Background Colorectal cancer (CRC) is the second most prevalent cancer in Jordan and a leading cause of cancer-related mortality. Early detection through screening campaigns significantly improves survival. However, Jordan lacks a national screening program, and disparities in access persist, particularly among the refugee population. The aim of this study was to evaluate knowledge, attitudes, and practices (KAP) regarding CRC and CRC screening among Jordanian and Syrian refugee populations in Mafraq governorate and to determine the factors associated. Methods A cross-sectional survey was conducted between May and July 2024 to a sample of 897 individuals aged above 50 years old. Data was collected using a structured, interviewer-administered questionnaire. Results The findings revealed a limited level of CRC awareness overall, with a median knowledge score of 7 out of 31. Refugees showed a higher level of awareness regarding lifestyle-related risks, and lower awareness of CRC symptoms and screening methods. Both groups expressed high CRC screening acceptability, with refugees demonstrating higher willingness to participate if invited by the Ministry of Health. The screening facilitators identified included free treatment, dissemination of information by healthcare professionals, and accessibility of services. Preventive practices were moderate, though refugees reported lower physical activity, reduced fruit and vegetable intake, and greater economic constraints. Multivariate analysis identified urban residence and higher education as predictors of better CRC knowledge. Rural residence and the type of occupation were associated with healthy habits, while the age, being female, higher education and having a health insurance were associated with better health-seeking behaviors. Conclusion These findings underscore the need for culturally adapted, equity-focused CRC education and screening initiatives in Jordan, taking into account the refugee populations.
Return migration, the second most common migration path, is shaped by social determinants of health (SDH). However, little is known about how interventions targeting these determinants work or for whom, especially in the dynamic and complex post-Brexit context. This study aimed to identify SDH-focused interventions to understand for whom, under what circumstances and why they may impact on socio-health inequities in returnees from Spain and the United Kingdom (UK) and to explore how Brexit may have affected the regulation and provision of health and social services for these population. Using a realist synthesis approach following RAMESES guidelines, it retrieved and analyzed academic and grey literature documents alongside expert consultation and co-production workshops. Six context-mechanism-outcome (CMO) configurations were developed: three for Spanish returnees (“Disaffection” “Lost and forsaken” and “Empowerment for action”) and three for British returnees (“In no one's land” “Face to face and at home” and “The best of both worlds”). These configurations reveal challenges such as disaffection, administrative barriers, and loss of rights. Spanish returnees struggled with professional recognition and weakened welfare systems, while British returnees faced uncertainty and rigid administrative requirements, impacting their quality of life. While programs targeting human capital can empower returnees, their exclusivity may exacerbate inequities. Findings highlight the need for tailored interventions addressing SDH to reduce inequities and provide actionable insights for inclusive policy design supporting returnees' well-being and fostering their sense of belonging.
Objective We evaluated associations between implementation of Florida Senate Bill 1718 and self-reported physical and mental health among Hispanic and non-Hispanic Black adults, and examined whether these associations differed by cancer survivorship. Methods Using 2022–2024 Behavioral Risk Factor Surveillance System data, Hispanic and non-Hispanic Black adults in Florida were compared with those in Southern control states; cancer survivors were propensity-matched 1:2 to adults without cancer. Survey-weighted difference-in-differences and triple-difference models estimated changes in self-reported poor physical and mental health days. Parallel pre-policy trends were assessed using event-study models on an extended 2020–2024 panel, and p values for state-comparative models were obtained using a wild cluster bootstrap. Results Among 5,991 respondents, the Florida-versus-control increase in poor physical health days among cancer survivors alone was imprecisely estimated (difference-in-differences, 4.97 days; 95% CI, −0.59 to 10.52; bootstrap p=0.137). In the survey-weighted analysis, implementation of SB 1718 was associated with a differential increase of 7.09 physically unhealthy days per month among cancer survivors relative to adults without cancer (triple difference, 95% CI, 3.63–10.54). However, this estimate was substantially attenuated and no longer statistically significant in the unweighted analysis (1.34 days; 95% CI, −0.19 to 2.87). The estimate also varied when the largest survey weights were excluded or winsorized and was based on small Florida cancer-survivor samples. No robust differential association was identified for mentally unhealthy days. Conclusion Although the survey-weighted analysis suggested an increase in physically unhealthy days among cancer survivors following implementation of Florida SB 1718, the magnitude and statistical significance of this estimate were not robust to the weighting specification. Small Florida cancer-survivor samples, unequal survey weights, and limited compositional comparability between Florida and the control states preclude a definitive conclusion regarding the policy’s association with self-reported health.
