sub-Saharan Africa Migrants Research Articles

Factors Associated with Psychological Distress during COVID-19: A Cross-Sectional Study of Sub-Saharan African Migrant Workers across Australia and Canada.

Objective: Ensuring the sustainability of the migrant workforce requires a comprehensive understanding of the psychological challenges faced by this sub-population due to concerns about the wellbeing and financial situation of family members in their home countries. Therefore, this study investigates the factors associated with psychological distress among sub-Saharan Africa (SSA) migrant workers across Australia and Canada during the COVID-19 pandemic. Method: Data were collected from 378 first-generation migrant workers with SSA ancestry residing in Australia and Canada using the Depression Anxiety and Stress Scale 21 (DASS-21). Multivariate logistic regression analysis was used to determine socio-demographic factors associated with depression, anxiety, and stress among SSA migrants' populations. Results: Across both countries, migrants with lower levels of education were more prone to reporting feelings of depression, anxiety, and stress during the pandemic. Female participants in Australia were more likely to report feeling of depression. Participants in Australia and Canada who were separated/divorced/widowed were less likely to report stress and depression, respectively. Participants in Australia who had lived in Australia between 11 and 20 years and those between 36 and 50 years old were more likely to report feelings of depression. Participants residing in Australia whose SSA ancestry was Southern Africa/Central Africa were more likely to report anxiety. Participants in Australia who worked as part-time permanent workers and those who worked as fixed-term workers/short-term/casual workers were less likely to report anxiety. Finally, participants in Canada who reported two or more people living with them had higher odds of reporting anxiety. Conclusions: The findings from this study highlight key factors associated with SSA migrant workers' psychological distress during the pandemic. The results can inform policies and provide insight to the development of mental health intervention strategies for migrant workers to minimize similar distress during pandemics.

Presumptive treatment or serological screening for schistosomiasis in migrants from Sub-Saharan Africa could save both lives and money for the Italian National Health System: results of an economic evaluation.

Schistosomiasis can lead to severe irreversible complications and death if left untreated. Italian and European guidelines recommend serological screening for this infection in migrants from Sub-Saharan Africa (SSA). However, studies on clinical and economic impact of this strategy in the Italian and European settings are lacking. This study aims to compare benefits and costs of different strategies to manage schistosomiasis in migrants from SSA to Italy. A decision tree and a Markov model were developed to assess the health and economic impacts of three interventions: (i) passive diagnosis for symptomatic patients (current practice in Italy); (ii) serological screening of all migrants and treating those found positive and (iii) presumptive treatment for all migrants with praziquantel in a single dose. The time horizon of analysis was one year to determine the exact expenses, and 28years to consider possible sequelae, in the Italian health-care perspective. Data input was derived from available literature; costs were taken from the price list of Careggi University Hospital, Florence, and from National Hospitals Records. Assuming a population of 100 000 migrants with schistosomiasis prevalence of 21·2%, the presumptive treatment has a greater clinical impact with 86.3% of the affected being cured (75.2% in screening programme and 44.9% in a passive diagnosis strategy). In the first year, the presumptive treatment and the screening strategy compared with passive diagnosis prove cost-effective (299 and 595 cost/QALY, respectively). In the 28-year horizon, the two strategies (screening and presumptive treatment) compared with passive diagnosis become dominant (less expensive with more QALYs) and cost-saving. The results of the model suggest that presumptive treatment and screening strategies are more favourable than the current passive diagnosis in the public health management of schistosomiasis in SSA migrants, especially in a longer period analysis.

Human urogenital schistosomiasis in West and Sub-Saharan Africa migrants in Sardinia, Italy: A retrospective monocentric study.

