Feminino , Infecções por HIV/psicologia , Humanos , Entrevistas como Assunto , Masculino , Adesão à Medicação/etnologia , Pessoa de Meia-Idade , Percepção , Pesquisa Qualitativa , Religião , Estigma Social , Reino Unido/epidemiologia
2.
Public Health ; 174: 134-144, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31369927

RESUMO

OBJECTIVE: This article presents empirical evidence on the quality of life (QoL) of Sub-Saharan African (SSA) migrants in Germany, exploring its association with subjective integration and the influence of some socio-economic and sociodemographic characteristics. STUDY DESIGN: This is a cross-sectional study design using quantitative data from 518 SSA migrants collected across the 16 federal states of Germany, and these data were analysed in this study. METHODS: Association between participants' QoL, measured by the four domains of the Bref version of the World Health Organisation QoL measure, subjective integration and sociodemographic characteristics were evaluated using Pearson product-moment correlations. Stepwise multiple linear regressions were performed to explore the contribution of predictor variables on the QoL domain. RESULTS: Participants' age averaged 32.5 years (standard deviation [SD] 7.93). The sample reported a low QoL score with a mean score of 64.3 (SD 14.4, range 70.2). Multiple linear regression analyses revealed that subjective integration, age, education and gender had significant associations and explained up to 27% of the variance in the QoL domain scores. CONCLUSION: The findings of this study support the conclusion that subjective integration positively and significantly associates with the physical health, psychological health, social relationships and environmental domains of SSA migrants' QoL in Germany.


Assuntos
Qualidade de Vida , Migrantes/psicologia , Adulto , África ao Sul do Saara/etnologia , Estudos Transversais , Pesquisa Empírica , Feminino , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Migrantes/estatística & dados numéricos , Adulto Jovem
3.
BMC Pregnancy Childbirth ; 19(1): 276, 2019 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-31382995

RESUMO

BACKGROUND: Implementation of high-quality national audits for perinatal mortality are needed to improve the registration of all perinatal deaths and the identification of the causes of death. This study aims to evaluate the implementation of a Regional Audit System for Stillbirth in Emilia-Romagna Region, Italy. METHODS: For each stillbirth (≥ 22 weeks of gestation, ≥ 500 g) occurred between January 1, 2014 to December 1, 2016 (n = 332), the same diagnostic workup was performed and a clinical record with data about mother and stillborn was completed. Every case was discussed in a multidisciplinary local audit to assess both the cause of death (ReCoDe classification) and the quality of care. Data were reviewed by the Regional Audit Group. Stillbirth rates, causes of death and the quality of care were established for each case. RESULTS: Total stillbirth rate was 3.09 per 1000 births (332/107,528). Late stillbirth rate was 2.3 per 1000 (251/107,087). Sixteen stillbirths were not registered by the Regional Birth Register. The most prevalent cause of death was placental disorder (33.3%), followed by fetal (17.6%), cord (14.2%) and maternal disorders (7.6%). Unexplained cases were 14%. Compared to local audits, the regional group attributed different causes of death in 17% of cases. At multivariate analysis, infections were associated with early stillbirths (OR 3.38, CI95% 1.62-7.03) and intrapartum cases (OR 6.64, CI95% 2.61-17.02). Placental disorders were related to growth restriction (OR 1.89, CI95% 1.06-3.36) and were more frequent before term (OR 1.86, CI95% 1.11-3.15). Stillbirths judged possibly/probably preventable with a different management (10.9%) occurred more frequently in non-Italian women and were mainly related to maternal disorders (OR 6.64, CI95% 2.61-17.02). CONCLUSIONS: Regional Audit System for Stillbirth improves the registration of stillbirth and allows to define the causes of death. Moreover, sub-optimal care was recognized, allowing to identify populations which could benefit from preventive measures.