Background:HIV remains a global challenge, with migrant women disproportionately affected bearing high HIV prevalence and poor outcomes, including reduced care continuity and higher progression to AIDS. Yet, gender-specific HIV-research remains limited. Therefore, this qualitative evidence synthesis (QES) aims to explore how migrant women in the European Union/European Economic Area and the United Kingdom experience HIV care, and what challenges they encounter. Method:A QES was conducted in accordance with PRISMA guidance. A systematic search of MEDLINE, Embase, Global Health and Web of Science Core Collection was conducted in June 2025, identifying studies published between January 2015 and June 2025, and focusing on the HIV care continuum, including prevention. The findings were interpreted using intersectionality framework. Results:Twelve studies met the inclusion criteria, predominantly involving African women living in Western Europe. Three analytical themes were formulated focusing on perceptions of HIV risk and prevention practices; navigation of HIV care in receiving countries; and navigation of stigma, relationships and wellbeing. Stigma was established as a central challenge shaping how women perceived their own risk, engaged with the HIV care, and experienced life after diagnosis. Stigma intersected with power imbalances, legal status, sociocultural contexts, and financial insecurities leading to diverse HIV-related practices. Conclusion:Migrant women's HIV experiences are shaped by intersecting inequities, such as gender, stigma, ethnicity, legal status, and socioeconomic insecurity. Gender-specific, culturally responsive programmes addressing stigma across care stages, including breastfeeding support, are needed. Evidence gaps around retention in care and viral suppression remain, warranting further research.
Introduction The elimination of hepatitis C virus (HCV) and hepatitis B virus (HBV) requires strategies to overcome barriers associated with access to healthcare among migrants. The objective was to design and implement a community-screening-strategy (MiCat) for HBV and HCV among migrant populations from high-prevalence countries residing in Catalonia. Methodology A pilot community-screening was conducted in religious sites, associations or community centres. A multidisciplinary team consisting of peer educators, community health agents, and nurses was established. interventions consisted of workshops pertaining to viral hepatitis, rapid tests featuring onsite results and the collection of dried blood samples for HCV RNA test if anti-HCV-positive result. HBsAg-positive and/or HCV-RNA-positive participants were contacted and referred for hepatology. Results A total of 1,505 people (71% men; 68% Pakistani) were screened over 10 months. Of the total, 71% were long-term residents in Catalonia (>5 years). The history of exposure was more common among women. A total of individuals tested, 3% (95% CI 2.2-4.0) (n=44) were HBsAg-positive (91% men; 33% new diagnoses), 36.4% (n=16) referred to hepatology (33% women) and 2 treated; and a 3.3% (95% CI 2.42-4.28) (n=49) were anti-HCV-positive (84% men), of these 32.6% (n=16) were HCV-RNA-positive (1.06% viremia prevalence; all new diagnoses), 13 patients completed the treatment. Conclusions MiCatC project was able to detect, link to care and treat migrant population from countries with high prevalence of HCV and/or HBV based on a multidisciplinary team including community assets. It is essential to include the gender perspective to ensure that migrant women with hepatitis can receive specialised care.
