In addition, refugees are frequently excluded from the national health care systems of host countries where they reside, and, until recently, voluntary counseling and testing (VCT) was not provided in many camp settings or to urban refugee populations 6, 7. However, few studies have been performed that document actual increased risk behaviors in specific refugee populations 5. Economic distress, conflict, sexual abuse and violence, oppression, discrimination, exploitation, gender bias, and sociopolitical marginalization contribute to conditions in which transmission of HIV may be enhanced 4, 5. Although the link between HIV and migration is complex and nonlinear, multiple factors heighten the HIV risk for refugees. The increasing global rates of new HIV infections, despite efforts in prevention, coupled with the increasing mobility of populations, make HIV/AIDS an important issue in every country. In addition, HIV/AIDS disproportionately affects certain vulnerable population groups, such as young adults, women, and children. While HIV/AIDS affects individuals throughout the world, certain regions, such as sub-Saharan Africa, have disproportionally high prevalence rates (exceeding 20% in some countries). In addition, an estimated 2.7 million new HIV infections occurred in 2007 2. More than 30 million people were living with HIV at the end of 2007, with approximately 2.1 million deaths annually due to AIDS 2. The HIV/AIDS pandemic remains one of the most serious global health challenges today 2, 3.
All refugee women who are pregnant should undergo routine HIV screening as part of their post-arrival and prenatal medical screening and care. The identification and treatment of HIV-infected pregnant women can prevent HIV infection in their infants.Special considerations for pregnant women: Children 6 weeks of age until they are confirmed to be uninfected.Appropriate referral for care, treatment, and preventive services should be made for all individuals confirmed to be HIV-infected.All HIV-infected individuals should receive culturally sensitive and appropriate counseling in their primary spoken language.When a refugee declines an HIV test, this decision should be documented in the medical record.The competence of interpreters and bilingual staff to provide language assistance to patients with limited English proficiency must be ensured. Information about HIV and HIV testing should be provided in the languages of the commonly encountered populations within the service area. Efforts should be made to understand the context of HIV testing, diagnosis, and care within specific cultural and societal norms.(A compendium of requirements in specific jurisdictions is available at external icon. Where separate consent is mandated by State law, a separate consent form for HIV testing must be utilized. With such notification, consent for HIV screening should be incorporated into the patient’s general informed consent for medical care on the same basis as other screening or diagnostic tests. Oral or written information should include an explanation of HIV infection and the meanings of positive and negative test results, and the patient should be offered an opportunity to ask questions. Refugees should be clearly informed orally or in writing that HIV testing will be performed. Screening should be performed on all refugees unless they decline (opt out).Specific testing for HIV-2 should be conducted for refugees who screen positive for HIV and are native to or have transited through the following countries: Angola, Benin, Burkina Faso, Cape Verde, Côte d’Ivoire (Ivory Coast), Gambia, Ghana, Guinea, Guinea-Bissau, Liberia, Mali, Mauritania, Mozambique, Niger, São Tomé, Senegal, Sierra Leone, and Togo.Subsequent screening should be done in accordance with CDC guidelines. Repeat screening 3-6 months following resettlement is recommended for refugees with a recent exposure or high-risk activity to identify individuals who may be in the “window period” when they arrive in the United States.Screening of all refugees on arrival, including those ≤12 years and ≥64 years of age, is also encouraged. Screening of all refugees 13-64 years of age is recommended in accordance with this policy. Current CDC guidelines for the United States recommend HIV screening in health-care settings for all persons 13-64 years of age 1.Beginning January 4th, 2010, refugees are no longer tested for HIV-infection prior to arrival in the U.S.
0 kommentar(er)