Assuntos
Doenças Fetais/epidemiologia , Retardo do Crescimento Fetal/epidemiologia , Doenças Placentárias/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Qualidade da Assistência à Saúde , Natimorto/epidemiologia , Adulto , África ao Sul do Saara/etnologia , África do Norte/etnologia , Causas de Morte , Auditoria Clínica , Europa Oriental/etnologia , Feminino , Morte Fetal/etiologia , Humanos , Índia/etnologia , Itália/epidemiologia , Análise Multivariada , Morte Perinatal/etiologia , Gravidez , Complicações na Gravidez/epidemiologia , Fatores de Risco , Cordão Umbilical
4.
Int J Equity Health ; 18(1): 125, 2019 08 14.
Artigo em Inglês | MEDLINE | ID: mdl-31412853

RESUMO

BACKGROUND: Immigrants face barriers in accessing healthcare services in high-income countries. Inequalities in health and access to healthcare services among immigrants have been previously investigated. However, little is known on the sub-Saharan African immigrants' (SSA) access to the Norwegian healthcare system. METHODS: The study had a qualitative research design. We used the snowball technique to recruit participants from networks including faith-based organizations and cultural groups. Forty-seven qualitative in-depth interview and two focus group discussions with immigrants from sub-Saharan African were conducted from October 2017 to July 2018 in Oslo and its environs. Interviews were conducted in Norwegian, English or French, audio-recorded and transcribed verbatim into English. The analysis was based on a thematic approach, using NVivo software. Interview data were analyzed searching for themes and sub-themes that emerged inductively from the interviews. RESULTS: Our findings reveal barriers in two main categories when accessing the Norwegian healthcare services. The first category includes difficulties before accessing the healthcare system (information access, preference for doctors with an immigrant background, financial barriers, long waiting time and family and job responsibility). The second category includes difficulties experienced within the system (comprehension/expression and language, the black elephant in the room and dissatisfaction with healthcare providers). CONCLUSION: Healthcare is not equally accessible to all Norwegian residents. This ultimately leads to avoidance of the healthcare system by those most in need. Lack of seeking healthcare services by immigrants from Sub Saharan Africa may have significant implications for the long-term health of this group of immigrants. Therefore measures to address the issues raised should be prioritized and further examined.


Assuntos
Emigrantes e Imigrantes , Acesso aos Serviços de Saúde , Disparidades em Assistência à Saúde , Adolescente , Adulto , África ao Sul do Saara/etnologia , Feminino , Grupos Focais , Humanos , Linguagem , Masculino , Pessoa de Meia-Idade , Noruega , Aceitação pelo Paciente de Cuidados de Saúde , Pesquisa Qualitativa , Fatores Socioeconômicos , Adulto Jovem
5.
BMC Pregnancy Childbirth ; 19(1): 217, 2019 Jun 27.
Artigo em Inglês | MEDLINE | ID: mdl-31248386

RESUMO

BACKGROUND: In many Western countries, higher rates of cesarean have been described among migrant women compared to natives of receiving countries. We aimed to estimate this difference comparing women originating from France and Sub-Saharan Africa (SSA), identify the clinical situations explaining most of this difference and assess whether maternal origin was independently associated with cesarean risk. METHODS: The PreCARE prospective multicenter cohort study was conducted in 2010-2012 in the north Paris area. Our sample was restricted to 1500 women originating from Sub-Saharan Africa and 2206 from France. Profiles of cesarean section by maternal origin were described by the Robson classification. Independent associations between maternal origin and 1) cesarean before labor versus trial of labor, then 2) intrapartum cesarean versus vaginal delivery were assessed by logistic regression models to adjust for other maternal and pregnancy characteristics. RESULTS: Rates of cesarean for women originating from France and SSA were 17 and 31%. The Robson 5A category "unique uterine scar, single cephalic ≥37 weeks" was the main contributor to this difference. Within this category, SSA origin was associated with cesarean before labor after adjustment for medical risk factors (adjusted odds ratio [aOR] = 2.30 [1.12-4.71]) but no more significant when adjusting on social deprivation (aOR = 1.45 [0.63-3.31]). SSA origin was associated with cesarean during labor after adjustment for both medical and social factors (aOR = 2.95 [1.35-6.44]). CONCLUSIONS: The wide difference in cesarean rates between SSA and French native women is mainly explained by the Robson 5A category. Within this group, medical factors alone do not explain the increased risk of cesarean in SSA women.


