The Global Burden of HIV
The HIV/AIDS pandemic remains one of the most serious global health challenges today [2,3]. More than 30 million people were living with HIV at the end of 2007, with approximately 2.1 million deaths annually due to AIDS . In addition, an estimated 2.7 million new HIV infections occurred in 2007 . 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, HIV/AIDS disproportionately affects certain vulnerable population groups, such as young adults, women, and children.
Refugees and HIV infection
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. Although the link between HIV and migration is complex and nonlinear, multiple factors heighten the HIV risk for refugees. 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]. However, few studies have been performed that document actual increased risk behaviors in specific refugee populations . 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]. Even when VCT is available, many barriers may exist for refugee populations that make testing less accessible (e.g., mistrust in how asylum countries may use information, difficulty in maintaining confidentiality in refugee settings) .
Approximately 14% of the incoming refugees to the U.S. arrive from countries with HIV prevalence [9,10,11]. These figures are based on country-specific HIV prevalence data from the end of 2006 and may underestimate true infection rates because of underreporting or lack of surveillance data. In addition, prior to resettlement, refugees may have traveled to or lived in other countries with high HIV prevalence rates. Refugees may also have been victims of physical and sexual violence and may be at risk of HIV acquisition through rape, drug use, blood product transfusions, or other medical procedures leading to infection [12,13,14]. Disclosure of these exposures may not be forthcoming during initial intake assessments. It is imperative that a scientific and rational approach to the screening, diagnosis, support, and care of these individuals be developed and implemented.
Pre-departure medical screening and HIV screening during the domestic medical screening examination (CDC Immigrant and Refugee Health)
Source: CDC Immigrant and Refugee Health
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