Background Agricultural work involves high physical demands and organizational and psychological factors that increase the risk of musculoskeletal disorders, especially in environments such as greenhouse horticulture. Migrant workers face additional vulnerabilities stemming from precarious working conditions and reduced access to preventive resources. The aim of this study was to compare functional capacity, musculoskeletal complaints, and psychosocial outcomes between migrant and non-migrant workers engaged in greenhouse horticultural production. Design A cross-sectional study was conducted among 146 agricultural workers employed in greenhouse horticultural production in the Basque Country (Spain). Cardiorespiratory fitness, lower-limb strength, musculoskeletal complaints using the Standardised Nordic Questionnaire (SNQ) and perceived stress and anxiety were compared between migrant and non-migrant workers. Results Musculoskeletal complaints were lower in migrants workers in both sexes (p < 0.05). A positive correlation was identified between depressive symptoms and musculoskeletal complaints. A multivariable regression model showed that being migrant, lower depressive symptom scores, greater handgrip strength, and higher work ability were associated with lower musculoskeletal complaint levels (R2 =0.574). Conclusion Musculoskeletal complaints among greenhouse agricultural workers are not explained solely by physical workload. Migrant status, psychological well-being, muscular strength, and work ability are independently associated with musculoskeletal complaints.
Background: In Spain, COVID-19 vaccination started on 27 December 2020, prioritizing people in long-term care facilities (LTCF), the elderly, and healthcare and essential workers. Different barriers to vaccination might have decreased or delayed uptake for migrant populations. We assessed the time to first COVID-19 vaccination by country of birth. Methods: We studied ≥12-year-olds registered within the Spanish healthcare administrative database between 27 December 2020 and 31 December 2021, not living in LTCF, with information on country of birth, and at least one COVID-19 vaccine dose. Using Weibull parametric survival models, we compared time to first vaccination between Spanish-born individuals and those born in: Western countries (WC), Eastern Europe (EE), North Africa and the Middle East (NAME), Sub-Saharan Africa (SSA), South-East Asia (SEA), Central America and the Caribbean (CAC), or South America (SA); adjusting for sex, age, priority vaccination group and region. Results: We included 26,720,450 individuals (Spanish-born: 86.1%; WC: 3.5%; EE: 0.4%; SSA: 0.6%; NAME: 2.1%; SEA: 0.6%; CAC: 1.4%; SA: 5.3%). Hazard Ratio for first vaccination was lower for all migrants’ groups, WC: 0.68, EE: 0.45, SSA: 0.49, NAME: 0.56, SEA: 0.64, CAC: 0.65 and SA: 0.74, and median time to vaccination (days) was higher, WC: 164, EE: 185, SSA: 181, NAME: 174, SEA: 167, CAC: 166 and SA: 160, compared to 147 in Spanish-born. Conclusions: Migrants of any origin living in Spain accessed COVID-19 vaccination later than Spanish-born individuals. These findings highlight existing barriers increasing migrants’ vulnerability during the pandemic and call for additional efforts to ensure equitable access.
International migrants are increasingly shaping the population health of high-income countries, yet existing research has treated immigrants as a single, homogenous group when estimating their impact on national life expectancy. Moreover, European research has only studied the impact of immigrants up until 2019—before the COVID-19 pandemic. Using Swedish total population administrative register data from 2010 to 2023, we calculate period life expectancy at age 1 for immigrant subpopulations defined by permit status (refugee; other permit) and for permit status by region of birth (Nordic, Other European, and non-European), applying the Arriaga decomposition to estimate each subgroup's contribution to national life expectancy. From 2010 to 2019, refugees were the primary driver of the positive impact of immigrants on Sweden’s national life expectancy, exhibiting consistently higher life expectancy than both non-migrants and immigrants with other permits. In 2020, COVID-19 struck refugees disproportionately hard. They exhibited life expectancy losses up to four times higher than non-migrants and other permit migrants, and their positive effect on life expectancy was temporarily reversed. The reversal was most pronounced among non-European refugees. Life expectancy recovery among refugees was achieved by 2023 but lagged 2-years behind non-migrants and other permit migrants. Demographic and public health research should routinely disaggregate immigrant populations accordingly. COVID-19 showed that the positive contribution of refugees is fragile. Targeted policies are required to protect refugee populations, particularly during periods of national crisis, if the positive and growing contribution of immigrants to Sweden’s life expectancy is going to be sustained.
