Assessing the Risk of HIV and Hepatitis C among Internally Displaced Persons in Georgia

Abstract

Background: Georgia is leading one of the world's first hepatitis C (HCV) elimination programs alongside interventions to combat a HIV epidemic concentrated among high-risk groups. Although progress has been substantial, neither strategy accounts for the nearly 150,000 internally displaced persons residing in collective centers (CC-IDPs) who are susceptible to deeply integrated risk environments that could promote infection. Achieving dedicated goals for HCV elimination and HIV suppression requires a clear understanding of the risks facing CC-IDPs. Objectives: This literature review aims to consolidate what is known about the socioeconomic and physical/mental health status of IDPs living in collective centers in Georgia, and to assess their vulnerability to HIV and HCV in light of local and global epidemiological trends. Methods: Sources were compiled from journal publications, reports by government ministries and transnational organizations, and the Integrated Household Survey database (2009-2018; updated annually by the National Statistics Office of Georgia) through manual searches in PUBMED, Google Scholar and Search, ProQuest, and digital repositories of government offices. Findings: Reports indicate that CC-IDPs are more susceptible to poverty, poor living conditions, mental illness, disability, substance use, and in some cases infectious disease; although, the correlation is not always present and subject to variability. These factors were linked to increased transmission and acquisition of HIV/HCV in both displacement and non-displacement contexts abroad. The geographic concentration of HIV/HCV in areas with greater clusters of CC-IDPs, and shared characteristics with local high-risk groups, indicate the possibility of inordinate transmission among CC-IDPs in Georgia. Conclusions: The disproportionate prevalence of psychosocial and clinical harms among CC-IDPs testifies to the serious potential of a greater burden of HIV and hepatitis C. Going forward, targeted research is needed to inform interventions and clarify the health status of CC-IDPs in Georgia.

Understanding the health needs of internally displaced persons: A scoping review

“…Poor living conditions may also facilitate transmission in some IDP populations. In Georgia, one study suggested a geographic concentration of HIV and hepatitis infection in areas with greater clusters of IDPs residing in collective centres with poor living conditions ( Elbaz, 2020 ).…”

Unified European support framework to sustain the HIV cascade of care for people living with HIV including in displaced populations of war-struck Ukraine

“…Ensure the identification of people with HIV, considering Ukrainian key populations with a high HIV prevalence [38][39][40][41][42] Registration of patients (including refugees) in need of ART; a proactive approach by health-care providers to identify those with HIV in key populations and overcome stigma; sufficient operational HIV expert teams on the ground; medical outreach teams to reach remote areas or areas without operational clinics because of warfare…”

“…Studies have shown that the HIV prevalence in people displaced from HIV endemic settings is high. [38][39][40][41] With the focus of the war now in the eastern, southern, and central parts of Ukraine, the population of people with some of the highest HIV infection rates in the country is affected and deprived of access to harm-reduction programmes, resulting in a high chance of viral spread because of migration internally and internationally. 10,62 Convincing evidence exists that adequate HIV treatment and linkage to care programmes are effective during war, and HIV networks should support implementing these initiatives, regardless of the local situation.…”

Left behind on the path to 90‐90‐90: understanding and responding to HIV among displaced people

“…Research on displaced people in Malaysia and Kenya showed that intervention to increase individual's resilience and reduce food and health insecurities might help improve ART adherence [74]. Furthermore, both people with a history of displacement and PLWH are more likely to have symptoms of depression and anxiety [52,53], which can be another barrier to treatment adherence [40,75].…”

“…Poor psychosocial health and mental wellbeing arising from the traumatic events many displaced people have experienced [52,53] and exacerbated by discrimination, barriers to social and economic inclusion, and difficulties accessing healthcare services [5,13] may be associated with HIV risk behaviours, particularly sexual risky behaviours, such as less frequent condom use, among forced migrants [18,54]. Alcohol and drug use can be a form of coping with traumatic experiences and other stressors in contexts of displacement [55], which can in turn increase the probability of engaging in behaviours that increase HIV risk [53].…”