Assuntos
Cesárea/estatística & dados numéricos , Migrantes/estatística & dados numéricos , Adulto , África ao Sul do Saara/etnologia , Cesárea/classificação , Feminino , França/epidemiologia , França/etnologia , Humanos , Trabalho de Parto/etnologia , Modelos Logísticos , Razão de Chances , Parto/etnologia , Gravidez , Estudos Prospectivos , Fatores de Risco
6.
East Mediterr Health J ; 25(4): 246-253, 2019 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-31210345

RESUMO

Background: Screenings for infectious diseases in asymptomatic immigrants currently takes place when receiving new arrivals. Aims: We describe the frequency of infections in a cohort of newly arrived asymptomatic immigrants in Southern Italy. Methods: We studied a cohort of 238 Sub-Saharan African and Asian men hosted at a reception centre (CARA) in Foggia between January and December 2015. The tuberculin skin test for diagnosis of latent tuberculosis infection (LTBI) and serology/virology testing for HBV, HCV, HIV were performed. Results: From this cohort, 205 individuals agreed to be tested for serological/virological markers only, while 82 agreed to be tested for LTBI only; 49 people agreed to have both tests. Among those tested for virological markers, 23/205 (11.2%) were HBsAg positive; 12/23 (52.2%) individuals had chronic active hepatitis; 77/205 (37.6%) individuals had only anti-HBc positivity. HCV infection was present in 8/205 (3.9%) individuals, and chronic HCV infection, was diagnosed in only two people. Only 2/205 (1.0%) individuals presented with anti-HIV and HIV-RNA positivity. We found LTBI in 29.6% of TB-tested individuals. Conclusions: Asymptomatic immigrants are at increased risk for some infections, mainly HBV and tuberculosis.


Assuntos
Doenças Transmissíveis/diagnóstico , Doenças Transmissíveis/etnologia , Emigrantes e Imigrantes , Programas de Rastreamento/estatística & dados numéricos , Adulto , África ao Sul do Saara/etnologia , Ásia/etnologia , Infecções por HIV/diagnóstico , Infecções por HIV/etnologia , Hepatite B/diagnóstico , Hepatite B/etnologia , Hepatite C/diagnóstico , Hepatite C/etnologia , Humanos , Itália/epidemiologia , Tuberculose Latente/diagnóstico , Masculino , Adulto Jovem
7.
Health Care Women Int ; 40(6): 665-681, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31084466

RESUMO

Sub-Saharan African immigrant (SSAI) men have significant influence on the health-seeking behavior including cervical cancer screening uptake by their female partners/wives. We conducted a qualitative descriptive study with 21 SSAI men to explore knowledge, perceptions, and support related to cervical screening. Participants were aged 36 ± 9 years, college educated (88%), and 53% have lived in the U.S. > 5 years. Three themes emerged; inadequate cervical cancer knowledge, willingness and strategies for support, and shared versus autonomous decision making for screening. Social structure with emphasis on male leadership could be leveraged in cervical cancer screening promotion for SSAI women.


Assuntos
Atitude Frente a Saúde/etnologia , Emigrantes e Imigrantes , Conhecimentos, Atitudes e Prática em Saúde , Cônjuges/psicologia , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/prevenção & controle , Esfregaço Vaginal , Adulto , África ao Sul do Saara/etnologia , Tomada de Decisões , Detecção Precoce de Câncer , Feminino , Humanos , Masculino , Homens/psicologia , Pessoa de Meia-Idade , Apoio Social , Estados Unidos/epidemiologia
8.
Rev Prat ; 69(2): 152-158, 2019 Feb.
Artigo em Francês | MEDLINE | ID: mdl-30983213

RESUMO

Management of uncomplicated malaria. Plasmodium falciparum malaria is a potentially severe imported tropical infection that should be systematically suspected in patients with fever returning from an endemic region, mainly sub-Saharan Africa. The diagnosis is based on the thin and thick film -possibly replaced by a rapid test-, the results of which must be reported within two hours. The recommendations for care were updated in 2017. The main advance is the positioning of artemisinin derivative- based combinations as first-line, given their rapidity of action and their effectiveness. Management is most often hospital based but criteria have been established for outpatient care provided that the close clinical and biological follow-up recommended at day 3, 7 and 28 is respected.


Assuntos
Malária , África ao Sul do Saara/etnologia , Antimaláricos , Combinação de Medicamentos , Febre , Humanos , Malária/diagnóstico , Malária/epidemiologia , Malária Falciparum
9.
Soins ; 64(834): 20-24, 2019 Apr.
Artigo em Francês | MEDLINE | ID: mdl-31023462

RESUMO

Since the emergence of the human immunodeficiency virus at the beginning of the 1980s, the epidemic has spread extensively in all regions of the world. In France, there is still a significant number of new contaminations each year, mainly among men having sexual relations with men and heterosexuals born in Sub-Saharan Africa. The prevention efforts targeting the most exposed populations must be continued.