Background Migration through Latin America has increased, resulting in new routes and greater diversity among migrants. Timely, accurate data on the epidemiologic profiles of migrants in-transit could inform public health surveillance and interventions. Objective Provide an overview of the type of data collected on the epidemiologic profiles of migrants in-transit through South America, Central America, and Mexico. Methods We conducted a scoping review from peer-reviewed and grey literature reporting quantitative health data on selected infectious and non-infectious diseases, vaccination coverage, and causes of mortality migrants in-transit through South America, Central America, and Mexico between 2013 and 2025 by searching Embase, Medline, Global Health, Sociological Abstracts, Scopus, LILACS, NTIS, OpenGrey, and MedRxlv. Results We identified 7,355 publications; 124 met inclusion criteria. Of these, 24% specified a transit migration phase. Cross-sectional methodology was employed in 86%; and 62% were published in the last four years (2022-2025). Sociodemographic variables were inconsistently reported, and migration-related variables were infrequent. Health concepts frequently investigated included HIV (28%), TB (14%) COVID-19 (15%), mental health (33%), food insecurity (14%), mortality (10%) and vaccination (6%). Chronic conditions were frequently reported as comorbidities. Conclusion Limited detailed information is available to inform health surveillance and interventions among migrants in-transit. Additional migration-related variables, including time in-transit and transit migration phase, an expansion of data collection to geographical areas experiencing an increase in mobility, and rigorous study designs could yield valuable insights.
Migrant and left-behind children experience health vulnerability that are shaped by climate change, including by climate change, including illness, displacement, and family separation, but also by the organisation of healthcare systems. This scoping review maps the evidence on healthcare services for migrant and left-behind children, with attention to health needs, service provision, barriers and facilitators to access, and gaps in care. Following PRISMA-ScR reporting guidance, searches were conducted in Web of Science/MEDLINE and Scopus for peer-reviewed English-language publications from the database inception to May 2026. After duplicate removal and two-stage screening, 35 publications were included. The evidence shows that migrant and left-behind children require a continuum of preventive, primary, specialist, developmental, nutritional, dental, mental health, and emergency care. However, access is frequently constrained by legal exclusion, documentation requirements, cost, language barriers, limited health system navigation, discrimination, mobility, disrupted continuity of care, and under-resourced services. Left-behind children remain especially under-represented, with limited evidence on preventive, mental health, and chronic care access. Facilitators include inclusive entitlements, community outreach, school provision, interpreters, bilingual professionals, culturally responsive care, health literacy support, and cross-sector coordination. The review argues that healthcare inequity for children affected by migration is produced not only by service absence, but by systems that fail to adapt to children’s legal, linguistic, relational, and transnational realities. Rights-based child health policy should therefore move from episodic and discretionary provision towards universal entitlements, continuous care pathways, and integrated support that is culturally responsive, developmentally appropriate, and accountable to the lived experiences of migrant and left-behind children.
Repeated cycles of conflict and forced displacement in the Gaza Strip have created a severe humanitarian crisis, with specific implications for the aging population. Older adults face distinct risks due to physical frailty, chronic health needs, and the breakdown of community support structures. This qualitative study investigates the psychosocial and material consequences of genocide on elderly Gazans, examining the impacts of displacement, deprivation, and loss of dignity. Through in-depth interviews with forty elderly men and women residing in shelters in Rafah, the research uncovers how repeated forced displacement has shattered the sense of home and security, amplifying chronic anxiety, grief, and disorientation. Systemic deprivation-including the collapse of health infrastructure and restricted access to essential medicines-further exacerbates physical suffering and a pervasive sense of helplessness. Overcrowded, unsanitary shelter conditions strip older adults of autonomy and dignity, intensifying psychological wounds. Despite severe hardship, many participants demonstrate resilience through faith, cultural values such as sumud (steadfastness), and mutual support, yet these coping strategies are stretched to their limits by ongoing violence and scarcity. The study calls for urgent, age-sensitive humanitarian responses to safeguard the health, dignity, and fundamental rights of Gaza's elderly in the face of continued genocide and deprivation.
