Sexual health of ethnic minority MSM in Britain (MESH project): design and methods

Background Men who have sex with men (MSM) remain the group most at risk of acquiring HIV infection in Britain. HIV prevalence appears to vary widely between MSM from different ethnic minority groups in this country for reasons that are not fully understood. The aim of the MESH project was to examine in detail the sexual health of ethnic minority MSM living in Britain. Methods/Design The main objectives of the MESH project were to explore among ethnic minority MSM living in Britain: (i) sexual risk behaviour and HIV prevalence; (ii) their experience of stigma and discrimination; (iii) disclosure of sexuality; (iv) use of, and satisfaction with sexual health services; (v) the extent to which sexual health services (for treatment and prevention) are aware of the needs of ethnic minority MSM. The research was conducted between 2006 and 2008 in four national samples: (i) ethnic minority MSM living in Britain; (ii) a comparison group of white British MSM living in Britain; (iii) NHS sexual health clinic staff in 15 British towns and cities with significant ethnic minority communities and; (iv) sexual health promotion/HIV prevention service providers. We also recruited men from two "key migrant" groups living in Britain: MSM born in Central or Eastern Europe and MSM born in Central or South America. Internet-based quantitative and qualitative research methods were used. Ethnic minority MSM were recruited through advertisements on websites, in community venues, via informal networks and in sexual health clinics. White and "key migrant" MSM were recruited mostly through Gaydar, one of the most popular dating sites used by gay men in Britain. MSM who agreed to take part completed a questionnaire online. Ethnic minority MSM who completed the online questionnaire were asked if they would be willing to take part in an online qualitative interview using email. Service providers were identified through the British Association of Sexual Health and HIV (BASHH) and the Terrence Higgins Trust (THT) CHAPS partnerships. Staff who agreed to take part were asked to complete a questionnaire online. The online survey was completed by 1241 ethnic minority MSM, 416 men born in South and Central America or Central and Eastern Europe, and 13,717 white British MSM; 67 ethnic minority MSM took part in the online qualitative interview. In addition 364 people working in sexual health clinics and 124 health promotion workers from around Britain completed an online questionnaire. Discussion The findings from this study will improve our understanding of the sexual health and needs of ethnic minority MSM in Britain.

Tuberculosis in HIV-Negative and HIV-Infected Patients in a Low-Incidence Country: Clinical Characteristics and Treatment Outcomes

Background In Switzerland and other developed countries, the number of tuberculosis (TB) cases has been decreasing for decades, but HIV-infected patients and migrants remain risk groups. The aim of this study was to compare characteristics of TB in HIV-negative and HIV-infected patients diagnosed in Switzerland, and between coinfected patients enrolled and not enrolled in the national Swiss HIV Cohort Study (SHCS). Methods and Findings All patients diagnosed with culture-confirmed TB in the SHCS and a random sample of culture-confirmed cases reported to the national TB registry 2000–2008 were included. Outcomes were assessed in HIV-infected patients and considered successful in case of cure or treatment completion. Ninety-three SHCS patients and 288 patients selected randomly from 4221 registered patients were analyzed. The registry sample included 10 (3.5%) coinfected patients not enrolled in the SHCS: the estimated number of HIV-infected patients not enrolled in the SHCS but reported to the registry 2000–2008 was 146 (95% CI 122–173). Coinfected patients were more likely to be from sub-Saharan Africa (51.5% versus 15.8%, P<0.0001) and to present disseminated disease (23.9% vs. 3.4%, P<0.0001) than HIV-negative patients. Coinfected patients not enrolled in the SHCS were asylum seekers or migrant workers, with lower CD4 cell counts at TB diagnosis (median CD4 count 79 cells/µL compared to 149 cells/µL among SHCS patients, P = 0.07). There were 6 patients (60.0%) with successful outcomes compared to 82 (88.2%) patients in the SHCS (P = 0.023). Conclusions The clinical presentation of coinfected patients differed from HIV-negative TB patients. The number of HIV-infected patients diagnosed with TB outside the SHCS is similar to the number diagnosed within the cohort but outcomes are poorer in patients not followed up in the national cohort. Special efforts are required to address the needs of this vulnerable population.

