HIV/AIDS prevention in young migrants across Europe: the AIDS&Mobility Project

Authors: Maria Chiara Pajno, Raffaele Di Palma, Annalisa Marini, Ilaria Uccella, Vittorio Silano, Aldo Morrone

M.D. PhD Maria Chiara Pajno
National Institute for Health, Migrants and Poverty (NIHMP)
Via di S.Gallicano 25/a 00153 Rome, Italy
Tel.:+39 0658543739
Fax:+39 0645503114
e-mail: chiarapajno@libero.it

Key words: HIV, migrants, prevention; transcultural mediators.

Abstract
The present paper highlights the main aspects of the Community Project AIDS&Mobility, aimed at reducing vulnerability and susceptibility to HIV infection of young migrants (16-25 yy), currently increasing in several E.U. Member states, through communication/information initiatives carried out by transcultural mediators trained for such a task.
The project consists of six different work packages. National Institute for Health, Migrants and Poverty (NIHMP) is the leader of the “Internal Evaluation Package”. As a result more than 2,000 young migrants are expected to be reached by HIV/AIDS prevention campaigns planned in order to meet specific needs of different groups of migrants in each one of the seven participating Countries.

Background
The number of international migrants in the last four decades has increased from about 76 million in 1965 to 191 million in 2005 worldwide [1]. While in the past migratory flow was mainly from European Countries, in the last four decades Western Europe became place of immigration. People move from one place to another, now quickly than before, for several kind of reasons: economical, political, travel. These movements contribute to determinate a multi-ethnic society, where migrants and ethnic minorities coexist with local population.
HIV infection continues to represent one of the main public health issues worldwide; also in Europe the number of people who every year get infected with HIV continues growing[2]. In 2007, according to the HIV/AIDS Surveillance System in Europe, 48,892 new cases of HIV were diagnosed and higher rates of new infection were registered in Eastern European Countries even if some individual countries, such as Portugal, maintain a high rate of new diagnoses too[2]. From 2000 to 2007 an increase in the annual rate of new diagnosis of about 90% was observed. Although available statistical data do not equally cover all European Countries, due to persisting limitations of reporting systems in some countries, it is possible to say that HIV/AIDS epidemic is constantly increasing among European Union Countries. In contrast, from 1996, a decrease of the number of case of AIDS was registered, due probably to the HAART [2].
The HIV/AIDS epidemic in Europe progressively affects migrant population and ethnic minorities [3,4]. It is well known that mobile populations (migrants and ethnic minorities) are considered more vulnerable and more susceptible to HIV infection [5,6].
Several factors as inequalities, origin from a country with high prevalence of HIV/AIDS, social exclusion, language and socio-economic barriers made human mobile population more vulnerable and more susceptible to HIV infection. These groups are often subject to inequalities in the health service accessibility [7]: moreover, they tend to attribute less importance to their own health because of many constraints. Individual factors linked with migration may increase the risk of HIV; these are both of cultural and psychosocial nature, such as the loss of cultural individual identity beliefs, and behavioral, as changing in sexual habits [8]. Migrants moreover, due to language and cultural barriers, do not usually benefit from prevention intervention against HIV addressed to resident population. Furthermore, the difficult access to health care system for migrants and ethnic minorities often leads to a delay in the diagnosis and treatment with possible spread of the infection due to ignorance of their disease.
Especially among adolescent migrants spread of HIV is a major health topic requiring effective preventive policies.
In this frame, the AIDS&Mobility Project intends to develop a transferable method of HIV/AIDS prevention for migrants.

The project
The main purpose of the project is to reduce HIV vulnerability of migrants and mobile populations in Europe, considered as more vulnerable groups, through the development, implementation and promotion of appropriate measures and policies. Prevention among migrants, is considered to be the focal point to reduce the spread of HIV/AIDS in Europe. The project moves from the long experience of the AIDS&Mobility Network and is based on more than 20 Countries and migrant-based organizations across Europe.
The project aims at protecting the health of every person who, for several reasons, moves from one country to another (e.g. communities of immigrants, asylum seekers, refugees, travelers); it addresses, in particular, to young migrant population (16-25 yy), one of the most vulnerable groups. The project is, through five implementation steps, an attempt to improve health education of migrants through teaching sessions held by ad hoc trained transcultural mediators belonging to different migrant communities, Education by Migrants for Migrants (MiMi ); Transcultural Mediators System is recognized to be a highly effective approach as it takes into account large differences in migrants subgroups regarding risk and stigma; the Transcultural Mediator approach appears to be an “obvious” first step in working across the language barrier but it clearly goes beyond overcoming the simple language difficulties.
Above mentioned steps are as follows: I) Development of Guidebook and Curriculum; II) Recruitment of Mediators; III) Training; IV) Information Campaign; V) Evaluation and feedback (Fig 1). Evaluation will strengthen the approach and form a basis for professional development of health education in migrant communities.
The project started in 2008 and the first step of the implementation phase began in February 2009; the other four steps should be completed within August 2010.
The Ethno-Medical Centre in Hannover, Germany - Salman Ramazan in the capacity of Project Leader and Matthias Wienold in the capacity of Programme Director - is the leader of the project and coordinates and the following Partners: AIDS-Fondet (Denmark), AISC (Estonia), EATG (Germany), NIHMP (Italy), THT (UK), Yeniden (Turkey). Every Partner is responsible for one of the six work packages and participates to the others. Associated Partners will meet six times for face-to-face management.

