|
Conference Proceedings 2000
Findings On Reproductive Health Of Refugees
And Displaced Populations
Washington DC | December 5-6, 2000
HIV/STDs - What Do We Know and What Can We Do?
| Moderator: Brad Woodruff, Centers for Disease Control and Prevention |
Presentations:
Meriwether
Beatty |
Reproductive health KAP survey amongst refugees in Guinea: Findings
concerning STIs & AIDS |
| Luke Mullany |
HIV/AIDS awareness among Burmese migrant factory workers along the
Thai/Burma border, Tak Province, July 2000 |
| Nipaporn Intong |
Increased condom practice in the refugee population, Nu Po camp
in Thailand |
|
| Reproductive health KAP survey amongst refugees in Guinea: Findings
concerning STIs and AIDS
Abstract revision date: December 5-6, 2000
|
| Authors |
Anna v. Roenne, Deutsche Gesellschaft für Technische Zusammenarbeit
(GTZ)
Sarah Kollie, Reproductive Health Group
|
| Presenter |
Meriwether Beatty, JSI Research and Training Institute
|
| Background |
The Reproductive Health Group (RHG) is a refugee NGO providing RH services
for Sierra Leonean and Liberian refugees in Guinea since 1995.
|
Purpose of study
or program |
RHG conducted a survey amongst a representative sample of Sierra Leonean
and Liberian refugees living in camps in Guinea's Forest Region to explore
their knowledge, attitudes and practices in relation to family planning,
STIs and AIDS and antenatal and delivery services. This paper presents
the findings in relation to STIs and AIDS.
|
Data collection
methods |
A cluster sample of refugees of reproductive age (15-49 years) was
interviewed in their homes, using a 14-page questionnaire developed on
the basis of validated questionnaires. 895 valid observations resulted,
and univariate and bivariate statistical analyses were performed.
|
Study or
program findings |
Most respondents had heard about these reproductive health problems
(STIs: 91%, AIDS: 88%). They knew that faithfulness (93% for STIs, 96%
for AIDS) and condom use (92% for STIs, 93% for AIDS), as well as the use
of clean needles for injections (94%) are effective ways of preventing
transmission. At the same time, various misconceptions were prevalent,
including a belief in HIV transmission through mosquito bites (54%) or
public toilets (44%), as well as concerns that touching (26%) or sharing
food (30%) with people with AIDS might cause infection.
Health facilitators, i.e. refugee women trained
and supervised by RHG, were named as the most important source of information
about STIs/AIDS (56%) and their users were significantly better informed
about these health problems than respondents using other sources of information.
26.7% of refugees stated that they had suffered
genital discharge and/or genital ulcers during the past 12 months. The
majority (78%) had sought advice at a health facility, yet even more (82%)
had bought medication at private pharmacies, highlighting the chronic lack
of STI drugs at health facilities.
Gender patterns emerged in relation to reported
changes in sexual behaviour during STI episodes or in response to the AIDS
threat. Although women are equally well informed about STIs, better informed
about AIDS and see themselves at greater risk to 'catch AIDS,' they are
less likely than men to report changes in their sexual behaviour. It is
hypothesized that women's lack of control over their sexuality prevents
them from acting upon their knowledge.
|
Conclusions
and program
implications |
Program implications include focused IEC messages to combat misconceptions
about STIs and AIDS, highlighting the alarming STI prevalence and the chronic
lack of the necessary drugs as well as the need to develop gender-specific
interventions that allow women to protect themselves from STIs/AIDS.
|
For further
information |
Sarah Kollie, RHG, c/o UNHCR, Monrovia, Liberia
Anna v. Roenne: gtz-guinea@gn.gtz.de |
|
| : |
| HIV/AIDS awareness among Burmese migrant factory workers along the
Thai/Burma border, Tak Province, July 2000
Abstract revision date: December 5-6, 2000
|
| Authors |
Cynthia Maung, Director, Mae Tao Clinic, Mae Sot, Thailand
Luke Mullany, Johns Hopkins School of Public Health
Aung Tun, Health Program Director, National Health and Education Committee
(NHEC)
Po Thaw Dah, Burma Medical Association (BMA)
|
| Presenter |
Luke Mullany
|
| Background |
Over 1 million Burmese migrant workers currently live along the Thai/Burma
border having fled oppression in Burma. Thousands find work in factories,
shops, farms, construction projects and restaurants, where they are vulnerable
to exploitation through low wages and harsh working conditions. Their legal,
social and economic situation prevents access to basic social services,
including health care and education, and has led to high-risk sexual and
social behavior.
|
Purpose of
study or program |
Little information has been systematically gathered on either the prevalence
of HIV virus infection or the level of knowledge within this sub-population
concerning risk factors, prevention and/or transmission of HIV. The Burma
Medical Association (BMA) and National Health and Education Council (NHEC)
designed an HIV/AIDS education pilot project outside the Mae Sot municipal
area (Tak Province, Thailand) in collaboration with Thai Public Health
officials.
|
Data collection
methods |
A survey was carried out in 8 factories to provide an outline of general
and specific HIV/AIDS knowledge levels among migrant workers and to assist
in the design and implementation of the peer-education training curriculum.
