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1.
Torture ; 31(1): 37-52, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34606476

RESUMO

INTRODUCTION: Due to the COVID-19 pandemic, Freedom from Torture developed remote telephone assessments to provide interim medico-legal reports, ensuring people could obtain medical evidence to support their asylum claim. METHOD: To audit this new way of working, feedback was collected from the doctors, interpreters, individuals being assessed, and senior medical and legal staff who reviewed the reports. This paper presents findings from the first 20 assessments. RESULTS: Individuals assessed reported that the doctor developed good rapport, but in 35% of assessments reported that there were some experiences they felt unable to disclose. In 70% of assessments, doctors felt that rapport was not as good compared to face-to-face. In the majority of assessments, doctors were unable to gain a full account of the torture or its impact. They reported feeling cautious about pressing for more information on the telephone, mindful of individuals' vulnerability and the difficulty of providing support remotely. Nevertheless, in 85% of assessments doctors felt able to assess the consistency of the account of torture with the psychological findings, in accordance with the Istanbul Protocol (United Nations, 2004). Factors that hindered the assessment included the inability to observe body language, the person's ill health, and confidentiality concerns. CONCLUSION: This research indicates that psychological medico-legal reports can safely be produced by telephone assessment, but are more likely to be incomplete in terms of both full disclosure of torture experiences and psychological assessment. The limitations underline the need for a follow-up face-to-face assessment to expand the psychological assessment as well as undertake a physical assessment.


Assuntos
COVID-19/epidemiologia , Relações Médico-Paciente/ética , Refugiados/psicologia , Consulta Remota/ética , Telefone , Tortura , Humanos , Anamnese , Pandemias , Exame Físico , SARS-CoV-2 , Reino Unido/epidemiologia
2.
Public Health Rep ; 136(6): 774-781, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34546812

RESUMO

OBJECTIVE: Little is known about COVID-19 vaccination intentions among refugee communities in the United States. The objective of this study was to measure COVID-19 vaccination intentions among a sample of refugees in the United States and the reasons for their vaccine acceptance or hesitancy. METHODS: From December 2020 through January 2021, we emailed or text messaged anonymous online surveys to 12 bilingual leaders in the Afghan, Bhutanese, Somali, South Sudanese, and Burmese refugee communities in the United States. We asked community leaders to complete the survey and share the link with community members who met the inclusion criteria (arrived in the United States as refugees, were aged ≥18, and currently lived in the United States). We compared the characteristics of respondents who intended to receive the COVID-19 vaccine with those of respondents who did not intend to receive the vaccine or were unsure. We then conducted crude and adjusted logistic regression analysis to measure the association between employment as an essential worker and COVID-19 vaccine acceptance. RESULTS: Of 435 respondents, 306 (70.3%) indicated that they planned to receive a COVID-19 vaccine. Being an essential worker (adjusted odds ratio [aOR] = 2.37; 95% CI, 1.44-3.90) and male sex (aOR = 1.87; 95% CI, 1.12-3.12) were significantly associated with higher odds of intending to receive a COVID-19 vaccine. Among respondents who intended to receive a COVID-19 vaccine, wanting to protect themselves (68.6%), family members (65.0%), and other people (54.3%) were the main reasons. CONCLUSION: Many refugees who responded to the survey, especially those who worked in essential industries, intended to receive a COVID-19 vaccine. Community organizations, health care providers, and public health agencies should work together to ensure that vaccine registration and vaccination sites are accessible to refugees.