Assuntos
Epidemias , Infecções por HIV/epidemiologia , África ao Sul do Saara/etnologia , Idoso , França/epidemiologia , Infecções por HIV/prevenção & controle , Heterossexualidade/estatística & dados numéricos , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Masculino
10.
Int J Equity Health ; 18(1): 59, 2019 04 24.
Artigo em Inglês | MEDLINE | ID: mdl-31014337

RESUMO

BACKGROUND: Immigrant populations face diverse barriers to accessing appropriate healthcare services on several levels. In the Basque Country, Sub-Saharan African women were identified as facing the largest barriers to access them. The aim of the study is to analyse Sub-Saharan African immigrant women's perceptions and experiences of access to appropriate healthcare in the public health system in the Basque Country, Spain. METHODS: Fourteen women from eight Sub-Saharan African countries who have used the Basque public healthcare services were interviewed. A qualitative content analysis was applied: meaning that units were identified, coded and the resulting codes were then organized into three categories. RESULTS: The first category, Fearing to enter a health system perceived as not friendly for immigrants, included factors, mainly those related to legal conditions for accessing healthcare services and lack of lawful documentation, that made women avoid or discontinue seeking out healthcare. The second category, Being attended on professionals' own communication terms, comprised how the lack of effective communication compromised not only the access of the immigrant women to healthcare services, but also their health. Lastly, the third category, Is mistreatment based on racism or merely on bad luck? described how being an immigrant and black influenced the way they were (mis)treated in the health system. CONCLUSION: For Sub-Saharan African immigrant women, accessing appropriate healthcare in the Basque Country was perceived to be subject to institutional barriers. At the legal level, barriers included lack of entitlement, difficulties in fulfilling legal access conditions and lack of documentation. The lack of communication with health centre staff and their attitudes, guided by a stereotyped social image of immigrants and black people, also hindered their possibilities of receiving appropriate healthcare. Facilitators for accessing healthcare included strategies from individual professionals, personal networks and social actors to help them to cope with the barriers. There is a need of reinforcing inclusion values and rights-based approach to attention among staff at the health centres to have more non-discriminatory and culturally appropriate health systems.


Assuntos
Atitude Frente a Saúde , Emigrantes e Imigrantes/psicologia , Acesso aos Serviços de Saúde , Saúde Pública , Adulto , África ao Sul do Saara/etnologia , Emigrantes e Imigrantes/estatística & dados numéricos , Feminino , Humanos , Pessoa de Meia-Idade , Pesquisa Qualitativa , Espanha
11.
Travel Med Infect Dis ; 29: 40-47, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30951905

RESUMO

BACKGROUND: Literature on health events in HIV-infected travellers is scarce, particularly in sub-Saharan African (SSA) migrants. METHODS: We investigated health events in HIV-infected SSA migrants living in France during and after travel to their native country. All had a pre-travel plasma viral load (pVL) below 200 copies/mL and were on stable combined antiretroviral therapy (cART). Logistic regression models were used to assess the risk factors for at least one adverse health event or febrile event. RESULTS: Among 264 HIV migrants, pre-travel median CD4 count was 439/mm3 and 27 migrants (6%) experienced a low-level viremia between 50 and 200 copies/mL. One hundred (38%) experienced at least one event (13 experienced two events). The most common events were gastrointestinal, including diarrhoea (n = 29, 26%), respiratory events (n = 20, 18%), and malaria (n = 17, 15%; 1 death). In multivariable analysis, a pre-travel low-level viremia and a lack of pre-travel medical advice significantly increased the risk for any event (OR 4.31, 95% CI, 1.41-13.1; and OR 3.62, 95% CI, 1.38-9.47; respectively). A lack of pre-travel advice significantly increased the risk for febrile event. CONCLUSIONS: Early and tailored counselling on pre-travel medical advice regarding diarrhoea and vector-borne diseases prophylactic measures in HIV-infected SSA migrants should be emphasised before travel to Africa.


