Coming and going: Some aspects of care for migrants with HIV in the UK

Anderson, Jane

doi:10.1016/j.jinf.2008.05.002

Cited by 9 publications

(11 citation statements)

References 43 publications

(30 reference statements)

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“…In research on sub-Saharan Africans at one of the SHCS centres [4], it was found that the majority of those who had left the country had been denied asylum. An uncertain legal situation, with the risk of deportation through the asylum process, which has also been described in other countries, is likely to contribute to LTFU [28]. Older participants had a better retention rate, which is in accordance with other recent data [10,11,29].…”

Section: Discussionsupporting

confidence: 88%

Participation, characteristics and retention rates of HIV‐positive immigrants in the Swiss HIV Cohort Study^*

et al. 2011

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ObjectiveData from observational cohorts may be influenced by population structure and loss to follow-up (LTFU). Quality of care may be associated with participation in cohort networks. We aimed to study the participation, characteristics and retention rates of immigrants in the Swiss HIV Cohort Study (SHCS). MethodsWe compared enrolment over time (1996-1999, 2000-2003 and 2004-2008) and LTFU between individuals from different geographical regions. In 2008, we performed a cross-sectional survey to investigate the proportion of individuals not participating in the SHCS but who were in care at SHCS institutions. Predictors for LTFU were analysed using Cox proportional hazard models, and those for nonparticipation using logistic regression. ResultsA total of 7840 individuals entered the SHCS during the observation period. The proportion of immigrants increased over time, especially the proportion of women from sub-Saharan Africa, which increased from 21 to 48% during the observation period. Overall LTFU was 3.76 [95% confidence interval (CI) 3.58-3.95]/100, with the highest hazard ratio in men from sub-Saharan Africa (2.82/100 patient-years; 95% CI 2.30-3.46/100), compared with men from northwestern countries. Other predictors for LTFU were age o30 years, lower education, injecting drug use, and higher baseline CD4 cell counts. Participants taking antiretroviral therapy had reduced LTFU. The survey showed that 84% of HIV-infected patients in care at SHCS institutions were enrolled in the cohort. Nonparticipation was more likely among men from non-European regions (odds ratio 2.73; 95% CI 2.29-3.24), women from sub-Saharan Africa (odds ratio 3.01; 95% CI 2.40-3.77) and women from Latin America/Caribbean (odds ratio 2.10; 95% CI 1.30-3.39). ConclusionsNumbers of HIV-infected immigrants are increasing but they are underrepresented in the SHCS, and immigrants are more likely to be lost to follow-up.

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Section: Discussionsupporting

confidence: 88%

Participation, characteristics and retention rates of HIV‐positive immigrants in the Swiss HIV Cohort Study^*

et al. 2011

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“…Secondly, public education campaigns are not adequately targeting migrants from the Middle East in either their native countries or Sweden due to low prevalence as compared to other regions/subgroups where the epidemic is more prevalent [2, 21]. These findings stress the need to adjust HIV education and preventative efforts to include low-educated immigrants and those from countries with low HIV prevalence, as their vulnerability to HIV acquisition might also increase as a result of the immigration process [2, 4, 8, 11, 15, 29]. The positive relationship between higher level of HIV knowledge and willingness to seek care at the bivariate level may be the result of a greater understanding of the disease, thereby the benefits of seeking care.…”

Section: Discussionmentioning

confidence: 99%

“…Although much of the previous research has not supported fear of deportation as a predictor of health seeking behavior for legal migrants, we presume that its impact may be mediated by a series of intervening factors that are linked to each other. In fact, fear of deportation may be operating through a cognitive appraisal of negative consequences following disclosure of HIV that may be based on perceived social attitudes towards migrants in general and persons living with HIV/AIDS in particular, and individual’s knowledge about HIV/AIDS, which, in turn may be influenced by socio-demographic characteristics [8, 11, 12, 15, 17, 19, 21, 30, 34, 35]. Further examination of the relationships among predictors is warranted.…”

Section: Discussionmentioning

confidence: 99%

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Fear of Deportation May Limit Legal Immigrants’ Access to HIV/AIDS-Related Care: A Survey of Swedish Language School Students in Northern Sweden

Nkulu-Kalengayi

Hurtig

Ahlm

et al. 2011

J Immigrant Minority Health

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The increasing rates of HIV infection that are currently being reported in high-income countries can be partly explained by migration from countries with generalized epidemics. Yet, early diagnosis of HIV/AIDS in immigrants remains a challenge. This study investigated factors that might be limiting immigrants’ access to HIV/AIDS care. Data from 268 legal immigrant students of two Swedish language schools in Northern Sweden were analyzed using logistic regression. Thirty-seven percent reported reluctance to seek medical attention if they had HIV/AIDS. Fear of deportation emerged as the most important determinant of reluctance to seek care after adjusting for socio-demographic factors, knowledge level, stigmatizing attitudes and fear of disclosure. Targeted interventions should consider the heterogeneity of migrant communities and the complex interplay of various factors which may impede access to HIV-related services. The myth about deportation because of HIV/AIDS should be countered.

