Stili di vita e percezione del rischio infettivo nelle persone migranti Nicola Petrosillo UOC Infezioni Sistemiche e dell Immunodepresso Istituto Nazionale per le Malattie Infettive L. Spallanzani, IRCCS-Roma
Factors contributing to emergence of infectious diseases (1) Factor Specific example Example of disease Population Rural/urban distribution; Spread of dengue; demographics proportion immunosuppressed increased reports of opportunistic infections Human Sexual practices; IV drug use; Spread of HIV, HCV; behaviour complacency regarding increased incidence of immunisation; use of child-care vaccine-preventable diseases; outbreaks of enteric illness International World wide movement of goods Dissemination of travel and and people; air travel mosquito vectors; commerce dissemination of O139 cholera Ecological Agriculture; dams; changes in Rift Valley fever (dams); change water ecosystem; deforestation/ Argentine haemorrhagic reforestation; flood/drought; fever (agriculture); hantavirus famine; climate change pulmonary syndrome, US (weather)
Factors contributing to emergence of infectious diseases (2) Factor Specific example Example of disease Technology Globalisation of food supply; Outbreak of E. coli O111, and industry changes in food processing; South Australia; antibiotic widespread use of antibiotics resistance Microbial Microbial evolution Antibiotic resistance; adaptation and pesticide resistance; antigenic change drift in the influenza virus Breakdown in Reduction in prevention Resurgence of tuberculosis public health programs; inadequate in the US; diphtheria in the measures sanitation and vector former Soviet Union control measures
Definitions of Categories of Migrants 1. Legally Admitted Permanent Residents/Immigrants 2. Legally Admitted Temporary Migrants 3. Short-term visitors 4. Illegal Migrants 5. Returning Nationals 6. Refugees 7. Asylum-seekers 8. Students 9. Migrant Workers 10. Diplomats
10 million Roma worldwide: 7 million people in central and eastern Europe. social factors, including poverty, limited access to medical care, substandard housing, and inadequate nutrition, may also contribute. Sepkowitz KA. Lancet 2006;367:1707-8
Roma population and HIV vulnerability In some countries, Roma are over-represented among injecting drug users, clients of sex workers, prisoners, and those whose partners are injecting drug users or clients of sex workers. As a consequence of aid dependency, violence, lack of education, and longterm unemployment, many Roma are further driven into high-risk behaviours. Petrosillo N, Broring G. Lancet 2006; 368:575-
Roma population and HIV vulnerability There is no hard evidence nor even any data on HIV/AIDS in these communities because ethnic breakdown is rarely collected, and in many countries is even illegal owing to fear of discrimination. The difficulties in improving the health of Roma communities derive also from basic obstructions such as language and cultural barriers. Petrosillo N, Broring G. Lancet 2006; 368:575-
La percezione del rischio è un processo cognitivo coinvolto in diverse attività quotidiane e che orienta i comportamenti delle persone di fronte a decisioni che coinvolgono dei rischi potenziali. La percezione del rischio coinvolge diverse dimensioni come, per esempio, le conseguenze sia immediate sia future e le loro implicazioni tanto su un piano razionale ed oggettivo quanto su un piano emozionale e soggettivo.
This article reconstructs how workers perceived asbestos hazards, using narratives from a group of migrant workers at the crocidolite mine of Wittenoom Gorge, Western Australia. The mine employed about 7000 workers over the entire period of its operation from 1943 to 1966 relying heavily on migrant workers. The exposure to asbestos dust caused a huge number of occupational respiratory diseases in workers, leading Wittenoom later to be labelled as a modern industrial disaster. Cappelletto F et al. Social Science & Medicine 2003;56: 1047 1059
The risk perception summed up in the statement the work there was not good for your health you could feel the danger ; I knew from day one that [the dust] was a poisonous thing. common sense told me that it couldn t be safe. When I got there, in the first few days, I thought, I m going to die here. No worker was given any information on the health risks of the job. Cappelletto F et al. Social Science & Medicine 2003;56: 1047 1059
The most frequent answer to questions about risk communication was, we weren t told anything about asbestos, nobody said anything, they never said, Listen it is dangerous. They didn t say anything at all about it. The only information that some workers received was a presentation of documentary materials on asbestos probably in the late 1950s in Perth In fact, several of the migrants showed a low level of awareness about the existence or risk of asbestos-related disease and they are still not fully aware of the risk of cancer. Cappelletto F et al. Social Science & Medicine 2003;56: 1047 1059
From the early 1950s onward, some of the workers became aware of a long-term connection between work at Wittenoom and lung illnesses that required hospitalisation and caused deaths. However, up to the early 1960s, workers at the mine were led to believe that the respiratory disease spreading among them was tuberculosis. Cappelletto F et al. Social Science & Medicine 2003;56: 1047 1059
Other societies, for example, Bosnia, teach that pharmaceuticals weaken the body and should be taken only when a person feels ill making the concept of treating latent infection difficult for Bosnian immigrants to grasp. Cookson ST et al. Emerg Infect Dis 2001; 7: 3 Immigrants bring with them their cultural and health beliefs. For instance, Ukrainians believed that positive tuberculin skin tests meant that the bacillus Calmette- Guérin vaccine was effective. However, after resettling in Seattle, they learned that people who test positive have latent tuberculosis.
Speaking different languages is a substantial barrier to immigrants receiving appropriate health care. In a California school, 1,000 students speak 15 languages. Medical interpreters are usually scarce. Family members are often recruited to translate, but this can lead to misunderstandings. When intervention is available, fear of consequences prevents many immigrants from seeking medical advice and treatment. Cookson ST et al. Emerg Infect Dis 2001; 7: 3
Even immigrants securely resettled may be reexposed to diseases when they return home to visit friends and relatives or associate with newly arrived members of their ethnic group. The incidence of malaria and typhoid fever is greater among immigrants returning home for visits than among other travelers because the former tend not to obtain pretravel health advice physicians are not consulted, and sometimes physicians do not provide appropriate advice. The lack of medical infrastructure in countries of origin and the lack of medical surveillance after resettlement are additional problems. Cookson ST et al. Emerg Infect Dis 2001; 7: 3
The majority of new HIV diagnoses in the UK occur in people with heterosexually acquired HIV infection, the majority of whom are migrant Africans. In the UK HIV positive Africans access HIV services at a later stage of disease than non-africans Burns FM et al. AIDS Care 2007; 19: 102-108
Schematic of pathway to HIV care Burns FM et al. AIDS Care 2007; 19: 102-108