Workers were questioned about their knowledge of prevention, transmission
and risk factors of HIV infection. The sampling of interviewees may not
have been completely random as factory owners excluded the HIV/AIDS working
group from the selection process.
|
Study or
program findings |
Responses were grouped into prevention, transmission and risk categories,
and the percentage answered correctly in each category was recorded for
all participants. Men consistently scored higher than women in each category,
with significant gender differences in the prevention and transmission
questions. Only 26.5% of respondents knew that they needed to have their
blood tested to learn their HIV status. 15% of females reported ever seeing
a condom and only 41% of the women understood that contraceptive pills
do not prevent infection. Men were eight times more likely than women to
report using a condom at least once (12.7% vs 1.7%, p<.00001).
|
Conclusions
and program
implications |
Caution must be used when interpreting these results because of the
sensitivity of the questions and the relative unfamiliarity of the interviewees
in being questioned by their peers. However, the results remain important
as virtually zero access has been extended to persons trying to document
health status or education in migrant worker factories. The survey reveals
a significant lack of knowledge about HIV and suggests the need for an
extensive broad-based educational curriculum, with messages specifically
tailored to the sexes. Varying levels of knowledge indicate areas that
need to be stressed during the training of peer-educators.
|
For further
information |
Luke Mullany, 904 St. Paul St. 1B, Baltimore, MD 21202
USA
Telephone 410-659-9894
Email mullany@jhsph.edu
|
|
| Increased condom practice in the refugee population, Nu Po camp
in Thailand
Abstract revision date: December 5-6, 2000
|
| Authors |
Nipaporn Intong, American Refugee Committee, Thailand
|
| Presenter |
Nipaporn Intong
|
| Background |
Nu Po camp is a Karen refugee camp on the Thai-Burma border with about
8,200 refugees. The refugees are those who fled to Thailand from the Burmese
army offense in their villages in 1997. The reproductive age group (15-45
years) comprises 46% of the population. Condom practice among this group
is a priority given the HIV/AIDS situation in Thailand, Burma and the refugee
camps. The attitudes of the refugees toward condom use, the denial of HIV/AIDS
infection in the camp and the opposition of the camp committee on condom
education were program challenges. To overcome these challenges, a variety
of theoretical perspectives in health education were drawn upon to guide
the program's condom promotion activities.
|
Purpose of study
or program |
The purposes of this program were to increase condom practice and to
change attitudes among refugees in the camp in preventing HIV/AIDS transmission.
|
Data collection
methods |
Information was gathered to plan and conduct condom promotion activities.
Personal interviews, survey, focus group, program document review and community
observations were conducted during the pre-assessment. A surveillance system
was developed to record/collect condom distribution by area, gender and
marital status. New and old users were also recorded. Data were used to
monitor and evaluate program implementation.
|
Study or program
findings |
The results of the pre-assessment showed that refugees would accept
condoms as a choice of contraceptive method. Condoms were more acceptable
when distributed to married couples and for family planning purposes. Talking
about condoms to prevent HIV/AIDS infection caused a negative reaction
and was embarrassing because of the conservative culture. Many women believed
strongly that their husbands were faithful and honest; they did not realize
that some of the men were practicing high-risk behaviors such as drug and
alcohol abuse and experimental sex. Some refugees did not understand that
condoms could protect them from HIV/AIDS/STDs, besides preventing unwanted
births. Some understood the health benefits, but denied using condoms because
of the associated stigma. The survey found only 33 out of 1,214 couples
(7.7%) who used condoms. The refugees felt comfortable talking about and
asking for condoms from the community health educator (CHE) in their sections.
The use of condoms increased from 0 to 39 people in the year 1999, according
to family planning service records. In addition, refugees who stopped using
pills and DepoProvera started using condoms.
|
Conclusions and
program implications |
Seven activities were undertaken: (1) staff training, (2) community
condom distribution, (3) group discussion about condom practice, (4) community
health education and promotion, (5) community health meetings to raise
awareness of condom practice, (6) family planning counseling and (7) epidemiological
surveillance. Post-implementation results showed some changes. Approximately
398 refugees (10.6%) were using condoms and more than 7,000 condoms had
been distributed from February 1999 to August 2000. The percentage of persons
using condoms increased by about 10% from the beginning of the implementation.
Refugees now are more familiar with condoms and openly talk about them.
Any refugee who needs condoms can easily get them from community health
education workers providing culturally sensitive services in every section
of the camp.
|
For further
information |
Ms. Nipaporn Intong, American Refugee Committee, P.O. Box 7, Umphang
Tak 63170 Thailand
Telephone and Fax 6655 561-177
Email: arcumpha@loxinfo.co.th
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