Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, USA.
Public Health Discipline, Burnet Institute, Melbourne, Victoria, Australia.
J Int AIDS Soc. 2022 Nov;25(11):e26031. doi: 10.1002/jia2.26031.
INTRODUCTION: In 2021, the number of people affected by displacement worldwide reached the highest on record, with an estimated 30.5 million refugees and 4.6 million asylum seekers seeking safety across international borders and further 53.2 million people displaced within their countries of origin. Most forcibly displaced persons come from or relocate to lower- and middle-income countries (LMICs) and many of those countries have large HIV epidemics. In this commentary, we describe some of the challenges at the intersection of HIV and displacement vulnerabilities that cannot be easily addressed in resource-limited environments. DISCUSSION: HIV transmission and prevention and treatment efforts in the context of displacement are affected by myriad behavioural, social and structural factors across different stages of the displacement journey. For example, structural barriers faced by people experiencing displacement in relation to HIV prevention and care include funding constraints and legal framework deficiencies. Such barriers prevent all forced migrants, and particularly those whose sexual identities or practices are stigmatized against, access to prevention and care equal to local residents. Xenophobia, racism and other social factors, as well as individual risky behaviours facilitated by experiences of forced migration, also affect the progress towards 90-90-90 targets in displaced populations. Current evidence suggests increased HIV vulnerability in the period before displacement due to the effect of displacement drivers on medical supplies and infrastructure. During and after displacement, substantial barriers to HIV testing exist, though following resettlement in stable displacement context, HIV incidence and viral suppression are reported to be similar to those of local populations. CONCLUSIONS: Experiences of often-marginalized displaced populations are diverse and depend on the context of displacement, countries of origin and resettlement, and the nature of the crises that forced these populations to move. To address current gaps in responses to HIV in displacement contexts, research in LMIC, particularly in less stable resettlement settings, needs to be scaled up. Furthermore, displaced populations need to be specifically addressed in national AIDS strategies and HIV surveillance systems. Finally, innovative technologies, such as point-of-care viral load and CD4 testing, need to be developed and introduced in settings facing displacement.
引言:2021 年,全球受流离失所影响的人数达到历史最高水平,估计有 3050 万难民和 460 万寻求庇护者跨越国际边界寻求安全,另有 5320 万人在原籍国内流离失所。大多数被迫流离失所者来自或迁往中低收入国家(LMICs),其中许多国家存在大规模的艾滋病毒流行。在本评论中,我们描述了艾滋病毒和流离失所脆弱性交叉点的一些挑战,这些挑战在资源有限的环境中不易解决。
讨论:在流离失所背景下,艾滋病毒的传播和预防以及治疗工作受到在流离失所旅程的不同阶段存在的无数行为、社会和结构性因素的影响。例如,在艾滋病毒预防和护理方面,经历流离失所的人面临的结构性障碍包括资金限制和法律框架缺陷。这些障碍使所有被迫移民,特别是那些性身份或行为受到歧视的人,无法获得与当地居民平等的预防和护理。仇外心理、种族主义和其他社会因素以及被迫移徙带来的个人危险行为也影响到在流离失所人群中实现 90-90-90 目标的进展。目前的证据表明,由于流离失所驱动因素对医疗用品和基础设施的影响,在流离失所之前,艾滋病毒易感性增加。在流离失所期间和之后,艾滋病毒检测存在很大障碍,但在稳定的流离失所环境中重新安置后,艾滋病毒发病率和病毒抑制率据报告与当地人群相似。
结论:经常被边缘化的流离失所者的经历是多样化的,取决于流离失所的背景、原籍国和重新安置国以及迫使这些人流动的危机性质。为了解决流离失所环境中艾滋病毒应对方面的当前差距,需要在中低收入国家(LMICs),特别是在不太稳定的重新安置环境中,扩大研究规模。此外,需要在国家艾滋病战略和艾滋病毒监测系统中专门解决流离失所者的问题。最后,需要在面临流离失所的情况下开发和引入即时护理病毒载量和 CD4 检测等创新技术。
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