Assuntos
Vacinas contra COVID-19/administração & dosagem , COVID-19/epidemiologia , COVID-19/prevenção & controle , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Refugiados/psicologia , Adolescente , Adulto , África/etnologia , Ásia/etnologia , COVID-19/etnologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , SARS-CoV-2 , Fatores Sexuais , Fatores Socioeconômicos , Estados Unidos/epidemiologia , Adulto Jovem
3.
Sch Psychol ; 36(5): 348-357, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34435837

RESUMO

COVID-19 has exacerbated the challenges that newcomer refugee and immigrant families face. While many of the supports that schools typically offer were disrupted by the pandemic, school-based assistance remains critical in this challenging context. In addition to education-related challenges, many newcomer families have been disproportionately impacted across financial, employment, and health contexts. The present study highlights the perspectives of newcomer families to understand their experiences, stressors, and ability to cope during the pandemic, as well as how their school communities can offer support to mitigate the potential for increased disparities. Qualitative interviews were conducted with 14 parents (Mage = 38.68) and 13 students (Mage = 14.31) engaged in a school-based intervention for newcomer students. Among students, 71.4% were identified as male, and the majority of caregivers were mothers (85.7%). Newcomer families reported significant challenges due to COVID-19, including difficult social-emotional adjustment, financial challenges, and significant academic difficulties. Themes also emerged related to sources of support and coping. Implications for how schools can further support newcomer families given these challenges and strengths are considered. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Assuntos
COVID-19 , Emigrantes e Imigrantes/psicologia , Família/psicologia , Refugiados/psicologia , Estudantes/psicologia , Adolescente , Adulto , Feminino , Humanos , Masculino , Pais/psicologia , Pesquisa Qualitativa , Instituições Acadêmicas
5.
PLoS One ; 16(8): e0254406, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34347775

RESUMO

Syria has been the main country of citizenship of refugees in Germany since 2013. Syrians face numerous human rights violations in their country that can be accompanied by the experience of potentially traumatic events, loss and displacement. Along the migration process, refugees are exposed to various factors that can have an impact on mental health. The aim of this study is to investigate sociodemographic, war- and flight-related as well as post-migration factors as predictors of posttraumatic stress, depression, somatization and anxiety in Syrian refugees with posttraumatic stress symptoms based in Germany. Data were based on the baseline sample of the "Sanadak" randomized-controlled trial. A total of 133 adult Syrian refugees participated in the study. A questionnaire covered sociodemographic and flight-related questions as well as standardized instruments for symptoms of PTSD (PDS-5), depression (PHQ-9), somatization (PHQ-15), anxiety (GAD-7), generalized self-efficacy (GSE), religiousness (Z-Scale), social support (ESSI) and mental health stigma (SSMIS-SF). Linear regression models were executed to predict mental health outcomes. Sociodemographic predictors (i.e., female sex, higher education) and flight-related predicting factors (i.e., variability of traumatic events) have a negative impact on mental health in Syrian refugees with posttraumatic stress symptoms in Germany. Mental health stigma predicts worse mental health outcomes. Post-migration factors have a major impact on mental health, such as low income, lack of social support, low life satisfaction or a strongly felt connection to Syria. Somatization is an important manifestation of mental distress in Syrian refugees with posttraumatic stress symptoms. Our study showed a range of factors predicting the mental health of Syrian refugees with posttraumatic stress symptoms. Measures to foster mental health could be securing financial security, promoting gender equality and tailored psychosocial programs addressing mental health stigma, loss and social support networks.


Assuntos
Ansiedade , Saúde Mental , Refugiados/psicologia , Transtornos de Estresse Pós-Traumáticos , Estresse Psicológico , Inquéritos e Questionários , Adolescente , Adulto , Ansiedade/epidemiologia , Ansiedade/psicologia , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Estresse Psicológico/epidemiologia , Estresse Psicológico/psicologia , Síria/epidemiologia
6.
PLoS Med ; 18(7): e1003512, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34252076

