HIV This Week

Tanaka Y, Kunii O, Hatano T, Wakai S. Knowledge, attitude, and practice (KAP) of HIV prevention and HIV infection risks among Congolese refugees in Tanzania. Health Place. 2007 Sep 21; [Epub ahead of print].

Little is known about HIV infection risks and risk behaviours of refugees living in resource-scarce post-emergency phase camps in Africa. This study at Nyarugusu Camp in Tanzania, covering systematically selected refugees (n=1140) and refugees living with HIV (PLHIV) (n=182), revealed that the level of HIV risk of systematically selected refugees increased after displacement, particularly regarding the number having transactional sex for money or gifts, while radio broadcast messages are perceived to promote a base of risk awareness within the refugee community. While condoms are yet to be widely used in the camp, some refugees having transactional sex tended to undertake their own health initiatives such as using a condom, under the influence of peer refugee health workers, particularly health information team members. Nevertheless, PLHIV were less faithful to one partner and had more non-regular sexual partners than the group without HIV. The study revealed that community-based outreach by refugee health workers is conducive to risk behaviour prevention in the post-emergency camp setting. It is recommended to increase the optimal use of « radio broadcast messages » and « health information team, » which can act as agents to reach out to wider populations, and to strengthen the focus on safer sex education for PLHIV; the aim being to achieve dual risk reduction for both refugees living with and without HIV.

Editors’ note: This study found that 18.8% of female refugees and 24.7% of male refugees were involved in transactional sex in the preceding 12 months. Fellow Congolese refugees represented the principal transactional sex partners for both males and females, with persons from local Tanzanian communities ranking second for men while police and humanitarian workers ranked second and third, respectively, in the case of women and adolescent girls 15 years of age and older. Condom use was low but significantly more likely in transactional sex, suggesting that the community outreach and peer education, which are having effect in this post emergency phase refugee camp, should be reinforced.

Pottie K, Janakiram P, Topp P, McCarthy A. Prevalence of selected preventable and treatable diseases among government-assisted refugees: Implications for primary care providers. Can Fam Physician 2007;53:1928-34.

This retrospective cohort study aimed to discover the prevalence of 4 preventable and treatable diseases among newly arriving refugees. The study was, conducted at an immigrant-friendly family medicine centre in Ottawa, Ontario, Canada that offers newly arriving refugees a clinical preventive programme following a specially designed protocol. A total of 112 adult government-assisted refugees seen during 2004 and 2005, within 6 months of their arrival, were included. The main outcome measures were demographic information and prevalence of HIV infection, latent tuberculosis (TB), chronic hepatitis B surface antigen-positive status, and intestinal parasites. 71% of the adults were younger than 35 years and 83% of them had come from sub-Saharan Africa. Disease prevalence rates were 6.3% for HIV (95% confidence interval [CI] 1.8 to 10.8), 49.5% for latent TB (95% CI 39.5 to 49.8), 5.4% for chronic hepatitis B surface antigen-positive status (95% CI 1.2 to 9.5), and 13.6% for intestinal parasites (95% CI 7.2 to 20.0). Most refugees (83%) successfully completed the preventive care programme. Performing chi squared analysis revealed a statistically significant higher risk of latent TB among the men (P < .032). Most of the women had never had a Papanicolaou test. In conclusion, refugees are a vulnerable population with unique, but often preventable or treatable, health issues. This study demonstrated substantial differences in the prevalence of HIV, TB, chronic hepatitis B, and intestinal parasites between government-assisted refugees and Canadian residents. These health disparities and the emerging field of health settlement are new challenges for family physicians and other primary health care providers.

Editors’ note: In 2002 Canada waived the burden-of-illness barriers for refugees who have fled their countries of origin because of well-grounded fears of persecution. Such refugees have higher disease prevalences than the recipient population for HIV, latent TB, chronic hepatitis B surface antigen, and intestinal parasites, reflecting rates in their countries of origin. Health assessments, immunization, and health promotion, including cervical screening for cancer, are key to enhancing the health of all populations, including the government-assisted refugees described in this study.