Assuntos
Infecções por HIV/tratamento farmacológico , Migrantes/estatística & dados numéricos , Doença Relacionada a Viagens , África ao Sul do Saara/etnologia , Antirretrovirais/uso terapêutico , Febre/epidemiologia , França/epidemiologia , Gastroenteropatias/epidemiologia , Infecções por HIV/virologia , Humanos , Malária/epidemiologia , Malária/mortalidade , Doenças Respiratórias/epidemiologia , Fatores de Risco , Carga Viral
12.
BMC Int Health Hum Rights ; 19(1): 10, 2019 03 05.
Artigo em Inglês | MEDLINE | ID: mdl-30832665

RESUMO

BACKGROUND: Among all newly diagnosed HIV cases in Germany in 2015, 16% originated from sub-Saharan Africa. Twelve percent of these infections were contracted within Germany and migrants from sub-Saharan Africa (misSA) are diagnosed later than Germans. Migrants, specifically those without health insurance, face many barriers accessing health care due to their residence status and cultural, socio-economic, legal and linguistic barriers. We assessed whether misSAs' access to healthcare and utilization of HIV testing services depends on their health insurance status to inform prevention strategies. METHODS: From January 2015 to February 2016, we conducted a cross-sectional survey on knowledge, attitude, behavior, practice (KABP) regarding HIV, viral hepatitis and sexually transmitted infections among misSA in Germany. The survey was a community-based participatory research project; trained peer researchers recruited participants through outreach. To detect differences between participants with a regular health insurance card compared to asylum seekers with a medical treatment voucher or participants without health insurance or medical treatment voucher, unadjusted and adjusted Odds Ratios, chi-squared tests and 95% confidence intervals were calculated. RESULTS: A total of 1919 cases were considered. Overall, 83% had a health insurance card, 10% had a medical treatment voucher and 6% had no health insurance. Participants living in Germany for less than 5 years were less likely to have a health insurance card and more likely to have lower German language skills. Participants without health insurance visited a physician in case of health problems less often than participants with medical treatment voucher or a health insurance card (41.2% vs. 66.1% vs. 90%). Participants without health insurance reported less frequently visiting physicians or hospitals and were less likely to undergo a HIV test. CONCLUSION: Having no health insurance or medical treatment voucher decreased the odds of contact with the healthcare system more than other socio-demographic characteristics. Furthermore, misSA without health insurance had lower odds of ever having done an HIV test than participants with health insurance. To increase health care utilization and testing and to ensure adequate medical care, all migrants should get access to health insurance without increasing costs and consequences for residence status.


Assuntos
Pesquisa Participativa Baseada na Comunidade , Infecções por HIV/diagnóstico , Acesso aos Serviços de Saúde , Seguro Saúde/estatística & dados numéricos , Programas de Rastreamento , Migrantes/estatística & dados numéricos , Adulto , África ao Sul do Saara/etnologia , Estudos Transversais , Feminino , Alemanha , Conhecimentos, Atitudes e Prática em Saúde , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoas sem Cobertura de Seguro de Saúde , Aceitação pelo Paciente de Cuidados de Saúde , Inquéritos e Questionários
13.
BMC Infect Dis ; 19(1): 264, 2019 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-30885144

RESUMO

BACKGROUND: Tuberculosis (TB) is a major cause of death in HIV patients worldwide. Here we describe the epidemiology and outcome of HIV-TB co-infections in a high-income country with low TB incidence and integrated HIV and TB therapy according to European guidelines. METHODS: This study was based on the HIV cohort of the Helsinki University Hospital which includes all HIV patients in the Helsinki region with a population of 1.5 million. Totally, 1939 HIV-positives who have been under follow-up between 1998 and 2015 were included. RESULTS: TB was diagnosed in 53 (2.7%) of the HIV-patients. The TB incidence rate was higher in injecting drug users (IRR 3.15; 95% CI 1.33-7.52) and heterosexuals (IRR 3.46; 95% CI 1.64-7.29) compared to men having sex with men. The incidence rate was also higher in those born in Sub-Saharan Africa (IRR 3.53; 95% CI 1.78-7.03) compared to those born in Finland. There was a significant reduction in the total TB incidence rate of 59% per 6-year period between 1998 and 2015 (p < 0.001). In injecting drug users there was a reduction in incidence rate from 1182 to 88 per 100,000 (p < 0.001) and in people born in Sub-Saharan Africa from 2017 to 195 per 100,000 (p < 0.001). Among the 53 HIV-TB co-infected cases, one female and 15 males died during follow up. HIV was the primary cause of death in five patients but none of the deaths were caused by TB. CONCLUSION: The incidence rate of tuberculosis among HIV-positives in Finland has been declining between 1998 and 2015. Among injecting drug users, the reduction is probably explained by harm reduction interventions and care in comprehensive care centers in Helsinki. The increased coverage of antiretroviral therapy is probably another main reason for the decline in TB incidence rates. Despite good treatment results for both HIV and TB, the all-cause mortality among Finnish males with HIV-TB was high, and common causes of death were intoxications and suicides.