RESUMO

BACKGROUND: Schools play a key role in supporting the well-being and resettlement of refugee children, and parental engagement with the school may be a critical factor in the process. Many resettlement countries have policies in place to support refugee parents' engagement with their children's school. However, the impact of these programs lacks systematic evaluation. This study first aimed to validate self-report measures of parental school engagement developed specifically for the refugee context, and second, to identify parent characteristics associated with school engagement, so as to help tailor support to families most in need. METHODS AND FINDINGS: The report utilises 2016 baseline data of a cohort study of 233 Arabic-speaking parents (77% response rate) of 10- to 12-year-old schoolchildren from refugee backgrounds across 5 schools in Sydney, Australia. Most participants were born in Iraq (81%) or Syria (11%), and only 25% spoke English well to very well. Participants' mean age was 40 years old, and 83% were female. Confirmatory factor analyses were run on provisional item sets identified from a literature review and separate qualitative study. The findings informed the development of 4 self-report tools assessing parent engagement with the school and school community, school belonging, and quality of the relationship with the schools' bilingual cultural broker. Cronbach alpha and Pearson correlations with an established Teacher-Home Communication subscale demonstrated adequate reliability (α = 0.67 to 0.80) and construct and convergent validity of the measures (p < 0.01), respectively. Parent characteristics were entered into respective least absolute shrinkage and selection operator (LASSO) regression analyses. The degree of parents' psychological distress (as measured by the Kessler10 self-report instrument) and postmigration living difficulties (PLMDs) were each associated with lower school engagement and belonging, whereas less time lived in Australia, lower education levels, and an unemployed status were associated with higher ratings in relationship quality with the schools' cultural broker. Study limitations include the cross-sectional design and the modest amount of variance (8% to 22%) accounted for by the regression models. CONCLUSIONS: The study offers preliminary refugee-specific measures of parental school engagement. It is expected they will provide a resource for evaluating efforts to support the integration of refugee families into schools. The findings support the need for initiatives that identify and support parents with school-attending children from refugee backgrounds who are experiencing psychological distress or resettlement stressors. At the school level, the findings suggest that cultural brokers may be effective in targeting newly arrived families.


Assuntos
Emigração e Imigração , Refugiados/psicologia , Instituições Acadêmicas , Estresse Psicológico/etnologia , Estresse Psicológico/psicologia , Estudantes/psicologia , Adulto , Austrália , Criança , Estudos de Coortes , Estudos Transversais , Feminino , Humanos , Iraque/etnologia , Masculino , Pesquisa Qualitativa , Autorrelato , Síria/etnologia
7.
Sci Rep ; 11(1): 14910, 2021 07 21.
Artigo em Inglês | MEDLINE | ID: mdl-34290327

RESUMO

Little is known regarding structural brain changes in traumatized refugees and the association with psychopathology. In the present study, the cortical thickness in North Korean refugees and the association with psychological symptoms were explored. North Korean refugees with lifetime post-traumatic stress disorder (PTSD group, n = 27), trauma-exposed North Korean refugees without lifetime PTSD (trauma-exposed control (TEC) group, n = 23), and healthy South Korean controls without traumatic experiences (HC group, n = 51) completed questionnaires assessing depression, anxiety, somatization, and PTSD symptoms. The cortical thickness was measured by magnetic resonance imaging (MRI) using FreeSurfer. Age- and sex-adjusted cortical thickness of the right medial prefrontal cortex (mPFC) was greater in the TEC group than in the HC group. However, significant differences were not observed between the PTSD and HC groups. Increased right mPFC thickness was significantly correlated with less anxiety and somatization after controlling for age and sex in the TEC group, but not in the PTSD or HC groups. North Korean refugees who did not develop PTSD after trauma showed increased right mPFC thickness, which was associated with less severe psychiatric symptoms. These findings indicate that increased mPFC thickness might have helped to reduce PTSD and psychiatric symptoms after trauma, and likely reflects resilience achieved by potentially enhancing emotional regulation in the mPFC.


Assuntos
Acontecimentos que Mudam a Vida , Córtex Pré-Frontal/patologia , Córtex Pré-Frontal/fisiologia , Trauma Psicológico/patologia , Refugiados/psicologia , Resiliência Psicológica , Transtornos de Estresse Pós-Traumáticos/patologia , Adulto , Ansiedade/patologia , República Democrática Popular da Coreia , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Córtex Pré-Frontal/anatomia & histologia , Córtex Pré-Frontal/diagnóstico por imagem , Transtornos Somatoformes/patologia , Adulto Jovem
9.
PLoS One ; 16(6): e0252982, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34143803