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“…To our knowledge, no research has so far been undertaken on access of Burmese migrants to health services in European countries, including the UK. Although the health care system in the UK is based on the dual principle of universality and fairness, the April 2004 amendments to the Department of Health charging regulations for overseas visitors tightened the conditions of entitlement to free access to NHS health services by migrants [7-9]. Although a court ruling in April 2008 has entitled most refused asylum seekers to free NHS health care (both primary and secondary), other undocumented migrants can access primary health care only at the discretion of General Practitioners [10].…”

Section: Introductionmentioning

confidence: 99%

Access to and utilisation of GP services among Burmese migrants in London: a cross-sectional descriptive study

Aung

Rechel

Odermatt

2010

BMC Health Serv Res

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BackgroundAn estimated 10,000 Burmese migrants are currently living in London. No studies have been conducted on their access to health services. Furthermore, most studies on migrants in the United Kingdom (UK) have been conducted at the point of service provision, carrying the risk of selection bias. Our cross-sectional study explored access to and utilisation of General Practice (GP) services by Burmese migrants residing in London.MethodsWe used a mixed-method approach: a quantitative survey using self-administered questionnaires was complemented by qualitative in-depth interviews for developing the questionnaire and triangulating the findings of the survey. Overall, 137 questionnaires were received (a response rate of 57%) and 11 in-depth interviews conducted. The main outcome variables of the study included GP registration, barriers towards registration, GP consultations, barriers towards consultations, and knowledge on entitlements to health care. Quantitative data were analysed using descriptive statistics, association tests, and a multivariate analysis using logistic regression. The qualitative information was analysed using content analysis.ResultsThe respondents were young, of roughly equal gender (51.5% female), well educated, and had a fair level of knowledge on health services in the UK. Although the GP registration rate was relatively high (80%, 109 out of 136), GP service utilisation during the last episode of illness, at 56.8% (54 out of 95), was low. The statistical analysis showed that age being younger than 35 years, lacking prior overseas experience, having an unstable immigration status, having a shorter duration of stay, and resorting to self-medication were the main barriers hindering Burmese migrants from accessing primary health care services. These findings were corroborated by the in-depth interviews.ConclusionsOur study found that having formal access to primary health care was not sufficient to ensure GP registration and health care utilisation. Some respondents faced difficulties in registering with GP practices. Many of those who have registered prefer to forego GP services in favour of self-medication, partly due to long waiting times and language barriers. To ensure that migrants enjoy the health services they need and to which they are entitled, more proactive steps are required, including those that make health services culturally responsive.

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Coming and going: Some aspects of care for migrants with HIV in the UK

Cited by 9 publications

References 43 publications

Participation, characteristics and retention rates of HIV‐positive immigrants in the Swiss HIV Cohort Study^*

Participation, characteristics and retention rates of HIV‐positive immigrants in the Swiss HIV Cohort Study^*

Fear of Deportation May Limit Legal Immigrants’ Access to HIV/AIDS-Related Care: A Survey of Swedish Language School Students in Northern Sweden

Access to and utilisation of GP services among Burmese migrants in London: a cross-sectional descriptive study

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Coming and going: Some aspects of care for migrants with HIV in the UK

Cited by 9 publications

References 43 publications

Participation, characteristics and retention rates of HIV‐positive immigrants in the Swiss HIV Cohort Study*

Participation, characteristics and retention rates of HIV‐positive immigrants in the Swiss HIV Cohort Study*

Fear of Deportation May Limit Legal Immigrants’ Access to HIV/AIDS-Related Care: A Survey of Swedish Language School Students in Northern Sweden

Access to and utilisation of GP services among Burmese migrants in London: a cross-sectional descriptive study

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Participation, characteristics and retention rates of HIV‐positive immigrants in the Swiss HIV Cohort Study^*

Participation, characteristics and retention rates of HIV‐positive immigrants in the Swiss HIV Cohort Study^*