Schistosoma (S.) haematobium is the aetiological agent of urogenital schistosomiasis endemic in Sub-Saharan Africa and the Middle East. Microhaematuria is strongly associated with schistosomiasis diagnosis. Praziquantel (PZQ) is the treatment of choice. We conducted a monocentric survey among African migrants from January 2017 to December 2018. The diagnosis of S. haematobium was performed by direct microscopic examination of urine. The treatment was PZQ 40 mg/Kg/die for three days. We enrolled 91 male patients with a median age of 20.2 years (IQR 18.9-23.4)]. Forty-five (49.5%) described a history of haematuria. Sixteen (17.6%) evidenced the presence of red blood cells (RBCs) during urine microscopy. Eighteen (19.8%) had urogenital schistosomiasis. Their median white blood count (WBC) was 5.15 x 109/L (IQR 4.45-6.08) and it was 6.37 x 109 /L (IQR 5.14-8.27), p = 0.009, after 15 days from treatment. Baseline eosinophil count was 0.5 x 109/L (IQR 0.3-0.6) and 0.7 x 109/L (IQR 0.2-1.9; p = 0.032). According to the univariate analysis, origin from Mali [odds ratio (OR) 3.6 (CI 1.2-10.9), p = 0.022] and microscopic evidence of RBCs [OR of 10.7 (CI 2.5-45.1), p = 0.001] were main predictors of urogenital schistosomiasis diagnosis. One (5.6%) treatment failure was registered. Three (16.7%) patients had bladder cancer. Detection of RBCs was a significant predictor of S. haematobium infection and could be used as a screening method in migrants coming from endemic areas. Early urogenital schistosomiasis diagnosis and ultrasound diagnostic tools are crucial for reducing the risk of potential neoplastic evolution.

Predictors for HIV testing among Chinese workers in infrastructure construction enterprises in Kenya

BackgroundThere are increasing Chinese migrants in sub-Saharan Africa currently. Most of them are engaged in infrastructure construction. Research has shown that they stay at particular risk of HIV and are recommended for HIV testing. However, their HIV testing behavior, and its relevant factors, have not been researched among them by now. This study describes the recent HIV testing behavior and relevant factors among Chinese migrant workers in Kenya.MethodsA cross-sectional survey was conducted among 110 male Chinese workers from six different Chinese infrastructure construction enterprises in Kenya. Furthermore, a two-stage cluster random sampling method was used to select participants. We used a questionnaire that included HIV testing history, demographic characteristics, and putative multilevel facilitators of HIV testing. Logistic regression was used to explore the predictors of recent HIV testing behavior among Chinese migrant workers in Kenya.ResultOf the 110 participants, 30 (27.27%) were tested for HIV in the recent year. All participants were male, and the majority were married (73.2%). The mean age was 37.49 years (SD = 9.73; range: 23 to 63), and a considerable proportion refused to answer questions about transactional sexual behaviors in the last year. Most were able to obtain HIV-related information (91.8%) and were exposed to HIV-related information in the last year (68.2%), but only 47.6% had sufficient HIV knowledge. Nearly one-fifth of them believed that selling sex and paying for sex is acceptable. Multiple logistic regression analysis indicated that participants who could accept the ‘pay for sex’ (OR: 2.74; 95% CI: 1.02, 7.36) and exposed to HIV related information (OR: 4.75; 95% CI: 1.29, 17.44) were more likely to test for HIV in the recent 1 year.ConclusionHigher current HIV test rates were associated with a more open sexual attitude towards paying for sex and being exposed to HIV-related information in the last year among Chinese workers in Kenya. More specific attention to HIV should be attached to this population to increase the rate of HIV testing among them.

Impacts of Covid-19 on Migration Dynamics and Remittances in Sub-Saharan Africa (SSA)

The paper therefore x-rays the impacts of the COVID-19 pandemic on migration dynamics by analyzing types and trends dynamics of migrants’ movement, demographic dynamics of migration as related to the inflow of remittances (both cash and in-kind) to SSA countries prior to the pandemic. Also discusses the constraints of transferring cash remittances and subsequent decline posed by the COVID-19 outbreak during and beyond the pandemics. Secondary evidence from Somali and Nigeria were analyzed on the constraints of remitting cash, while in-kind remittance from the Republic of Chad was evaluated. The importance of remittances to the home communities was established. Measures to safeguard SSA migrants’ mobility and their remittances, citing some selected countries of destination, were exploited. The paper concludes that COVID-19 impacts on migration should be opportunities for policymakers (both home and destination countries) to reset their efforts towards protecting migrants and their future activities.

Prevalence of Untreated HIV and Associated Risk Behaviors Among the Sexual Partners of Recent Migrants and Long-term Residents in Rakai, Uganda.

