HIV spreads fastest in conditions of poverty, powerlessness and social instability - conditions which many refugees can find themselves in. Probably among the most unprotected groups in their original home countries, the health status of many refugees can often reflect HIV prevalence there. In the UK, refugees appear to be poorly reached by official HIV prevention and health promotion services. Worries over day-to-day survival often overshadow their outlook towards HIV-related issues. Many refugees feel that attitudes to HIV are racist. The study, carried out by the Health and Education Research Unit, Institute of Education, University of London, and sponsored by the Ethnic Minorities Unit of the UK Department of Health assessed the HIV health promotion needs of refugees. What (they asked)are the main blocks to HIV education and prevention among Britain's refugee communities and what kinds of initiatives appear most likely to involve them in the future?

From among the UK's existing refugee and asylum seeker population, 22 people from refugee communities, health service networks and NGO contacts were interviewed to identify key issues. Meetings with refugee organisations helped identify what refugees themselves felt stood in the way of better HIV prevention. Specific needs and concerns of 10 refugee communities were identified. Then 10 local HIV projects were chosen as case studies and examined in detail to establish aims, experiences,

Barriers to HIV education were found to include more immediate health worries, including mental health problems and a sense of alienation from host communities. Health promotion literature portraying HIV as an African disease, intensified fears of discrimination. Refugees also worried that HIV-positive status might mean immigration authorities would be less likely to let them stay. From the case studies and surveys, strong evidence emerged that the HIV prevention needs of refugees deserve special recognition, including:

• information about HIV prevention more closely related to refugees' own concerns and circumstances
• extra attention to concerns of specific groups such as women, men who have sex with men and young people
• assurances for refugees that they can rely on confidential handling of their case.

Campaigns for improving HIV prevention among refugees will be improved if they:

• consider the different and special needs of each focus community and sub-groups within it
• involve local communities and existing local organisations that command their trust
• tackle cultural stigma and discrimination directed at and within refugee communities.

The report suggests health officials may gain more from HIV prevention campaigns if they:

• make application forms for funding of local groups simpler and provide adequate technical backup
• attend to special community needs and heed differences between and within refugee communities
• ensure actions are not racist and do not further exclude isolated groups within communities
• integrate HIV prevention campaigns with other services seeking to involve refugee groups.

Source(s):
`An assessment of HIV prevention interventions with refugees and asylum seekers with particular reference to refugees from the African continent.` Report commissioned by Ethnic Minorities Unit, Department of Health, UK from the Health and Education Research Unit, Institute of Education, University of London. By K. Maharaj, I. Warwick et al. (1997)

Funded by: Ethnic Minorities Unit, Department of Health UK

id21 Research Highlight: 1998-November-06

Further Information:
Ian Warwick
Associate Director
Health and Education Research Unit
Institute of Education
University of London
55-59 Gordon Square
London WC1H ONT
UK

Tel: + 44 (0) 171 612 6820
Fax: +44 (0) 171 612 6819
Contact the contributor: i.warwick@ioe.ac.uk

Health and Education Research Unit