RESUMO

INTRODUCTION: The complex relationship between intimate partner violence and psychological distress warrants an integrated intervention approach. In this study we examined the relevance, acceptability, and feasibility of evaluating a multi-sectoral integrated violence- and mental health-focused intervention (Nguvu). METHODS: We enrolled 311 Congolese refugee women from Nyarugusu refugee camp in Tanzania with past-year intimate partner violence and elevated psychological distress in a feasibility cluster randomized trial. Women were recruited from local women's groups that were randomized to the Nguvu intervention or usual care. Participants from women's groups randomized to Nguvu received 8 weekly sessions delivered by lay refugee incentive workers. Psychological distress, intimate partner violence, other wellbeing, and process indicators were assessed at baseline and 9-weeks post-enrollment to evaluate relevance, acceptability, and feasibility of implementing and evaluating Nguvu in refugee contexts. RESULTS: We found that Nguvu was relevant to the needs of refugee women affected by intimate partner violence. We found reductions in some indicators of psychological distress, but did not identify sizeable changes in partner violence over time. Overall, we found that Nguvu was acceptable and feasible. However, challenges to the research protocol included baseline imbalances between study conditions, differential intervention completion related to intimate partner violence histories, differences between Nguvu groups and facilitators, and some indication that Nguvu may be less beneficial for participants with more severe intimate partner violence profiles. CONCLUSIONS: We found evidence supporting the relevance of Nguvu to refugee women affected by partner violence and psychological distress and moderate evidence supporting the acceptability and feasibility of evaluating and implementing this intervention in a complex refugee setting. A definitive cluster randomized trial requires further adaptations for recruitment and eligibility screening, randomization, and retention. TRIAL REGISTRATION: ISRCTN65771265, June 27, 2016.


Assuntos
Violência por Parceiro Íntimo/estatística & dados numéricos , Angústia Psicológica , Refugiados/psicologia , Congo/etnologia , Estudos de Viabilidade , Feminino , Humanos , Medicina Integrativa , Violência por Parceiro Íntimo/psicologia , Avaliação de Programas e Projetos de Saúde , Tanzânia/etnologia
10.
Reprod Health ; 18(1): 130, 2021 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-34167553

RESUMO

BACKGROUND: The war in Syria caused the forced displacement of millions of Syrians to neighboring countries. Lebanon is the host country with the largest overall number of Syrian refugees per capita. Adolescent refugee girls experience a unique level of vulnerability during human emergencies and are at increased risk of suffering from poor sexual and reproductive health (SRH) outcomes. We conducted an exploratory qualitative study to learn about the SRH perceptions and experiences of refugee adolescent girls living in Bourj Hammoud, an urban setting in Lebanon. METHODS: We employed a qualitative design with eight focus group discussions (FGDs) conducted with 40 Syrian Arab and Syrian Kurdish adolescent girls between January and March 2020. Every FGD consisted of five participants aged 13 to 17 years. A semi-structured guide was used covering multiple themes: menstruation, puberty, SRH awareness, and sexual harassment. FGDs were transcribed and analyzed using thematic analysis. FINDINGS: The participants discussed adolescent girls' health and named six elements of good health, such as healthy activities and self-protection. The majority of the FGD participants reported a lack of awareness about menstruation when they experienced it for the first time and the social stigma associated with menstruation. When defining puberty, they indicated its social link to a girl's readiness for marriage and her need to become cautious about sexual harassment. Most FGD participants had very poor knowledge of the female reproductive system. Mothers were the most approached persons to receive information on SRH issues; however, the girls indicated a wish to receive advice from specialists in a comfortable and private atmosphere. All the girls reported that either they themselves, or an acquaintance, had experienced some type of sexual harassment. The girls rarely reported those incidents due to fear of being blamed or subjected to mobility restrictions, or forced to drop out of school. CONCLUSIONS: The findings show the refugee girls need for satisfactory knowledge on SRH issues and interventions to prevent sexual and gender-based violence that take into consideration the complexity of urban settings.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Refugiados/psicologia , Saúde Reprodutiva , Saúde Sexual , Adolescente , Feminino , Grupos Focais , Humanos , Líbano/epidemiologia , Pesquisa Qualitativa , Assédio Sexual , Síria/etnologia , População Urbana
11.
Reprod Health ; 18(1): 131, 2021 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-34167555