Migrants in sub-Saharan Africa are at increased risk of HIV acquisition after migration, but little is known about their sexual partners at place of destination. Rakai Community Cohort Study (RCCS) in Uganda. From 1999 to 2016, persons aged 15-49 years were surveyed in the RCCS and reported on their 4 most recent sexual partners in the last year. We compared the characteristics of sexual partners reported by migrants moving into RCCS communities in the last 2 years (ie, in-migrants) with those of long-term residents with no recent migration history. Among a subset of participants in cohabitating epidemiologically linked couples of known HIV serostatus, we also assessed prevalence of having ≥1 untreated HIV-positive partner among in-migrants and long-term residents. One hundred sixteen thousand seven hundred forty-four sexual partners were reported by 29,423 participants. The sexual partnerships of in-migrants were significantly less likely to be marital, more likely to span community boundaries, and shorter in duration than those of long-term residents. In-migrants also reported more sexual partners and were less likely to know their partner's HIV status or to have told their partner their HIV status. Among 7558 epidemiologically linked couples, HIV-negative in-migrants were more likely to partner with untreated HIV-positive persons compared with HIV-negative long-term residents (women: 6.3% vs. 4.1%; prevalence risk ratio = 1.77, 95% confidence interval: 1.49 to 2.11; men: 6.9% vs. 3.9%; prevalence risk ratio = 1.72, 95% confidence interval: 1.38-2.14). There is a higher frequency of risky sexual behaviors among the partnerships of in-migrants compared with those of long-term residents. Among cohabitating couples, in-migrants are more likely to partner with untreated HIV-positive individuals.

C-reactive protein and hypertension among Ghanaian migrants and their homeland counterparts: the Research on Obesity and Diabetes among African Migrants study.

Background:Hypertension (HTN) is a growing public health problem in sub-Saharan Africa (SSA) and SSA migrants in Europe. Elevated levels of inflammatory marker C-reactive protein (CRP) have been linked to HTN but the relationship of CRP and HTN among SSA populations has not been studied. To address this knowledge gap, we studied the association between CRP and HTN in migrant and nonmigrant SSA populations residing in different settings.Methods:Cross-sectional data from the multicentre Research on Obesity and Diabetes among African Migrants (RODAM) study were analysed including 5683 Ghanaians aged at least 18 years, residing in rural and urban Ghana, and Europe. Multivariate logistic regression analyses were used to assess the association between high levels of CRP (≥3 mg/l) and HTN (SBP ≥140 mmHg and/or DBP ≥90 mmHg and/or use of antihypertensive medication) per geographical site and sex.Results:The association between CRP levels and HTN varied by sex and geographical location. In age-adjusted models, there was an association between high CRP levels and HTN in urban-Ghanaian women (odds ratio 1.50, 95% confidence interval 1.10–2.03), and European-Ghanaian men (1.68, 1.16–2.43) and women (1.63, 1.28–2.07). However, these associations were attenuated after adjustment for conventional risk factors, especially BMI. No association was found in rural-Ghanaians or urban-Ghanaian men.Conclusion:Our findings show an association between CRP and HTN among Ghanaian migrants and urban-Ghanaian women, however, this was largely explained by conventional risk factors. Thus, prevention of conventional risk factors, in particular obesity, may help to reduce the potentially low-grade inflammatory mechanism underlying HTN.

‘This is what is going to help me’: Developing a co-designed and theoretically informed harm reduction intervention for mobile youth in South Africa and Uganda

ABSTRACT Young migrants in sub-Saharan Africa are particularly vulnerable to HIV-acquisition. Despite this, they are consistently under-served by services, with low uptake and engagement. We adopted a community-based participatory research approach to conduct longitudinal qualitative research among 78 young migrants in South Africa and Uganda. Using repeat in-depth interviews and participatory workshops we sought to identify their specific support needs, and to collaboratively design an intervention appropriate for delivery in their local contexts. Applying a protection-risk conceptual framework, we developed a harm reduction intervention which aims to foster protective factors, and thereby nurture resilience, for youth ‘on the move’ within high-risk settings. Specifically, by establishing peer supporter networks, offering a ‘drop-in’ resource centre, and by identifying local adult champions to enable a supportive local environment. Creating this supportive edifice, through an accessible and cohesive peer support network underpinned by effective training, supervision and remuneration, was considered pivotal to nurture solidarity and potentially resilience. This practical example offers insights into how researchers may facilitate the co-design of acceptable, sustainable interventions.