Outcomes of antiretroviral therapy in the Swiss HIV Cohort Study: latent class analysis

An in-depth understanding of the different groups that make up the HIV-infected population should inform prevention and care. Using latent class analysis (LCA) we identified seven groups with similar socio-demographic and behavioral characteristics at enrolment in the Swiss HIV Cohort Study: older gay men, younger gay men, older heterosexual men, injection drug users, single migrants, migrant women in partnerships and heterosexual men and women. Outcomes of combination antiretroviral therapy (ART) were analyzed in 1,633 patients starting ART. Compared to older gay men, the probability of a virologic response to ART was reduced in single migrants, in older heterosexual men and in IDUs. Loss to follow-up was higher in single migrants and IDUs, and mortality was increased in older heterosexual men and IDUs. Socio-behavioral groups identified by LCA allow insights above what can be gleaned from traditional transmission groups, and may identify patients who could benefit from targeted interventions.

Developing a smoking cessation program for Turkish-speaking migrants in Switzerland: novel findings and promising effects

Introduction: Recent studies show that smoking prevalence in the Turkish-speaking migrant population in Switzerland is substantially higher than in the general population. A specific group treatment for Turkish-speaking migrants was developed and tested in order to provide the migrant population with equal access to smoking cessation programs and to improve the migration-sensitive quality of such programs by sociocultural targeting. Methods: The evaluation of the program included quantitative (questionnaires t1 and t2 and follow-up by telephone) and qualitative methods (participant observation and semi-structured interviews). Results: The results showed that 37.7% of the 61 participants were smoke free at the 12-month follow-up. The factors of being in a partnership and using nicotine replacement products during the program were positively associated with successful cessation. We also demonstrated the importance of “strong ties” (strong relationships between participants) and the sensitivity of the program to sociocultural (e.g., social aspects of smoking in Turkish culture, which were addressed in relapse prevention), socioeconomic (e.g., low financial resources, which were addressed by providing the course for free), and migration-specific (e.g., underdeveloped access to smoking cessation programs, which was addressed using outreach strategy for recruiting) issues. Conclusions: Overall, the smoking cessation program was successfully tested and is now becoming implemented as a regular service of the Swiss Public Health Program for Tobacco Prevention (by the Swiss Association for Smoking Prevention).

Oral lichenoid contact lesions induced by areca nut and betel quid chewing: a mini review

Betel quid (BQ) and areca nut chewing is widely prevalent in many parts of Asia and Asian-migrant communities throughout the world. Global reports estimate 600 million users. Sufficient evidence of carcinogenicity has been found for BQ and its main ingredient, areca nut. BQ areca nut users have an increased risk of potentially malignant disorders. Among chewers, BQ remains in contact with the oral mucosa for prolonged periods. This review examines the clinical and pathological aspects of lichenoid lesions caused by areca nut and BQ, a condition that has received little attention in the published literature.

Communication barriers in counselling foreign-language patients in public pharmacies: threats to patient safety?

Foreign-language (FL) patients are at increased risk for adverse drug events. Evidence regarding communication barriers and the safety of pharmaceutical care of FL patients in European countries is scarce despite large migrant populations.