Assuntos
Infecções por HIV/epidemiologia , Tuberculose Pulmonar/epidemiologia , Adolescente , Adulto , África ao Sul do Saara/etnologia , Idoso , Criança , Pré-Escolar , Estudos de Coortes , Coinfecção , Feminino , Finlândia/epidemiologia , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Heterossexualidade , Homossexualidade Masculina , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Tuberculose Pulmonar/complicações , Adulto Jovem
14.
Artigo em Inglês | MEDLINE | ID: mdl-30901957

RESUMO

People born in sub-Saharan Africa and Southeast Asia are overrepresented in HIV notifications in Australia. Just under half of all notifications among people from sub-Saharan Africa and Southeast Asia are diagnosed late. Increased HIV testing among these communities is necessary to ensure early diagnosis, better care and reduce likelihood of HIV onward transmission. Recently, Australia has made new HIV testing methods available: rapid HIV testing and self-testing kits. We conducted 11 focus groups with 77 participants with people from sub-Saharan Africa, Southeast Asia and Northeast Asia in four jurisdictions in Australia. Focus groups discussed barriers to HIV testing and the acceptability of new testing methods. Barriers to HIV testing included: cost and eligibility of health services, low visibility of HIV in Australia, HIV-related stigma, and missed opportunities by general practitioners (GPs) for early diagnosis of HIV and linkage into care. Participants had low levels of knowledge on where to test for HIV and the different methods available. Diverse opportunities for testing were considered important. Interventions to increase HIV testing rates among sub-Saharan African, Southeast Asia and Northeast Asian migrants in Australia need to be multi-strategic and aimed at individual, community and policy levels. New methods of HIV testing, including rapid HIV testing and self-testing, present an opportunity to engage with migrants outside of traditional health care settings.


Assuntos
Infecções por HIV/diagnóstico , Infecções por HIV/etnologia , Migrantes/psicologia , Adolescente , Adulto , África ao Sul do Saara/etnologia , Ásia/etnologia , Austrália/epidemiologia , Feminino , Grupos Focais , Conhecimentos, Atitudes e Prática em Saúde , Homossexualidade Masculina/psicologia , Humanos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Estigma Social , Adulto Jovem
15.
AIDS Care ; 31(7): 897-907, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30709323

RESUMO

Migrants from sub-Saharan Africa (SSA) are often diagnosed at an advanced stage of HIV, and many of them have harsh living conditions. We aimed to evaluate the entry into care after HIV diagnosis and examine the related social determinants. The ANRS PARCOURS study is a life-event survey conducted in 2012-2013 in the Paris region among. Time between HIV diagnosis of SSA migrants living diagnosed HIV positive in France and HIV care and the determinants was assessed yearly by using mixed-effects logistic regression models. Among a total of 792 participants, 94.2% engaged in HIV care within the year of HIV diagnosis, 4.3% in the following year and 2.5% beyond the second year after diagnosis. The participants were more likely to engage in HIV care during years when they were effectively covered by health insurance and if the HIV test was carried out at the initiative of the doctor. Immigration for economic reasons or owing to threats in his/her country of origin was associated with delayed engagement in HIV care. Additionally, 4.3% of treated participants discontinued HIV care at least once at the time of the survey and more often if diagnosed at an advanced HIV disease stage and financially dependent.


