Ana Gama

Immigrant women’s perceptions and experiences of health care services: Insights from a focus group study

AimThis study aimed to describe perceptions and experiences related to access and utilization of health care services of African and Brazilian immigrant women in Portugal.Subjects and methodsSix focus groups were conducted with 35 African and Brazilian women with low income and living in Lisbon, chosen through purposive sampling. Content analysis was undertaken through identification of themes and categories.ResultsAfrican and Brazilian women expressed different perceptions and patterns of use of health care services. Most participants pointed out several barriers to access and utilization of services related to legal issues, economic constraints or health professionals’ attitudes.ConclusionThese results highlight the challenges to providing health care within a multicultural setting and the need to assure the provision of integrated and comprehensive health care services. Improving access to general health care is essential in order to minimize disadvantages from vulnerable subgroups, like immigrant women. Supporting better integration into the health system may lead to improved health outcomes.

Health workers’ attitudes toward immigrant patients: a cross-sectional survey in primary health care services

BackgroundHealth workers’ attitudes toward immigrant patients influence behaviour, medical decisions, quality of care and health outcomes. Despite the increasing number of immigrant patients in health services and the potential influence of health workers’ attitudes, there is little research in this area. This study aimed to examine attitudes of different health workers’ groups toward immigrant patients and to identify the associated factors.MethodsThis cross-sectional study was conducted with a random sample of 400 health workers from primary health care services in the Lisbon region, Portugal. Among those, 320 completed a structured questionnaire. Descriptive analysis and multiple linear regression analysis were used for the evaluation of data.ResultsMost participants did not agree that immigrant patients tend to behave like victims, but about half considered that some are aggressive and dangerous. Doctors and nurses showed more positive attitudes than office workers. Among doctors, the older ones reported less positive attitudes compared to the younger ones. Health workers who have less daily contact with immigrants revealed more positive attitudes. Most participants evaluated their knowledge and competencies to work with immigrants as moderate or low.ConclusionsAlthough health workers reveal positive attitudes, this study reinforces the need to develop strategies that prevent negative attitudes and stereotyping in health services. Efforts should be made to improve workers’ competencies to deal with culturally diverse populations, in order to promote quality of health care and obtain positive health outcomes among immigrant populations.

Factors associated with HIV testing among immigrants in Portugal

ObjectivesThis paper describes the uptake of HIV testing and its associated factors among a sample of immigrants in Portugal.MethodsA questionnaire was completed by 1,513 immigrants at the National Immigrant Support Centre, in Lisbon. The magnitude of the association between ever been HIV tested and socio-demographic variables was estimated by means of crude and adjusted odds ratios, and their 95% confidence intervals, using logistic regression.ResultsApproximately half of the participants reported having ever been HIV tested. Age, sex, educational level, region of origin, immigration status and knowing someone infected were independently associated with the HIV test uptake. Almost 90% of participants reported knowing where to obtain support on HIV-related issues. Most declared preferring doctors to get HIV information. However, only 9.2% had sought HIV information at the National Health Service.ConclusionsOur results suggest differences between migrant groups regarding HIV testing. Adopting more innovative approaches to HIV testing could improve the efficacy of HIV prevention strategies, especially among vulnerable groups within immigrant population as male and undocumented.

Risk-taking behaviours and HIV infection among sex workers in Portugal: results from a cross-sectional survey