Mental Health on the Move: A Nationwide Study to Characterize Post-migration Depression Among Migrants From Sub-Saharan Africa in China

Background: Migrants from Sub-Saharan Africa to China faced challenges in accessing healthcare. Less is known about their depression prevalence. We aim to address this gap by providing an initial estimation on the depression prevalence and its correlates. Methods: A cross-sectional survey was conducted from August to October in 2019. Eligibility was defined as being originally from a Sub-Saharan African country and cumulative residence in China for at least one month. A convenience sample was drawn from snowball sampling online and venue-based sampling by community outreach. The primary outcome depression was measured by the Centre for Epidemiologic Studies Depression Scale using 16 as the cutoff. Multivariable logistic regressions were employed to examine the association between depression and its migration-related correlates. Data were analyzed using SAS 9.4. Results: The depression prevalence was high at 44% among 928 participants. Depression was positively associated with unsatisfactory housing conditions (aOR: 1.7, 95%CI: 0.8 to 3.3) and perception of very unfriendly attitudes from the local people (aOR: 4.5, 95%CI: 1.2 to 16.1) after adjusting for covariates. Conclusions: Depression is prevalent among Sub-Saharan Africa migrants in China and warrants attention and intervention. Support should be provided during the post-migration period in China to mitigate depression risks for Sub-Saharan Africa migrants. Future studies are needed to build more evidence on Sub-Saharan Africa migrants’ mental health and to inform global health policies and programming.

Migrant health penalty: evidence of higher mortality risk among internal migrants in sub-Saharan Africa

ABSTRACT Background: Despite the greater attention given to international migration, internal migration accounts for the majority of movements globally. However, research on the effects of internal migration on health is limited, with this relationship examined predominantly in urban settings among working-age adults, neglecting rural populations and younger and older ages. Objectives: Using longitudinal data from 29 mostly rural sub-Saharan African Health and Demographic Surveillance Systems (HDSS), this study aims to explore life-course differences in mortality according to migration status and duration of residence. MethodsCox proportional hazards models are employed to analyse the relationship between migration and mortality in the 29 HDSS areas. The analytical sample includes 3 836,173 people and the analysis spans 25 years, from 1990 to 2015. We examine the risk of death by sex across five broad age groups (from ages 1 to 80), and consider recent and past in- and return migrants. Results: In-migrants have a higher risk of mortality compared to permanent rural residents, with return migrants at greater risk than in-migrants across all age-groups. Female migrants have lower survival chances than males, with greater variability by age. Risk of dying is highest among recent return migrant females aged 30–59: 1.86 (95% CI 1.69–2.06) times that of permanent residents. Only among males aged 15–29 who move to urban areas is there evidence of a ‘healthy migrant’ effect (HR = 0.62, 95% CI 0.51–0.77). There is clear evidence of an adaptation effect across all ages, with the risk of mortality reducing with duration following migration. Conclusions: Findings suggest that adult internal migrants, particularly females, suffer greater health disadvantages associated with migration. Policy makers should focus on improving migrant’s interface with health services, and support the development of health education and promotion interventions to create awareness of localised health risks for migrants.

Utilization of healthcare services among Chinese migrants in Kenya: a qualitative study

BackgroundThe number of Chinese migrants in Sub-Saharan Africa (SSA) is increasing, which is part of the south-south migration. The healthcare seeking challenges for Chinese migrants in Africa are different from local people and other global migrants. The aim of this study is to explore utilization of local health services and barriers to health services access among Chinese migrants in Kenya.MethodsThirteen in-depth interviews (IDIs) and six focus group discussions (FGDs) were conducted among Chinese migrants (n = 32) and healthcare-related stakeholders (n = 3) in Nairobi and Kisumu, Kenya. Data was collected, transcribed, translated, and analyzed for themes.ResultsChinese migrants in Kenya preferred self-treatment by taking medicines from China. When ailments did not improve, they then sought care at clinics providing Traditional Chinese Medicine (TCM) or received treatment at Kenyan private healthcare facilities. Returning to China for care was also an option depending on the perceived severity of disease. The main supply-side barriers to local healthcare utilization by Chinese migrants were language and lack of health insurance. The main demand-side barriers included ignorance of available healthcare services and distrust of local medical care.ConclusionsProviding information on quality healthcare services in Kenya, which includes Chinese language translation assistance, may improve utilization of local healthcare facilities by Chinese migrants in the country.

