Fear of Deportation May Limit Legal Immigrants’ Ac

Authors: Faustine Kyungu Nkulu Kalengayi AnnaKarin Hurtig Clas Ahlm Ingela Krantz

Publish Date: 2011/08/04

Volume: 14, Issue: 1, Pages: 39-47

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Abstract

The increasing rates of HIV infection that are currently being reported in highincome 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 Thirtyseven 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 sociodemographic 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 HIVrelated services The myth about deportation because of HIV/AIDS should be counteredIncreasing numbers of reported HIV infections are being observed in highincome countries it is thought due to migration from highprevalence countries 1 2 3 4 For instance 43 percent of all new HIV cases reported in the European Union EU as acquired heterosexually in 2007 were migrants from highprevalence countries 1 However there is also evidence of immigrants becoming infected after migration to EU countries 4 5 6 Similarly in Sweden 54 percent of all new HIV infections reported in 2009 were immigrants from countries with generalized epidemics 5 7The current association between migration from high prevalence countries and the epidemiology of HIV has raised concerns in many receiving countries where governments are responding by adopting laws and policies specifically targeting migrants 2 3 4 8 In Sweden foreignborn persons from high risk countries are systematically offered a medical screening that also includes voluntary HIVtesting soon after arrival 9 Furthermore the Swedish Communicable Disease Act 2004168 which classifies HIV infection and AIDS disease HIV/AIDS as ‘public health threats’ urges anyone who suspects being infected to consult a physician without delay for diagnosis and treatment to assist clinicians in contact tracing and to protect others from the risk of infection including disclosing one’s HIV status to those at risk 10Most investigators acknowledge that care treatment and prevention of HIV/AIDS in immigrants are influenced by a wide range of social cultural and political factors 3 8 11 12 13 14 15 Immigrants bring with them not only their disease profiles but also their sociodemographic and cultural backgrounds Thus the meaning of HIV diagnosis and perceptions of people living with HIV/AIDS PLWH are likely to be grounded in the knowledge and experience from their country of birth 13 15 16 17 Additionally immigrants living with HIV/AIDS may be unlikely to disclose their HIV status if they expect stigma and prejudice from their own/host communities 12 16 18 19 20 21 Finally concerns about deportation following disclosure of HIV status may impede contacts with official government agencies including health care services 3 8 13 21 22 In the present study we aim to assess the relationships between sociodemographic characteristics HIV knowledge stigma towards PLWH fear of disclosure fear of deportation and willingness to seek careOver the period October 2007 to September 2008 a total of 592 immigrants were registered as students in the Swedish for Immigrants’ SFI Svenska för Invandare and Individual Programme’s Introductory Course IVIK Individuellt Program Introduktionskurs in Umeå a university town in Northern Sweden with about 111600 inhabitants including 9577 immigrants We adopted Statistics Sweden’s definition of an immigrant which was foreignborn legally admitted and expected to stay at least 12 months in Sweden 23The study followed the guidelines for ethical clearance provided by the Regional Ethical Review Board in Umeå and its protocol was approved by the Doctoral Education Board Faculty of Medicine at Umeå University 24 Permission was obtained from the principals of the schools before commencement Participation in the study was voluntary and written consent of parents/guardians was required for minorsThe schools were visited six times and of the 592 students formally registered 214 students were not included for various reasons such as sick/parental leave dropouts parttime students or duplicate records In addition 69 students could not participate due to lack of interpreters for their languages SFI 10/276 IVIK 23/102 or missing guardian’s consent 36/102—this resulted in a sample of 309 students SFI 266/276 and IVIK 43/102 We could not ascertain the reason for 29 students failing to participate The analysis was thus based on 268 96 of the 280 individuals who completed the questionnaire which gave an overall response rate of 71 percent 268/378—276 adults and 102 youthsAn original questionnaire developed by the first author based on other Knowledge Attitudes and Practices KAP surveys on HIV/AIDS was pilottested revised and then anonymously administered to participants 25 26 27 It included 69 items concerning knowledge and beliefs about different aspects of HIV/AIDS 17 items concerning attitudes towards PLWH and five items regarding fear of disclosure of HIV status with which they could agree or disagree Also added were a set of sociodemographic items and a series of items related to HIV/AIDS control in Sweden The questionnaire was available in Swedish English or French and language assistance was provided where necessary in such cases interpreters read and clarified items in the students’ vernacular Of the 268 respondents six were interviewed in Amharic 71 in Arabic 38 in Badinani nine in Chinese three in Dari 28 in English 22 in French three in Japanese 13 in Persian 23 in Somali four in Sorani 13 in Spanish eight in Swahili 23 in Thai and four in Tigrinya

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