RESUMO

BACKGROUND: Children under 18 years old constituted more than half (52%) of the refugee population in 2017. Adolescent Sexual and reproductive health is an essential component of primary health care. Yet, not every refugee adolescent is able to access sexual and reproductive health services. METHODS: Using quantitative data from 356 refugee adolescents and qualitative data (17 in-depth interviews and nine key informant interviews), we examine refugee adolescent sexual behaviour in Bidibidi settlement-the largest refugee settlement in Uganda using a binary logistic regression model. RESULTS: The results show that 25% of refugee adolescents in Bidibidi refugee settlement had ever had sex. After controlling for all factors, results show that refugee adolescents aged 16-18 years (OR = 3.47; 95% CI = 1.09-10.94), males (OR = 17.59; 95% CI = 4.48-69.07), not in school (OR = 14.57; 95% CI = 2.20-96.35) were more likely to engage in sexual behaviour than their counterparts. Refugee adolescents who do not agree that a girl cannot get pregnant if she has sex while standing up (knowledge about getting pregnant) were significantly less associated with sexual behaviour (OR = 0.30; 95% CI = 0.10-0.85). CONCLUSIONS: Results from this study show that keeping refugee adolescents in school and providing sexual and reproductive health information are likely to delay refugee adolescents' engagement in sexual behaviour. Therefore, there is need to promote keeping refugee adolescents in school in order to improve sexual and reproductive health of adolescent refugees living in low-income countries such as Uganda.


Assuntos
Refugiados , Saúde Reprodutiva , Direitos Sexuais e Reprodutivos , Comportamento Sexual , Saúde Sexual , Adolescente , Comportamento do Adolescente , Feminino , Humanos , Entrevistas como Assunto , Masculino , Gravidez , Pesquisa Qualitativa , Refugiados/psicologia , Migrantes , Uganda
12.
PLoS One ; 16(6): e0253648, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34161389

RESUMO

AIM: This study aimed to assess the fear of COVID-19 and its associates among older Rohingya (Forcibly Displaced Myanmar Nationals or FDMNs) in Bangladesh. METHOD: We conducted a cross-sectional survey among 416 older FDMNs aged 60 years and above living in camps of Cox's Bazar, Bangladesh. A semi-structured questionnaire was used to collect information on participants' socio-demographic and lifestyle characteristics, pre-existing non-communicable chronic conditions, and COVID-19 related information. Level of fear was measured using the seven-item Fear of COVID-19 Scale (FCV-19S) with the cumulative score ranged from 7 to 35. A multiple linear regression examined the factors associated with fear. RESULTS: Among 416 participants aged 60 years or above, the mean fear score was 14.8 (range 8-28) and 88.9% of the participants had low fear score. Participants who were concerned about COVID-19 (ß: 0.63, 95% CI: -0.26 to 1.53) and overwhelmed by COVID-19 (ß: 3.54, 95% CI: 2.54 to 4.55) were significantly more likely to be fearful of COVID-19. Other factors significantly associated with higher level of fear were lesser frequency of communication during COVID-19, difficulty in obtaining food during COVID-19, perception that older adults are at highest risk of COVID-19 and receiving COVID-19 related information from Radio/television and friends/family/neighbours. CONCLUSIONS: Our study highlighted that currently there little fear of COVID-19 among the older Rohingya FDMNs. This is probably due to lack of awareness of the severity of the disease in. Dissemination of public health information relevant to COVID-19 and provision of mental health services should be intensified particularly focusing on the individual who were concerned, overwhelmed or fearful of COVID-19. However, further qualitative research is advised to find out the reasons behind this.