Objectives Sex workers (SW) are key populations at an increased risk of HIV infection. This study aimed to characterise risk-taking behaviours and assess HIV prevalence among SW in Portugal. Methods A cross-sectional survey was conducted with 1040 SW using a participatory research approach. SW were recruited in sex-work locations and community-based organisation offices. Data were collected through a questionnaire with trained interviewers. An HIV rapid test was performed in 213 respondents. Results Reported HIV prevalence was 8%: 17.6% of man-to-woman transgenders, 7.4% of women and 5% of men. Of SW reportedly living with HIV, 52.2% reported ever injecting drug use. Inconsistent condom use with clients in the last month was higher among male SW (26.5%) and with non-paying partners in the last year was higher among women (71.3%). Among reported HIV-positive SW, the proportions of inconsistent condom use were high. In multivariate regression analysis, reported HIV infection remained significantly higher among transgenders (OR 6.4; 95% CI 1.7 to 24.3), those older (OR 5.1; 95% CI 1.3 to 21.1), working outdoors (OR 5.4; 95% CI 1.9 to 15.6), having ever used psychoactive substances (OR 4.1; 95% CI 2.2 to 7.7) and earning ≤€1000 per month (OR 2.6; 95% CI 1.2 to 5.9). Of those who had an HIV rapid test, 8.9% were reactive; 73.7% were unaware of their seropositivity. Conclusions The HIV infection burden in SW is high. Efforts to promote HIV testing must be sustained in order to reduce undiagnosed infection. The diverse risk profiles of SW must be addressed in targeted HIV interventions. Prevention interventions should be systematically implemented within most-at-risk subgroups of SW.

Impact of Socio-Demographic Factors on HIV Testing Among African Immigrants in Portugal

This study aimed to describe the proportion of HIV testing among an African immigrant population in Portugal and identify the socio-demographic factors that may be associated. A questionnaire was applied to 522 African immigrants (53% men) who attend the National Immigrant Support Centre, in Lisbon. Odds ratios (OR) with corresponding 95% confidence intervals (95% CI) were calculated through logistic regression to analyse the relationships between HIV testing and other variables. Around 52% of participants reported having been HIV tested, mostly women. After adjusting for potential confounders, age and educational level were significantly associated with HIV testing for both women and men. Searching for HIV information at NHS was also significantly associated with HIV testing, but only among men. This study points out interesting challenges for HIV prevention programs among African immigrants and may help in the development of tailored projects focused on the promotion of HIV testing among these populations.

HIV Risky Sexual Behaviors and HIV Infection Among Immigrants: A Cross-Sectional Study in Lisbon, Portugal

This study aimed to examine risky sexual behavior, its associated factors and HIV infection among immigrants. A participatory cross-sectional survey was conducted with 1187 immigrants at the National Immigrant Support Centre, in Lisbon (52.2% female; 34.0% Africans, 33.8% Brazilians, 32.2% Eastern Europeans). About 38% of participants reported ≥2 sexual partners in the previous year, 16.2% both regular and occasional sexual partners (last 12 months), 33.1% inconsistent condom use with occasional partners, and 64% no condom use in the last sexual intercourse. Unprotected sex in the last sexual intercourse was more likely among women, Africans, those older, with elementary education, those married and those who didn’t receive free condoms in the previous year. No condom use was less likely among those having only occasional sexual partners and both regular and occasional sexual partners. One third of participants had never been tested for HIV. Those never tested reported more frequently inconsistent condom use than those ever tested. Overall, 2.0% reported being HIV positive (2.5% of men; 4.4% of Africans); 4.3% admitted having a STI in previous year. HIV-positive immigrants reported high-risk sexual behaviors. Tailored interventions to promote awareness of HIV serostatus among immigrants as well as culturally adapted risk reduction strategies should be strengthened.

Avaliação dos cuidados de saúde: percepções de mulheres imigrantes em Portugal

Objectives: to describe the health care seeking behavior and perceptions relating to the use of health services of women immigrants residing in Portugal. Methods: in 2009 a cross-sectional study was carried out in the metropolitan area of Lisbon, in which a questionnaire was applied to a sample of 703 women immigrants. The questionnaire included items relating to social and demographic characteristics and the health care seeking behavior and perceptions of the participants regarding the use of services. A descriptive analysis of the variables under study was carried out. Results: most participants (82.4%) reported that they had already used the National Health Service (SNS), although this response was more frequent among Africans (94.5%) and East Europeans (87.2%) than among Brazilians (66.8%). Around 60% of respondents reported that they were satisfied or highly satisfied with the service, with the Africans responding in this manner more frequently (77%) than the Brazilians (49.7%) and East Europeans (43.4%). The groups of participants point to various obstacles to the use of health services, including issues related their status as immigrants, interaction with health professionals and the services provided. Conclusions: differences in the perceptions of immigrant groups regarding health services and professionals reflect the importance of developing evaluative practices that identify where intervention is needed. Knowing this would make it possible to better adapt the health care provided to specific immigrant groups.