Social and structural factors and engagement in HIV care of sub-Saharan African migrants diagnosed with HIV in the Paris region

ABSTRACTMigrants from sub-Saharan Africa (SSA) are often diagnosed at an advanced stage of HIV, and many of them have harsh living conditions. We aimed to evaluate the entry into care after HIV diagnosis and examine the related social determinants. The ANRS PARCOURS study is a life-event survey conducted in 2012–2013 in the Paris region among. Time between HIV diagnosis of SSA migrants living diagnosed HIV positive in France and HIV care and the determinants was assessed yearly by using mixed-effects logistic regression models. Among a total of 792 participants, 94.2% engaged in HIV care within the year of HIV diagnosis, 4.3% in the following year and 2.5% beyond the second year after diagnosis. The participants were more likely to engage in HIV care during years when they were effectively covered by health insurance and if the HIV test was carried out at the initiative of the doctor. Immigration for economic reasons or owing to threats in his/her country of origin was associated with delayed engagement in HIV care. Additionally, 4.3% of treated participants discontinued HIV care at least once at the time of the survey and more often if diagnosed at an advanced HIV disease stage and financially dependent.

Return Migrants Reintegration Projects in West Africa: Critical Notes on the Sahel

Migration issue is more than ever on the agenda of global concerns, particularly with regard to Africa, even though human mobility remains essentially internal on the African continent and rooted in centuries-old circulatory traditions. While a large literature emphasizes the criminalization of migration from the South to the North, but also the policies of outsourcing borders and the control of flows, the links between migration and development are still poorly studied, particularly with regard to the returnees, expelled and other categories (re) integration. However, return migrants are often at the heart of different logics and realities in tension, especially in the context of various reintegration projects, with mixed results. This paper contributes to rethink critically the public policies of reintegration of return migrants in Sub-Saharan Africa as a component of the European Union governance of migration, and in a context of regional free movement promotion. It is based on a combined analysis of some projects implemented as part of the transfer of European migration governance policies and measuring the scope, but also their inconsistencies.

Influence of geographic origin on AIDS and serious non-AIDS morbidity/mortality during cART among heterosexual HIV-infected men and women in France.

BackgroundThe influence of geographic origin on the risk of severe illness and death on cART has not been explored in European countries.MethodWe studied antiretroviral-naïve heterosexual HIV-1-infected individuals enrolled in the FHDH-ANRS CO4 cohort in France who started cART between 2006 and 2011. Individuals originating from France (French natives), sub-Saharan Africa (SSA) and non-French West-Indies (NFW) were studied until 2012. Crude and adjusted rate ratios (aRR) of severe morbid events/deaths (AIDS-related and non-AIDS-related) were calculated using Poisson regression models stratified by sex, comparing each group of migrants to French natives.ResultsAmong 2334 eligible men, 1379 (59.1%) originated from France, 838 (35.9%) from SSA and 117 (5.0%) from NFW. SSA male migrants had a higher aRR for non-AIDS infections, particularly bacterial infections (aRR 1.56 (95% CI 1.07–2.29), p = 0.0477), than French natives. Among 2596 eligible women, 1347 (51.9%) originated from France, 1131 (43.6%) from SSA, and 118 (4.5%) from NFW. SSA and NFW female migrants had a higher aRR for non-AIDS infections, particularly non-bacterial infections (respectively, 2.04 (1.18–3.53) and 7.87 (2.54–24.4), p = 0.0010), than French natives. We observed no other significant differences related to geographic origin as concerns the aRRs for AIDS-related infections or malignancies, or for other non-AIDS events/deaths such as cardiovascular disease, neurological/psychiatric disorders, non-AIDS malignancies and iatrogenic disorders, in either gender.ConclusionHeterosexual migrants from SSA or NFW living in France have a higher risk of non-AIDS-defining infections than their French native counterparts. Special efforts are needed to prevent infectious diseases among HIV-infected migrants.

Factors Associated with HIV Status Disclosure in HIV-Infected Sub-Saharan Migrants Living in France and Successfully Treated with Antiretroviral Therapy: Results from the ANRS-VIHVO Study.