Assuntos
Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Infecções por HIV/diagnóstico , Acesso aos Serviços de Saúde , Seguro Saúde , Qualidade da Assistência à Saúde , Migrantes/estatística & dados numéricos , Adulto , África ao Sul do Saara/etnologia , Grupo com Ancestrais do Continente Africano/etnologia , Emigração e Imigração , Feminino , França/epidemiologia , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Fatores Socioeconômicos , Inquéritos e Questionários
16.
Infection ; 47(3): 447-459, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30666616

RESUMO

OBJECTIVES: To evaluate ultrasound and praziquantel to, respectively, assess and reduce urogenital schistosomiasis (UGS)-associated morbidity in migrants from Sub-Saharan Africa (SSA). METHODS: Migrants from SSA with UGS attending three Italian centres for tropical diseases during 2011-2016 were retrospectively enrolled. Data on clinical symptoms, routine laboratory, parasitological tests, and ultrasound reported as per the WHO-Niamey protocol were collected at baseline and at available follow-up visits after treatment with praziquantel 40 mg/kg/day for 3 days. RESULTS: One hundred and seventy patients with UGS were enrolled and treated with praziquantel. Baseline ultrasonography showed urinary tract abnormalities in 115/169 patients (68%); the mean global Schistosoma haematobium score was 2.29 (SD 2.84, IQR 0-2), the mean urinary bladder intermediate score 1.75 (SD 1.73, IQR 0-2), and the mean upper urinary tract intermediate score 0.54 (SD 2.37, IQR 1-10). Abnormalities were more common among the 111 (65%) who were symptomatic (p < 0.02; OR 2.53; 95% CI 1.19-5.35). Symptoms started in 94/111 (85%) before arriving (median 63 months, IQR 12-119). At follow-up, we observed a significant reduction in the prevalence of UGS-related symptoms, blood, urine, and ultrasound abnormalities. CONCLUSIONS: Our study results support the use of ultrasound and praziquantel for assessing and reducing UGS-associated morbidity in migrants. Health-seeking behaviour, diagnostic, and treatment delays contribute to the advanced pathology and qualified treatment success. To ensure earlier treatment, based on our findings, clinical experience, and available literature, we propose an algorithm for the diagnosis and clinical management of UGS. Multicentre studies are needed to improve the management of subjects with UGS in non-endemic countries.


Assuntos
Emigrantes e Imigrantes , Esquistossomose Urinária/diagnóstico , Esquistossomose Urinária/tratamento farmacológico , Adolescente , Adulto , África ao Sul do Saara/etnologia , Idoso , Animais , Estudos de Coortes , Emigrantes e Imigrantes/estatística & dados numéricos , Feminino , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Schistosoma haematobium , Esquistossomose Urinária/epidemiologia , Adulto Jovem
17.
AIDS Care ; 31(1): 113-116, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30244601

RESUMO

No study to date has focused on barriers to condom use specifically among young immigrants to Europe from sub-Saharan Africa. Based on a qualitative study in sociology, this paper explores generational differences in barriers to condom use between first-generation immigrants (born in Africa and arrived in Switzerland after age 10) and second-generation immigrants (born in Switzerland to two native parents or arrived in Switzerland before age 10). Results are based on in-depth, semistructured individual interviews conducted with 47 young women and men aged 18 to 25 to understand how individual, relational, and cultural dimensions influence sexual socialization and practices. Six main barriers to consistent condom use were identified: reduced pleasure perception, commitment and trust, family-transmitted sexual norms and parental control, lack of accurate knowledge on HIV transmission, lack of awareness about HIV in Switzerland, and gender inequalities. The three first barriers concerned both generations of immigrants, whereas the three last revealed generational differences. These findings can help sexual health providers identify social causes for young sub-Saharan immigrants not using condoms. The findings also highlight the necessity of offering accurate, accessible, and adapted information to all young immigrants, as well as the particular importance of addressing families' lack of discussions about sex, understanding the sexual norms transmitted by parents, and taking into consideration cultural differences among young people born in immigration countries.