HIV Research with Men who Have Sex with Men (MSM): Advantages and Challenges of Different Methods for Most Appropriately Targeting a Key Population

The difficulty in accessing hard-to-reach populations as men who have sex with men presents a dilemma for HIV surveillance as their omission from surveillance systems leaves significant gaps in our understanding of HIV/AIDS epidemics. Several methods for recruiting difficult-to-access populations and collecting data on trends of HIV prevalence and behavioural factors for surveillance and research purposes have emerged. This paper aims to critically review different sampling approaches, from chain-referral and venue-based to respondent-driven, time-location and internet sampling methods, focusing on its main advantages and challenges for conducting HIV research among key populations, such as men who have sex with men. The benefits of using these approaches to recruit participants must be weighed against privacy concerns inherent in any social situation or health condition. Nevertheless, the methods discussed in this paper represent some of the best efforts to effectively reach most-at-risk subgroups of men who have sex with men, contributing to obtain unbiased trends of HIV prevalence and HIV-related risk behaviours among this population group.

HIV Infection, risk factors and health services use among male-to-female transgender sex workers: a cross-sectional study in Portugal

ABSTRACT Male-to-female transgender sex workers (TSW) have been identified as a key population at risk for HIV. This study examined risk behaviors and HIV prevalence among TSW, and described health services use. A participatory cross-sectional survey was conducted with 125 TSW recruited in locations and networks where sex workers congregate. HIV-risk behaviors were common among participants. Inconsistent condom use with clients in the previous month was reported by 12.0% of participants and was associated with Portuguese nationality, inconsistent condom use with non-paying partners and not been reached by HIV prevention programs in the previous year. Ever use of psychoactive substances was reported by 61.6% of participants and was associated with being non-employed, doing full-time sex work, having higher number of non-paying partners and having never used health services. Also, ever use of psychoactive substances was negatively associated with older age and Portuguese nationality. About 34% of the participants reported having not been tested in the previous 12 months; 20.2% never used the health services. Overall, 14.9% (95%CI: 8.0–21.0%) reported being HIV-positive. Of those, 22.2% (95%CI: 1.0–43.5%) had unprotected sex with clients in the previous month, 26.7% (95%CI: 1.3–52.0%) had unprotected sex with non-paying partners in the previous year, 13.3% (95%CI: 0.0–33.0%) had ever injected drugs, 60.0% (95%CI: 23.0–97.0%) reported a past STI and 33.3% (95%CI: 2.0–64.6%) had currently HIV/STI co-infection. The socioeconomic, relational or partnering, and structural contexts conducive to increased risk are warranting further investigation. This knowledge would be valuable to inform prevention programs. HIV interventions, including secondary prevention, should address specific needs of TSW. Outreach initiatives aimed to reach TSW who are difficult to access can play a role in promoting access to health services and reducing HIV infection and transmission.

Health Policies, Patterns and Barriers to Migrants’ Access to Primary Health Care

Primary health care (PHC) should be a preferential way to access healthcare. Access to PHC is fundamental in terms of preventive medicine and an important health equity indicator. In Portugal, PHC has been continuously strengthened with an ongoing reform initiated in 2006. Although migrants are recognized as a group that tend to underuse preventive healthcare services, knowledge about patterns, determinants and barriers to migrants’ access and use PHC is still scarce. Using data from the National Health Survey we compare migrants’ access and utilization of PHC in 2005 and 2014. For the same time period, we explore the existing policies regarding migrants’ access to healthcare services and, more specifically to PHC. Through document analysis, we describe the main barriers to migrants’ access to PHC. Based on the results, we discuss how policies on migration and health, the economic crisis and PHC reform can explain access to PHC by migrants in Portugal. Resulting recommendations will inform policies and strategies that will promote access to PHC by migrants and reinforce preventive and health promotion initiatives among this population.