Refugee Sexual Health

by A.J. Bustos, MPH

Note: This post represents the view of the author and is not endorsed by any agency or unit.

Sex

The sexual health of a community is greatly intertwined with education and with the entire community – ask any college town in the south (stdcheck). Access to sexual health services need to be available to everyone, not just those able to afford or obtain health coverage. These services also need to be marketed to the correct populations in the correct manner for them to be effective. Being identified as a refugee has several inequalities that attribute to refugees being at a greater risk for certain sexual and reproductive health risks, including a lack of security, lack of resources, and greater probability of recent traumatic experiences [2]. After a quick check of some local services specifically for refugees, many of these services abstain from mentioning sexual health [5]. In Texas, a state that resettles the most refugees in the US, many services that target sexual health among refugees are commonly under the titles for other populations (like lower socioeconomic populations) and are usually in separate buildings from the main hub of refugee services [7]. Refugees need to feel welcomed and safe enough to reach out and take control of their own sexual health, to include STI testing and prevention. This can be as simple as adding the word “refugee” to a website/building which will let our new community members know that they are welcomed there and the staff there will be knowledgeable of their situation and have resources at the ready.

Impact

Just like each of your friends, every refugee has a different story with different experiences and different ways in which they process an experience. Sex and sexual health may be taboo for them and the culture they were raised in. It may also bring back a traumatic experience they suffered previously, having been sexually assaulted in a time of war, in a refugee camp, or in an unfortunate family situation. The refugee is now in the community and, if you need to be reminded, any one person’s health within a community impacts the entire community’s health. This needs to be at the forefront of everyone’s mind, especially when it comes to vaccinations and sexual health services.  One person with measles can infect twelve to eighteen people in a year. If we place R0 at 15, that basic reproduction number can lead to over 3,200 infections in three years. This Guardian article is a great animated representation of how an infection (measles depicted) can spread through a susceptible vaccinated population versus a susceptible unvaccinated population [1].  Please, do the smart thing and vaccinate your offspring and support access to sexual health services for all.

Strategy

Successful health interventions require the community to be knowledgeable of the services that are being offered as well as how to easily navigate those services both financially and physically. These need to make it appropriate and easy enough that the likelihood of a refugee utilizing the service is high. This becomes especially important if there are only one to two organizations in the city that offer such services. Various elements need to be taken into consideration, including cultural norms from the area that refugees are fleeing from. An Australian study uncovered a problem when promoting women-centered health care due to the cultural norm of a male (usually husband) having a major influence on health decisions [3].

To achieve this, any marketing crafted needs to be in a language and in a setting that the refugee will understand and will see. Most larger cities offer a telephonic translation service for personal interactions. Should this not be available, the trustworthy smart phone has been utilized by myself to communicate effectively on more than one occasion for a variety of different languages. But translation services are more of a back-end thought with the initial goal to be getting the individual through that door and to the professional in the first place.

Second to the plate for success is the plan that utilizes one campaign to discover and support another. It would be like the CIA utilizing a hepatitis vaccination campaign to retrieve DNA from Osama bin Laden’s family members in order to help identify and locate him [4]. Only in our campaign, it would be ethical and would not lead to a global polio vaccination emergency along with the murder of humanitarian teams [4]. A mental health team could select those they identify as individuals needing information regarding sexual health services and do 1 of 2 things.

  1. Offer the information to them in a language and delivery they can understand.
  2. Refer them specifically to a designated person at the clinic and set up the appointment for the refugee along with providing transportation information to and from the appointment.

In this scenario, mental health is supported, sexual health is addressed, and transportation roadblocks are identified and defeated. This effort would go towards helping recover from international tragedies rather than spawning an international tragedy.

tl;dr – refugees are assets to our community & as humans deserve a safe place to live. sexual health affects everyone with genitals so support access to health care for all. vaccinate kids.

References

1. Harris, R., Popovich, N., Powell, K., & Team, G. U. (2015, February 05). Watch how the measles outbreak spreads when kids get vaccinated – and when they don’t. Retrieved March 21, 2019, from https://www.theguardian.com/society/ng-interactive/2015/feb/05/-sp-watch-how-measles-outbreak-spreads-when-kids-get-vaccinated

2. Keygnaert, I., Vettenburg, N., Roelens, K., & Temmerman, M. (2014). Sexual health is dead in my body: participatory assessment of sexual health determinants by refugees, asylum seekers and undocumented migrants in Belgium and the Netherlands. BMC Public Health, 14(1). doi:10.1186/1471-2458-14-416

3. Mengesha, Z. B., Perz, J., Dune, T., & Ussher, J. (2017). Refugee and migrant women’s engagement with sexual and reproductive health care in Australia: A socio-ecological analysis of health care professional perspectives. Plos One, 12(7). doi:10.1371/journal.pone.0181421

4. Novella, S. (2018, June 27). Polio Outbreak in Papua New Guinea. Retrieved March 21, 2019, from https://sciencebasedmedicine.org/polio-outbreak-in-papua-new-guinea/

5. Refugee Services of Texas. (2018). Refugee services of Texas: Austin programs. Retrieved February 02, 2018, from https://www.rstx.org/programs

6. STDcheck. (2019, March 04). 5 Colleges with the highest std rates. Retrieved March 21, 2019, from https://www.stdcheck.com/blog/5-colleges-with-the-highest-std-rates/

7. STD Test Express. (2018). Free std testing in Austin, Tx. Retrieved February 02, 2018, from https://www.stdtestexpress.com/free-std-testing-austin-tx/

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