To estimate rates and identify correlates of HIV disclosure in migrants from sub-Saharan Africa (SSA) successfully treated, a sub-analysis was conducted in HIV-1 native SSA migrants, living in France with undetectable viral load on antiretroviral, included in the VIHVO adherence study. Logistic regression models assessed factors associated with HIV disclosure. Among 246 individuals (40% male, median age 41), 79% of those in a steady heterosexual partnership (n=167) had disclosed their status to their partner, 55% of the total 246 to a relative, and 33% to (an)other person(s). Disclosure to one's steady partner was associated with a follow-up duration since HIV diagnosis of more than 5years, a higher literacy level, a better social context and marital status. Women were more likely to disclose their HIV status to relatives. Interventions targeting this population should be provided to improve disclosure which in turn ensures better social support, testing of the partner and lower rates of undiagnosed HIV.

Detection Probabilities and Absolute Densities of Birds in Trees

For a study of long-distance migrants in sub-Saharan Africa, a census method was developed that combined precision and accuracy regarding bird numbers and tree choice. The number of birds present in trees and shrubs can be counted accurately, although it is time-consuming. We describe how much time is needed to detect all birds present in trees, using data collected in over 2000 plots across West Africa during the dry season (October–March in 2007–2015). The observation time per tree depended on tree size, number of birds present and the opacity of the crown. The giving-up time of the observers increased with canopy volume, but was independent of the number of birds in a tree. Detection probabilities of bird species differed relative to microhabitat choice and feeding techniques. Species-specific detectabilities hardly varied during the day or the season. All foraging birds and immobile birds (save a few percent in dense canopies) were detected using the individual-tree-approach. Bird density is expressed as number per canopy volume, but little information is lost when density is given as number per canopy surface. The variation in bird density was large and differed per tree species. Within tree species, bird density was related to the opacity of the crown, the abundance of insects and whether there were berries or flowers. These findings suggest that, to collect biologically relevant information, the density of tree-dwelling birds should be measured at the level of the individual tree, and not per surface area, habitat type or tree species (as is typical in published studies).

The converging burdens of infectious and non-communicable diseases in rural-to-urban migrant Sub-Saharan African populations: a focus on HIV/AIDS, tuberculosis and cardio-metabolic diseases.

Africa has the unenviable challenge of dealing with a double burden of disease: infectious diseases (IDs) such as HIV/AIDS and tuberculosis are high while non-communicable diseases (NCDs) are rapidly rising in the region. Populations with increased susceptibility to both include migrants. This review highlights the susceptibility of rural-to-urban migrants in Sub-Saharan Africa to the IDs of HIV/AIDS and tuberculosis, and to NCDs, particularly cardiovascular diseases. The disruption that occurs with migration is often accompanied by unhealthy exposures and environments. These include partaking in risky sexual practices and a subsequent greater risk for HIV infection in migrants than the general populations which contributes to the spread of the disease. Migrants frequently work and live in conditions that are poorly ventilated and overcrowded with suboptimal sanitation which increases their risk for tuberculosis. Considering that migrants have an increased risk of acquiring both HIV/AIDS and tuberculosis, and in view of the interaction between these diseases, they are likely to be at high risk for co-infection. They are also likely to facilitate the geographical spread of these infections and serve as conduits of disease dissemination to rural areas. Changes in lifestyle behaviours that accompany migration and urbanisation are exemplified primarily by shifts in physical activity and dietary patterns which promote the development of obesity, diabetes, hypertension and cardiovascular diseases. Urban living and employment is generally less physically exerting than rural routines; when migrants relocate from their rural residence they adapt to their new environment by significantly reducing their physical activity levels. Also, nutritional patterns among migrants in urban centres change rapidly with a shift to diets higher in fat, sugar and salt. Consequently, increases in weight, blood pressure and glucose levels have been reported within a year of migration. Interactions between IDs and NCDs are common; considering that migrants have an increased susceptibility to IDs and demonstrate a rapid rise in their risk for NCDs, the concurrent prevalence of both is likely in this population. There is a need for a combined strategy to combat IDs and NCDs with screening and treatment programmes geared towards this high risk group.

Sex Differences in HIV Prevalence, Behavioral Risks and Prevention Needs Among Anglophone and Francophone Sub-Saharan African Migrants Living in Rabat, Morocco.