Background: Housing is a key social determinant of health, yet little is known about how homelessness shapes migrants' health in Nordic welfare states where legal status, labour market attachment and welfare entitlements are unevenly distributed. This article examines how homelessness affects the physical and mental health of migrants, and how structural barriers limit their capacity to navigate access to health care. Methods: Exploratory mixed-methods study combining registry data on shelter use in Oslo (2019-2023) and interviews with ten frontline health and social care staff at along-term, NGO-run shelter. Analyses were informed by precarious citizenship and structural vulnerability. Results: Homeless migrants represented a heterogeneous group in terms of citizenship status and health problems. Migrants' region of origin influenced their resident status, the uncertainty of their situation, and the duration of their stay. Homelessness interacted with migrants' pre-existing vulnerabilities, such as precarious legal and economic status, language barriers, limited access to public services, and untreated chronic disease, to accelerate health decline. Precarious citizenship can be enacted through gendered arenas of exploitation, with consequences for safety, access to care and possibilities for recovery. Conclusion: Homelessness among migrants reflects structural vulnerability and contributes to cumulative disadvantage. Homelessness is not simply a backdrop to migrant ill-health; it is an active health risk that exacerbates disease, disrupts treatment, and limits recovery. Shelters and low-threshold services play a crucial bridging role by enabling access to treatment and rehabilitation. Addressing migrant health inequities requires rights-based approaches and integrated policies linking housing stability and health care access.
Introduction The experiences of immigrants navigating the United States (US) healthcare system in the post-COVID-19 pandemic era are unknown. This study explores the experiences of recently arrived Haitian and Ugandan immigrants navigating this greatly changed system. Methods This single-center study used photo-elicitation, a qualitative method in which photos taken by participants served as an interview guide. Participants were recruited between 11/2022 and 08/2023 and took photos that captured their experiences in healthcare overall and as they related to COVID-19. Interviews were in English or Haitian Creole. All interviews were translated as necessary, transcribed, coded, and analyzed using an inductive, grounded approach. Results Eleven Haitian and 8 Ugandan participants completed interviews. Five themes emerged: (1) US response to COVID-19 compared to country of origin; (2) the US healthcare system as a welcoming, supportive space; (3) influence of isolation and longing for home on immigrant experience and social determinants of health; (4) difficulties navigating a complex, foreign healthcare system; and (5) experiences participating in photo-elicitation. Discussion Free protective resources (e.g., masks) and translated public health information engendered trust and should be included in future pandemic efforts. More attention should be devoted to the social isolation of immigrants, especially during pandemics. Supporting health systems to integrate immigration-informed and trauma-informed care into training for all staff is important, as many recent immigrants interact with clinical and nonclinical staff to address health and social needs. Finally, photo-elicitation is an effective research methodology in this population, but must be done thoughtfully to avoid exacerbating feelings of alienation.
