AIDS mortality in African migrants living in Portugal: evidence of large social inequalities

Abstract

Objective:To examine infectious disease and AIDS mortality among African migrants in Portugal, gender and socio-economic differences in AIDS mortality risk, and differences between African migrants to Portugal and to England and Wales.Methods:Data from death registrations, 1998–2002, and the 2001 Census were used to derive standardised death rates by country of birth, occupational class (men only), and marital status.Results:Compared with people born in Portugal, African migrants had higher mortality for infectious diseases including AIDS. There was considerable heterogeneity among Africans, with those from Cape Verde having the highest mortality. Death rates were more than five times higher among those who were unmarried than those who were. A larger proportion of Africans were unmarried accounting for some excess mortality. Death rates were also higher among men from manual occupational classes than among men from non-manual. A comparison with England and Wales shows that death rates for infectious disease and AIDS in Portugal are much higher and Africans in Portugal also fare worse than Africans in England and Wales.Conclusion:AIDS mortality rates were higher among Africans than those born in Portugal and were associated with socio-environmental factors. Further research is required to interpret the excess mortality among Africans and there is a need to ensure the inclusion of relevant data items on ethnicity in national monitoring and surveillance systems.

Factors associated with HIV testing among immigrants in Portugal

“…These strategies concurrently with the guarantee of free access to counselling, diagnosis and appropriate referral for populations that find it difficult to access formal health care services can promote the uptake of HIV testing. Nevertheless, the previously described high proportion of undiagnosed HIV infection and the late diagnosis in immigrant groups remain a significant challenge for health gain (Levy et al 2007;Williamson et al 2009). In our sample, the majority of the participants would use the NHS structures if they faced HIV-related issues and would prefer to get information about HIV from doctors.…”

“…This may be partly explained by the fact that undocumented migrants are more likely to report less utilization of health services (Derose et al 2007;Dias et al 2008) and evidence shows that the underuse of health services hinders the uptake of HIV test (Williamson et al 2009). Indeed, these immigrants may face obstacles in accessing HIV health services (Baptista-Gonçalves 2009).…”

“…Underutilization of HIV health services for prevention, testing and treatment has been identified as a factor that contributes to vulnerability (Chee et al 2005;Mykhalovskiy et al 2009;Shedlin and Shulman 2004). Knowledge on HIV testing among immigrants is limited and the available data suggests a wide variation across countries; nevertheless, they tend to present high rates of undiagnosed HIV infection and to utilize HIV health services at a later stage of disease (Burns et al 2007;Sinka et al 2003;Williamson et al 2009). …”

Country of Birth Does Not Influence Long-term Clinical, Virologic, and Immunological Outcome of HIV-Infected Children Living in the Netherlands

“…7,9,11,15 Without adjustment for these factors, African immigrants did have a shorter survival time and faster disease progression. [16][17][18][19] In NL, virologic failure during cART occurred more often in adult immigrants as compared with nonimmigrants, which was a potential result of different resistance patterns at cART initiation, different HIV subtypes, and differences in pharmacokinetics and therapy adherence. 13,20 The results of these adult studies imply that special attention-especially toward therapy adherence and virologic follow-up-may be warranted for immigrant HIV-infected populations in the industrialized world.…”

Mortality from infectious diseases among refugees and immigrants compared to native Danes: a historical prospective cohort study

“…(i) They may reflect increased morbidity owing to infectious exposure in countries of origin and also more advanced disease upon arrival. This could explain why individuals from regions with high prevalences of infectious diseases, such as North Africa (including Somalia) and sub‐Saharan Africa, have notably higher mortality risks (Williamson et al. 2009).…”