Assuntos
Preservativos/estatística & dados numéricos , Emigrantes e Imigrantes/psicologia , Infecções por HIV/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Comportamento Sexual/estatística & dados numéricos , Adolescente , África ao Sul do Saara/etnologia , Feminino , Infecções por HIV/epidemiologia , Humanos , Entrevistas como Assunto , Masculino , Pesquisa Qualitativa , Sexo Seguro , Doenças Sexualmente Transmissíveis/epidemiologia , Doenças Sexualmente Transmissíveis/prevenção & controle , Suíça/epidemiologia , Adulto Jovem
18.
J Immigr Minor Health ; 21(3): 483-489, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29968003

RESUMO

We sought to evaluate the frequency of anxiety, depression, PTSD, and any experiences of violence in women who had undergone Female Genital Mutilation/Cutting (FGM/C) and were seeking asylum in the United States. We undertook a retrospective qualitative descriptive study of FGM/C cases seen in an asylum clinic over a 2-year period. Standardized questionnaires provided quantitative scores for anxiety, depression and PTSD. Clients' personal and physician medical affidavits were analyzed for experiences of violence. Of the 13 cases, anxiety and depression were exhibited by 92 and 100% of women, while all seven women screened for PTSD had symptoms. Qualitative analysis revealed extensive violence perpetrated against these women, demonstrating that FGM/C is only part of the trauma experienced. The high level of mental health disorders and endured violence has implications for providers working with FGM/C survivors and indicates the need for accessible mental health services and trauma-informed care.


Assuntos
Ansiedade/etnologia , Circuncisão Feminina/psicologia , Depressão/etnologia , Refugiados/psicologia , Transtornos de Estresse Pós-Traumáticos/etnologia , Adulto , África ao Sul do Saara/etnologia , Circuncisão Feminina/etnologia , Feminino , Violência de Gênero , Humanos , Pesquisa Qualitativa , Estudos Retrospectivos , Estados Unidos/epidemiologia
19.
J Immigr Minor Health ; 21(3): 555-562, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29948651

RESUMO

There is a dearth of obesity study among sub-Saharan African immigrants in Seoul, Korea. We investigated the prevalence and perception of obesity among this population. A cross-sectional study involving 211 immigrants aged 20 years and above from sub-Saharan Africa was carried out, using a structured questionnaire. Obesity (BMI ≥ 30.0 kg/m²) was calculated as the primary outcome variable. The overall prevalence of obesity was 27.0% (men 22.6% and women 36.8%). In a logistic regression analysis adjusting for age, obesity was significantly associated with increased duration of residence. Participants were 4.03 (95% CI 1.63-9.94) more likely to disagree than agree that obesity is a sign of wealth and that it gives respect. There is an urgent need to assess the possible factors predisposing sub-Saharan Africans to obesity and interventions should be designed targeting their lifestyle modification for healthy weight.


Assuntos
Obesidade/etnologia , Obesidade/psicologia , Aculturação , Adulto , África ao Sul do Saara/etnologia , Fatores Etários , Índice de Massa Corporal , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Sobrepeso/etnologia , Sobrepeso/psicologia , Percepção , Prevalência , República da Coreia/epidemiologia , Fatores de Risco , Fatores Sexuais , Fatores de Tempo , Adulto Jovem
20.
AIDS Care ; 31(6): 699-706, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30512965

RESUMO

Sub-Saharan African migrants living in France are particularly affected by HIV. Due to the fear of sexual transmission of the virus, those in a relationship could experience a union break-up after an HIV diagnosis. Based on data from the time-event ANRS-Parcours survey that was conducted among a representative sample of sub-Saharan migrants living with HIV (France, 2012-2013), we studied union break-ups after HIV diagnosis among people who were in a relationship at the time of their diagnosis. Women experienced a more rapid union break-up after HIV diagnosis than did men. The living conditions of men were not correlated to their risk of union break-up while among women, having a personal dwelling reduced the risk of union break-up. For both sexes, less established relationships were more likely to break up after HIV diagnosis. Having disclosed the HIV status to a partner was associated with a reduced risk of separation between partners, after adjustment on socio-economic conditions and migration characteristics.


Assuntos
Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Infecções por HIV/diagnóstico , Parceiros Sexuais/psicologia , Migrantes/estatística & dados numéricos , Revelação da Verdade , Adulto , África ao Sul do Saara/epidemiologia , África ao Sul do Saara/etnologia , Grupo com Ancestrais do Continente Africano/psicologia , Feminino , França/epidemiologia , Infecções por HIV/epidemiologia , Infecções por HIV/etnologia , Infecções por HIV/psicologia , Humanos , Entrevistas como Assunto , Masculino , Estado Civil , Pessoa de Meia-Idade , Comportamento Sexual/estatística & dados numéricos , Inquéritos e Questionários , Migrantes/psicologia
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