Türkische Übersetzung und erste psychometrische Überprüfung der deutschsprachigen FAMOS (Fragebogen zur Analyse Motivationaler Schemata) und INK (Inkongruenzfragebogen)

Theoretischer Hintergrund: Standardisierte psychologische Messinstrumente in der Psychotherapie für Personen mit Migrationshintergrund fehlen weitgehend. Fragestellungen: Die türkischsprachigen Übersetzungen des Fragebogens zur Analyse Motivationaler Schemata (FAMOS) und des Inkongruenzfragebogens (INK) wurden in die türkische Sprache übersetzt und psychometrisch überprüft. Methode: Insgesamt füllten 73 türkischsprachige Patienten und 230 gesunde türkischsprachige Personen mit Migrationshintergrund in der Schweiz FAMOS und INK aus. Ergebnisse: Die Skalen von FAMOS und INK zeigen gute Reliabilität und Validität. Patienten weisen stärker ausgeprägte Vermeidungsziele und Inkongruenzwerte als gesunde Personen auf. Schlussfolgerungen: Die türkischen Versionen von FAMOS und INK eignen sich sowohl für die klinisch-psychologische Forschung als auch für die Praxis.

Bevezető: utak és úton lévők

A kvalitatív módszerekkel nyert kutatási eredményeink értelmezése során a transznacionális tér, a transznacionális és az etnikai migráció elméleti és szemléleti kereteit egyaránt figyelembe vettük. Az általunk vizsgált migrációs folyamatok transznacionális térben zajlanak, és a transznacionális irodalomban leírt migráns élethelyzetek, gyakorlatok – különböző nemzetállamokban elhelyezkedő lokalitásokhoz való egyidejű, bár eltérő intenzitású kötődés, kapcsolatok – több példájával is találkoztunk. Ludger Pries nyomán a transznacionális migrációt és a transznacionális migráns alakját olyan ideáltípusnak tekintettük, amelyhez az egyes migráns utak és helyzetek csupán közelítenek, és empirikus eredményeink alapján azt mondhatjuk, hogy a valóban plurilokális, vagyis a két helyhez való egyidejű, intenzív és tartós kötődés s az ehhez kapcsolódó gyakorlatok csupán a migránsok kisebbségét, illetve a migrációs életpályák egy-egy szakaszát jellemzik. A vizsgált migrációs folyamatokban az etnicitás strukturális tényezőként és a migráns tapasztalatok értelmezési kereteként egyaránt perdöntő szerepet játszik. Az etnikai migráció szakirodalomban tárgyalt mindhárom magyarázó modellje – az anyaországba való hazatérés, a gazdasági okokból való, illetve a kisebbségi létben elszenvedett sérelmek által ösztönzött migráció – alkalmas a migrációt kiváltó és mozgató okok elemzésére, a migráns narratívák értelmezésére, azt azonban nem állíthatjuk, hogy bármelyikük kizárólagos érvényre tehet szert. Más kutatókhoz hasonlóan Rogers Brubaker meghatározását tartjuk a leginkább gyümölcsözőnek, aki az etnikai migráció tág értelmezését használva minden olyan vándorlási folyamatot etnikai migrációnak tekint, amelyben az etnicitás kulturális és szimbolikus tőkeként szabályozó szerepet játszik. This special issue of Tér és Társadalom presents some results of an international research project carried out by researchers from Switzerland, Hungary and Serbia between 2010 and 2012. The topic of the research was “Integrating (Trans-)national Migrants in Transition States” (TRANSMIG) and was financed by the Swiss National Science Foundation (SNSF). The research aimed to explore and interpret migration flows from the Vojvodina (Serbia) to Hungary and from ex-Yugoslav republics to the Vojvodina. In the first period of the last twenty years, wars which contributed to the disintegration of Yugoslavia and the formation of new national states have caused migration flows. After the change of the millennium, educational migration of Vojvodina Hungarian youth can be considered the most important migratory movement from the Vojvodina to Hungary. Labour (economic) migration also occurs, but this cannot be understood as a one-way movement, since in the Hungarian–Serbian border zone migrants from the Vojvodina who already resettled to Hungary commute to the Vojvodina. While interpreting the qualitative research data the theoretical frameworks and approaches of transnational space, transnationalism and ethnic migration were taken into consideration. The migration movement in question occurs in a transnational social space where migrants are in constant motion. By their movements and actions that space is continually recreated. With Ludger Pries we see a transnational migrant as an ideal type to whom individual migratory movements and positions only approximate. Based on our empirical results we can conclude that real pluri-local, intensive and long-lasting bonding to two places at the same time and the relating practices only characterise a minority of migrants and certain sections of migratory careers. In the migration processes studied, ethnicity as a term is needed as a “structural factor” and frame of interpretation to approach migrant experiences. All three explanatory models for ethnic migration – return migration, economic migration, migration motivated by grievances suffered in a minority situation – are suitable to analyse the reasons that initiated migration and kept it in motion. They are helpful in interpreting migrant narratives. However, none of the reasons can claim exclusive validity. Agreeing with other researchers, we find Roger Brubaker’s definition the most useful: Ethnic migration should be comprehended in a broad sense. In addition, every migration can be considered as “ethnically” motivated where ethnicity plays a dominant role as a cultural and symbolic capital.