Morocco has experienced a dramatic increase of migration from sub-Sahara Africa during the past decade. Recently included among the most vulnerable populations cited in the Morocco National Strategic Plans on HIV/TB for 2012-2016, sub-Saharan Africa migrants living in an irregular administrative situation participated in a survey to provide baseline data about their socio-demographic, sexual and HIV testing behaviors and HIV and syphilis prevalence. Two surveys using respondent driven sampling were conducted in 2013 among males and females, ≥18 years, originating from sub-Saharan African countries and living and/or working in an irregular administrative situation in Rabat and residing at least 3 months in Morocco. Analysis was conducted to evaluate differences between the two samples and between females and males within each sample using the successive sampling estimator in RDS Analyst. Roughly 3 % of francophone and anglophone migrants were infected with HIV, whereas a statistically significantly higher percentage of francophone (2.8 %), compared to anglophone (0.3 %), migrants were infected with syphilis. Females were found to have HIV infection rates three times higher and past year sexually transmitted infection signs and symptoms more than two times higher than their male counterparts. Female migrants also had statistically significantly higher percentages of ever testing for HIV and HIV testing and receiving results in the past year compared to males. We found distinct and important differences between migrants depending on whether they come from francophone versus anglophone countries and whether they were male or female. Future research should continue to explore these differences, while policies and programs should note these differences to best allocate resources in providing social and health services to these populations.

Socialization, Adaptation, Transnationalism, and the Reproductive Behavior of Sub-Saharan African Migrants in France

Migrants from Sub-Saharan Africa (SSA) move from a region with high fertility to regions with low fertility. Yet very few studies have examined the reproductive behavior of international migrants from SSA. This study examines the roles of origin and destination socialization on the fertility and fertility ideals of SSA migrants in France. The study draws on measures of assimilation to systematically examine the effects of socialization and adaptation as well as transnationalism for the effects of sustained origin ties. Data are from the TEO (“Trajectoires et Origines”) survey conducted in France (2008/2009). Logistic regression is used to examine current fertility (the odds of having a birth in the preceding 5 years), and poisson regression is used to examine cumulative fertility (children ever born) and fertility ideals (reported ideal number of children in a family). Controlling for sociodemographic factors, first-generation SSA migrants have higher fertility than second-generation SSA migrants and non-immigrants. But first- and second-generation SSA migrants have higher fertility ideals than non-immigrants. Among SSA migrants, first- and second-generation migrants do not differ in fertility and fertility ideals when adaptation is accounted for. Most measures of adaptation are negatively associated with actual fertility and fertility ideals. Transnationalism is associated with higher fertility ideals but less so with actual fertility. The study finds some evidence for origin socialization, but the findings are more strongly supportive of adaptation to the host society. Origin socialization appears to have a stronger influence on fertility ideals than actual fertility.

Infectious diseases in North Africa and North African immigrants to Europe.

The epidemiological transition has reduced infectious diseases mortality in most European countries, yet increased migrant influx risks importing diseases. All reported prevalence rates must be considered on a case-by-case basis depending on the disease in question, respective European Union (EU) country and migratory patterns at work. Tuberculosis has seen a re-emergence in Europe and is concentrated among migrants. Migrants arriving from North Africa (NA) and sub-Saharan Africa (SSA) carry higher rates of hepatitis C and B than the local EU population. The human immunodeficiency virus (HIV) impact of NA migrants to Europe is very low but a hallmark of the HIV epidemic is the penetration and circulation of non-B strains, recombinant forms and HIV-drug-resistant profiles through SSA migrants using NA as a transit point into Europe. Leishmaniasis is a re-emerging zoonotic disease prevalent to Southern Europe although not specifically isolated in migrant groups. Although not endemic in NA countries, malaria represent S: a risk in terms of re-emergence in Europe through transitory migrants arriving from SSA with the destination to Europe. Schistosomiasis has been largely eliminated from NA. High migrant flux into European countries has resulted in changing patterns of communicable disease and collectively requires a continuous surveillance. World Health Organization guidelines recommend targeted screening and preventative vaccination, followed by integration of migrants into the local health-care systems allowing for long-term treatment and follow-up. Finally, effective public health campaigns as a form of prevention are essential for the mitigation of disease dissemination in the migrant pool and for second-generation children of migrants.