Assuntos
Atitude Frente a Saúde , COVID-19/psicologia , Medo , Refugiados/psicologia , Idoso , Bangladesh , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mianmar , Fatores Socioeconômicos , Inquéritos e Questionários , Populações Vulneráveis/psicologia
13.
J Cross Cult Gerontol ; 36(2): 217-228, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34106391

RESUMO

We interviewed older Hmong refugees in the U.S. to understand how they experience and define depression. Methods. Data were collected in California (N = 20). The study sample included Hmong immigrants aged 55 and over. The qualitative method allowed for an in-depth understanding of events that occurred throughout the participants' life course and how these events impacted depression in later life. Results. The participants' conceptualization of depression was defined with reference to their lived experiences. Three main conceptualizations emerged: behavioral descriptions of depression, mental or emotional descriptions, and physical descriptions of depression. The use of personal examples to describe depression was common. Our findings suggest that this sample's understanding of depression may not be fully captured by conventional measurement and thus more work is needed to develop a measure of depression that aligns with these respondents' descriptions.


Assuntos
Americanos Asiáticos/psicologia , Depressão/etnologia , Emigrantes e Imigrantes/psicologia , Refugiados/psicologia , Idoso , Idoso de 80 Anos ou mais , California/epidemiologia , Depressão/diagnóstico , Depressão/psicologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa
14.
Philos Trans R Soc Lond B Biol Sci ; 376(1827): 20200030, 2021 06 21.
Artigo em Inglês | MEDLINE | ID: mdl-33938275

RESUMO

Migrant and refugee women are at risk of perinatal depression due to stressors experienced before, during and after migration. This study assesses the associations between social support and perinatal depression among migrant and refugee women on the Thai-Myanmar border. We conducted a cohort study of pregnant and post-partum women. Depression status was assessed using a structured clinical interview. Received support, perceived support and partner support were measured in the third trimester. Logistic regression was used to calculate associations between social support measures and perinatal depression controlling for demographic, socio-economic, migration, obstetric and psychosocial factors. Four hundred and fifty-one women (233 migrants; 218 refugees) were included. The prevalence of perinatal depression was 38.6% in migrants and 47.3% in refugees. Migrants had higher levels of received, perceived and partner support than refugees. After controlling for all other variables, higher levels of received support remained significantly associated with a lower likelihood of perinatal depression in migrants (adjusted odds ratio 0.82; 95% CI 0.68-0.99). In both groups, depression history and trauma were strongly associated with perinatal depression. Our study highlights the importance of received social support to perinatal depression in migrant women on the Thailand-Myanmar border. The perinatal period offers a valuable opportunity to ask women about their support and offer community-level or public policy interventions to nurture support networks in current locations and resettlement destinations. This article is part of the theme issue 'Multidisciplinary perspectives on social support and maternal-child health'.


Assuntos
Depressão Pós-Parto/epidemiologia , Refugiados/psicologia , Apoio Social , Migrantes/psicologia , Adulto , Depressão Pós-Parto/psicologia , Feminino , Humanos , Pessoa de Meia-Idade , Mianmar/epidemiologia , Prevalência , Refugiados/estatística & dados numéricos , Tailândia/epidemiologia , Migrantes/estatística & dados numéricos , Adulto Jovem
15.
Australas Psychiatry ; 29(4): 417-419, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33818174

RESUMO

OBJECTIVE: This paper highlights the significant mental health vulnerabilities of people who have sought asylum in Australia and their additional adversities as a result of the Covid-19 pandemic. CONCLUSIONS: Australia's policies in relation to asylum seekers result in multiple human rights violations and add significantly to mental health vulnerabilities. Despite a majority being identified as refugees, people spend years in personal and administrative limbo and are denied resettlement in Australia. Social isolation and other restrictions associated with Covid-19 and recent reductions in welfare and housing support compound their difficulties. The clinical challenges in working with people impacted by these circumstances and the role of psychiatrists and the RANZCP in advocacy are identified.