Fig 1: Implementation steps

The contribution of NIHMP: the developing of the Work Package on Internal evaluation
In the frame of AIDS&Mobility Project, the National Institute for Health, Migrants and Poverty NIHMP has been requested to develop an effective approach to internally evaluate the appropriate running of the project and the satisfactory achievement of its objectives, in particular the effectiveness of HIV-prevention driven by transcultural mediators. Evaluation will be based on a systematic literature review of health education models and their application to HIV prevention to establish a common basis of reference of methods to determine effectiveness and efficacy of mediators trainings and community group sessions (with a focus on migrant youth); detailed mapping of the size of the population served; evaluation of development and implementation of training including extent to which knowledge and attitudes of transcultural mediators and their perceived capacity to work with migrants is influenced by the training; evaluation of qualitative and quantitative data generated from mediator trainings, community group sessions and certification events will be also carried out. Input, analysis and report on results of the feedback and extensive data provided through the system of community-based research will be included in a Report on systematic literature review of scientific literature and a Summary Report of Evaluation.
Expected outcomes
The training of transcultural mediators should start next September 2009 and finish at the beginning of 2010. The potential of the capacity building effects in migrant communities is demonstrated by the following trend graph (showing the sustainable character of the program). These effects are also expected for capacity building activities under the AIDS & Mobility umbrella. This estimate accounts for a family background of 2.2 individuals reached indirectly per participant in the community group sessions (Fig 2).

Fig 2: Evaluation of community involvement and four years projection

At the conclusion of the project more than 120 migrants will be recruited and trained as mediators acting in HIV prevention. In this way it is foreseen that more than 2000 young migrants will be reached by HIV/AIDS prevention campaign through community based group session. It is also expected an expansion to other countries and the enrollment of new partners and network in order to involve in the future an increasing number of migrants working for migrants in order to overcome all that barriers that impede an adequate health service access and health care for (HMP) mobile population. This approach could be recognized all over Europe and standardized to be promoted as central node in HIV prevention among migrants. This method, once recognized and standardized, could be a universal method used also in different fields of population education and integration. The NIHMP, constantly working with vulnerable groups of people through a transcultural approach to the health of the individual, is collaborating with the other Partners taking advantage of its long experience in the field of poverty and migration related diseases.

References
1. World Migration: 2008: Managing Labour Mobility in the Evolving Global Economy. International Organization for Migration (IOM), Janury 2009.
2. Van de Laar MJ, Likatavicius G, Stengaard AR, Donoghoe MC. HIV/AIDS surveillance in Europe: update 2007. Euro Surveill. 2008 Dec 11;13(50). pii: 19066.
3. Del Amo J, Broring G, Hamers F, Infuso A, Fenton K. Monitoring HIV/AIDS in Europe’s migrant communities and ethnic minorities. AIDS 2004; 18:1867-73.
4. Suligoi B, Boros S, CamoniL, Lepore D. Ferri M, Roazzi P. aggiornamento dei casi di AIDS e delle nuove diagnosi di HIV in Italia. Not Ist Super Sanit, 2006; 19(6) Suppl 1:1-23.
5. UNAIDS. HIV and refugees. Policy brief; 2007.
6. Anderson J. Coming and going: some aspects of care for migrants with HIV in the UK. J Infect. 2008 Jul;57(1):11-5. Epub 2008 Jun 9
7. Kawachi I, Berkman LF. Social cohesion, social capital and health. Social epidemiology 2000: 174-90.
8. Migration and HIV prevention programmes: linking structural factors, culture, and individual behavior-an Israeli ewperience. Soskolne V, Shtarkshall RA. Soc Sci Med. 2002 Oct;55(8):1297-1307.