Background: Immigrants experience poorer HIV outcomes and poor mental health. How immigration-related stressors affect engagement with HIV care and mental health care is unclear. This study aimed to use community-based participatory research (CBPR) approaches to explore how immigration-related stressors impact HIV and mental health care for immigrants living with HIV. Methods: We conducted a qualitative interview study with semi-structured interviews of immigrants in New York City with or at risk of HIV. A Community Advisory Board of immigrants aided in study development and interpretation of findings. Purposive sampling was used to balance HIV status and immigration detention experience. Interviews focused on experiences accessing health care and social resources. We analyzed the data using an iterative, grounded theory approach. Key results: We conducted 19 interviews. 17/19 participants were from Latin America, 12/19 were trans or genderqueer, 10/19 were living with HIV and 9/19 had immigration detention experiences. Key themes included: stress from resource scarcity was partially addressed by services specific to people with HIV; entry into medical care was facilitated by targeted services for people with HIV; structural barriers limited engagement in mental health services, and community-based connections were instrumental in overcoming structural barriers. Conclusions: Our findings show how structural barriers to social and health-related resources impact those living with and at risk of HIV, which are partially addressed by resources specific to people with HIV and communitybased support. This study highlights the need for status-neutral, structural level approaches to improve access to resources for immigrants.
Introduction: Forced migrants experience trauma that adversely affects their health, leading to disproportionately high rates of sleep disturbance. Despite this burden, gaps remain in sleep research, clinical training, and the development of treatment protocols for this population. Likewise, limited research exists on the bidirectional relationship between sleep and other prevalent conditions in this population. This study assessed the relationship of sleep quality with anxiety, depression, post-traumatic stress disorder (PTSD), chronic pain, blood pressure, resting heart rate, and heart rate variability in a forced migrant population. It also reports on associations of sleep quality with trauma exposure and social participation. Materials and Methods: This was a cross-sectional study of 65 forced migrants who have at least mild chronic pain. Partial correlations were conducted with sleep quality and each outcome, controlling for age, body mass index (BMI), sex, length of time in the United States, and length of services at two trauma rehabilitation clinics. Results: Participants experienced high rates of poor sleep (92.3%). Sleep quality scores were significantly associated with PTSD, depression, anxiety, and chronic pain but not blood pressure, resting heart rate, or heart rate variability. Trauma exposure was significantly associated with poorer sleep quality, whereas social participation was associated with better sleep quality. Conclusion: Sleep quality was significantly associated with PTSD, anxiety, depression, and chronic pain in forced migrants and may represent an important clinical target in trauma rehabilitation. The contribution of this study is documenting these associations within a forced migrant population, where sleep remains understudied. Future work should develop and test sleep interventions adapted for the needs and context of forced migrants.
In Germany, abortion is criminalised but permitted without punishment through a specific mandatory counselling process. Navigating this highly regulated pathway may be particularly challenging for recently arrived migrants such as asylum-seekers, who often face specific vulnerabilities. The study analyses the barriers to access to abortion for recent migrants in Germany, to identify barriers for recent migrants with unwanted pregnancies by analysing qualitative data from 17 interviews with counsellors providing mandatory counselling, client advocates, and healthcare providers in the federal states of Berlin and Brandenburg. We employed a thematic analysis approach using MaxQDA.We identified two kinds of barriers for migrant access to abortion care in Germany. The first includes barriers that arise from the current legal frameworks for abortion and for migration, specifically related to mandatory counselling for abortion-seekers in Germany, and housing in collective large-scale accommodation facilities for asylum-seekers. The second relates to health system capacity and includes barriers that directly result from the limited and unequal availability of information and services in the languages spoken by clients. Interviews revealed a clear difference between Brandenburg, where abortion services are limited and predominantly provided by white German-speakers, and Berlin, where there is a more diverse network of healthcare providers, client advocates and support persons, relatively better access to care for migrants and language needs are more systemically addressed.Our findings of the disproportionate barriers experienced by migrants and asylum-seekers under the current abortion pathway further underscore the importance of the recommendation for decriminalisation of abortion in the first trimester, and of the diversification of healthcare providers. This would ensure better access to abortion care for migrants and asylum-seekers, themselves often a vulnerable group at higher risk for an unwanted pregnancy.