Assuntos
COVID-19/psicologia , Saúde Mental/estatística & dados numéricos , Refugiados/psicologia , Ansiedade , Austrália , COVID-19/epidemiologia , COVID-19/prevenção & controle , Acesso aos Serviços de Saúde , Direitos Humanos , Humanos , Pandemias , SARS-CoV-2
17.
J Int AIDS Soc ; 24(3): e25674, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33713571

RESUMO

INTRODUCTION: HIV-related risks may be exacerbated in humanitarian contexts. Uganda hosts 1.3 million refugees, of which 60% are aged under 18. There are knowledge gaps regarding HIV testing facilitators and barriers, including HIV and intersecting stigmas, among urban refugee youth. In response, we explored experiences and perspectives towards HIV testing strategies, including HIV self-testing, with urban refugee youth in Kampala, Uganda. METHODS: We implemented a qualitative study with refugee cisgender youth aged 16 to 24 living in Kampala's informal settlements from February-April 2019. We conducted five focus groups with refugee youth, including two with adolescent boys and young men, two with adolescent girls and young women and one with female sex workers. We also conducted five key informant (KI) interviews with government, non-government and community refugee agencies and HIV service providers. We conducted thematic analyses to understand HIV testing experiences, perspectives and recommendations. RESULTS: Participants (n = 49) included young men (n = 17) and young women (n = 27) originally from the Democratic Republic of Congo [DRC] (n = 29), Rwanda (n = 11), Burundi (n = 3) and Sudan (n = 1), in addition to five KI (gender: n = 3 women, n = 2 men; country of origin: n = 2 Rwanda, n = 2 Uganda, n = 1 DRC). Participant narratives revealed stigma drivers included fear of HIV infection; misinformation that HIV is a "Ugandan disease"; and blame and shame for sexual activity. Stigma facilitators included legal precarity regarding sex work, same-sex practices and immigration status, alongside healthcare mistreatment and confidentiality concerns. Stigma experiences were attributed to the social devaluation of intersecting identities (sex work, youth, refugees, sexual minorities, people living with HIV, women). Participants expressed high interest in HIV self-testing. They recommended HIV self-testing implementation strategies to be peer supported and expressed concerns regarding sexual- and gender-based violence with partner testing. CONCLUSIONS: Intersecting stigma rooted in fear, misinformation, blame and shame, legal precarity and healthcare mistreatment constrain current HIV testing strategies with urban refugee youth. Findings align with the Health Stigma and Discrimination Framework that conceptualizes stigma drivers and facilitators that devalue intersecting health conditions and social identities. Findings can inform multi-level strategies to foster enabling HIV testing environments with urban refugee youth, including tackling intersecting stigma and leveraging refugee youth peer support.


Assuntos
Atitude do Pessoal de Saúde/etnologia , Infecções por HIV/psicologia , Teste de HIV , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Refugiados/psicologia , Estigma Social , Adolescente , Medo , Feminino , Grupos Focais , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Humanos , Masculino , Pesquisa Qualitativa , Uganda/epidemiologia , População Urbana , Adulto Jovem
18.
PLoS One ; 16(3): e0247033, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33755695