Falkland Island English

This chapter examines some of the grammatical variability and non-standardness found in the English of the Falkland Islands. The Falklands are an archipelago of over 700 islands located in the western South Atlantic Ocean, 480km off the east coast of Argentina. Although the population is small – around 3000 - the islands cover an area of over 12000km2 – slightly larger than Jamaica and half the size of Wales, making them, after Greenland, the most sparsely populated political entity in the world. In political terms, the Falklands are an Overseas Territory of the United Kingdom. In contrast to the rural isolated image that the Falklands perhaps conjure up, the community is, in demographic terms, an urban and diverse one. Over 85% of the population living in the capital Stanley. The 2006 census (Government of the Falkland Islands 2007: 6) shows that 55% of the population were not born on the Islands, with the largest migrant groups coming from the UK, St Helena (another British Overseas Territory, located in the eastern South Atlantic), Chile and Australia. It also highlighted the fact that people born in 62 different countries were resident on the islands at the time (Pascoe and Pepper 2008: 38). By way of a comparison, only Monaco and Andorra, in Europe, have a higher proportion of their populations made up of migrants. In addition to the local Falkland population, there is a large military presence on the islands at the Royal Airforce Base at Mount Pleasant, 50km south-west of Stanley. The Head of State is the monarch of the UK, who is represented on the islands by a governor. The democratically elected 11-member Legislative Assembly is responsible for day-to-day government of the islands. The Falklands are perhaps most famous because of their 74 day occupation by Argentina in 1982. It is not appropriate here to go into detail about the dispute between the UK and Argentina about the sovereignty of the Islands. What is undisputed is that there has been a continuous Anglophone speech community on the islands since the early 1830s, making it one of the most recently developed ‘Inner Circle’ (Kachru 1985) Englishes in the world. This chapter examines the grammatical characteristics of Falkland Island English, drawn from a transcribed corpus of over 500,000 words of informal conversational speech, collected by Andrea Sudbury both in Stanley and in ‘Camp’ (the local name for the rest of the islands) (see Sudbury 2000, 2001 for more details about the methods used in the survey).

A Foraging Cost of Migration for a Partially Migratory Cyprinid Fish

Migration has evolved as a strategy to maximise individual fitness in response to seasonally changing ecological and environmental conditions. However, migration can also incur costs, and quantifying these costs can provide important clues to the ultimate ecological forces that underpin migratory behaviour. A key emerging model to explain migration in many systems posits that migration is driven by seasonal changes to a predation/growth potential (p/g) trade-off that a wide range of animals face. In this study we assess a key assumption of this model for a common cyprinid partial migrant, the roach Rutilus rutilus, which migrates from shallow lakes to streams during winter. By sampling fish from stream and lake habitats in the autumn and spring and measuring their stomach fullness and diet composition, we tested if migrating roach pay a cost of reduced foraging when migrating. Resident fish had fuller stomachs containing more high quality prey items than migrant fish. Hence, we document a feeding cost to migration in roach, which adds additional support for the validity of the p/g model of migration in freshwater systems.