RESUMO

BACKGROUND: The U.S. immigration system mandates that persons seeking asylum prove their persecution claim is credible and their fear of returning home is well-founded. However, this population represents a highly trauma-exposed group, with neuropsychiatric symptoms consequent to prior torture or maltreatment that may interfere with cognitive function and their ability to recall their trauma. These memory lapses may be incorrectly perceived by asylum adjudicators as indicators of dishonesty and jeopardize the person's credibility and asylum claim. Our retrospective mixed methods study seeks to present associations between trauma and memory loss in a sample of persons seeking asylum to the U.S. and describe how memory impairments manifest in this trauma-exposed population. METHODS: We randomly selected 200 medico-legal affidavits from 1346 affidavits collected in the past 30 years, as part of the Physicians for Human Rights Asylum Network connecting clinicians with legal providers for medical and/or psychiatric affidavits of U.S. asylum seekers and persons seeking other forms of humanitarian relief (hereafter, "asylum seekers"). Data was extracted from these affidavits using a coding manual informed by the Istanbul Protocol, the global standard for torture documentation. Seven affidavits were excluded due to missing age. We used multiple logistic regression to assess the association of memory loss with neuropsychiatric diagnoses: head trauma, post-traumatic stress disorder (PTSD), and depression. We supplemented these findings with a qualitative content analysis of the affidavits documenting memory loss. Memory loss presented among the asylum seekers' affidavits in several ways: memory gaps of the traumatic event; challenges with presenting a clear chronology of the trauma, avoidance of traumatic memories, and persistent short-term memory loss interfering with daily activity. RESULTS: A majority of the sample received a neuropsychiatric diagnosis: 69% (n = 132) of asylum-seekers received a diagnosis of PTSD and 55% (n = 106) of depression. Head trauma was reported among 30% (n = 58) of affidavits. Further, 68% (n = 131) reported being subject to physical violence and 20% (n = 39) were documented as being at risk of suicide. Memory loss was documented among 21% (n = 40) asylum-seekers. In adjusted models, both PTSD and depression, but not head trauma, were associated with memory loss (p<0.05). CONCLUSION: Stakeholders in the asylum process, spanning the medical, legal and immigration enforcement sectors, must be aware of the interplay of trauma and memory loss and how they might impact immigration proceedings for this vulnerable population.


Assuntos
Transtornos da Memória/psicologia , Refugiados/psicologia , Adulto , Feminino , Humanos , Masculino , Estudos Retrospectivos , Estados Unidos
20.
Reprod Health ; 18(1): 58, 2021 Mar 08.
Artigo em Inglês | MEDLINE | ID: mdl-33685476

RESUMO

BACKGROUND: Women and girls are disproportionately affected in times of conflict and forced displacement, with disturbance in access to healthcare services leading to poor sexual and reproductive health outcomes. The minimal initial service package (MISP) was created to mitigate the consequences of conflict and prevent poor sexual and reproductive health (SRH) outcomes, especially among women and girls. The aim of this narrative review was to explore the SRH response for Syrian refugee women and girls in Lebanon, with a focus on MISP implementation. METHODOLOGY: A comprehensive literature search was conducted for peer-reviewed articles in 8 electronic databases and multiple grey literature sites for articles published from March 2011 to May 2019. The target population was Syrian refugee women in Lebanon displaced from Syria as a result of the conflict that erupted in March 2011. The selected articles addressed MISP, SRH needs and services, and barriers to service access. A narrative synthesis was conducted, guided by the six main objectives of the MISP. RESULTS: A total of 254 documents were retrieved, from which 12 peer-reviewed articles and 12 reports were included in the review. All identified articles were descriptive in nature and no studies evaluating MISP or other interventions or programs were found. The articles described the wide range of SRH services delivered in Lebanon to Syrian refugee women. However, access to and quality of these services remain a challenge. Multiple sources reported a lack of coordination, leading to fragmented service provision and duplication of effort. Studies reported a high level of sexual and gender-based violence, pregnancy complications and poor antenatal care compliance, and limited use of contraceptive methods. Very few studies reported on the prevalence of HIV and other STIs, reporting low levels of infection. Multiple barriers to healthcare access were identified, which included system-level, financial, informational and cultural factors, healthcare workers. CONCLUSION: This study highlights the main SRH services provided, their use and access by Syrian refugee women in Lebanon. Despite the multitude of services provided, the humanitarian response remains decentralized with limited coordination and multiple barriers that limit the utilization of these services. A clear gap remains, with limited evaluation of SRH services that are pertinent to achieve the MISP objectives and the ability to transition into comprehensive services. Improving the coordination of services through a lead agency can address many of the identified barriers and allow the transition into comprehensive services.


Assuntos
Refugiados/psicologia , Serviços de Saúde Reprodutiva , Saúde Reprodutiva , Adolescente , Criança , Atenção à Saúde , Feminino , Humanos , Recém-Nascido , Líbano , Masculino , Gravidez , Comportamento Sexual , Síria
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