Introduction Germany is a major destination country for asylum-seekers, including from many countries where female genital mutilation/cutting (FGM/C) is practiced. Our study aimed to provide empirical data on FGM/C prevalence, associated health complaints and FGM/C-related perceptions among asylum-seeking women in Berlin. Methods A cross-sectional study was conducted among asylum-seeking women in Berlin, Germany between October 2018 and September 2022. Adult women self-reporting FGM/C were interviewed using a questionnaire querying FGM/C type, physical complaints, and pain domains, and open-ended questions on women’s experiences regarding FGM/C. Results In total, 15,167 women underwent the mandatory medical examination for asylum-seekers during the study period, 1.9% of which self-reported FGM/C. The prevalence reached 18.6% when restricting the population to FGM/C-practicing countries. Women living with FGM/C came predominantly from the African WHO region (61.9%). A total of 151 women consented to being interviewed. The majority (57.0%) self-allocated to FGM/C Type I/II. Menstrual pain was the most reported complaint (77.5%), followed by pain during defecation (29.1%). Most physical complaints were reported by slightly higher proportions among women with FGM/C type III. Women reported a median age of six years at FGM/C execution, which was performed largely by female, non-relatives (64.5%). The majority (90.1%) perceived FGM/C negatively while 7.9% had a neutral or positive attitude towards it due to its cultural significance. Conclusion FGM/C is prevalent in host countries like Germany with a potentially associated physical and psychosocial health burden. Our findings emphasize the need for a holistic, culturally sensitive response to such health demands by healthcare systems.
Alcohol consumption is a significant public health concern in the US, increasingly impacting racial/ethnic minority youth. This study investigates binge drinking from adolescence to mature adulthood among Asian and Latinx Americans, using three waves of Add Health data and mixed-effects (melogit) modeling technique. Nativity and gender were used as key moderating variables. Guided by the acculturative risk framework, which posits that immigrants' healthier behavioral profiles diminish with longer US residence, the findings from this study offer only partial support for this hypothesis but provide stronger evidence for selection effects. Immigrants reported lower binge drinking rates than their US-born counterparts. While some acculturative risk was observed (e.g., English use among Latinx individuals), most immigrant segments maintained healthier profiles. Notably, immigrant females, particularly within the Latinx group, exhibited the flattest binge drinking trajectories, highlighting gender as a fundamental indicator of selective retention of alcohol consumption among US immigrants.
Men who move for work (e.g., taxi drivers, fishermen, labourers) are often described as a homogeneous group at equal risk of HIV acquisition. This framing often masks important differences between men. Using data from rapid ethnographic assessments and a baseline survey in two settings in South Africa and one in Uganda, we examine how sexual risk-taking among men who travel frequently for work is shaped by mobility. We describe the different mobility patterns of men who are engaged in fishing, driving taxis and trucks and motorcycle-taxi riders, showing how these patterns interacted with reputational and respectable masculinities to shape sexual risk. The availability of alcohol and sex workers while away from home offered opportunities for engaging in opportunistic sex, particularly among younger mobile men drawn to building their reputation as a sexually-active man. Other factors such as older age, relationship status, fatherhood, time in the place and previous risky behaviours, shaped the enactment of respectable masculinities, especially among the older men. These findings illustrate that the link between HIV risk and mobility is understood better when looking at the different interacting factors at play in different contexts. The same mobile men may enact different forms of masculinity depending on their relationships status, social obligations and past experiences with risk, resulting in different exposures to HIV risk. Intervention approaches which target men who are mobile for work need to be tailored to address the different factors which affect risk-taking at different times in mobile men's lives.
Introduction Children and Young People seeking asylum and refugees who are unaccompanied (CYPSAR-U) have a high risk of developing depression, anxiety, and post-traumatic stress disorder (PTSD), yet culturally sensitive screening approaches remain limited. This evaluation explored the use of the Refugee Health Screener (RHS), focusing on patient outcomes and healthcare professionals’ experiences of administration. Methods A mixed-methods service evaluation was conducted in two London-based clinics. The demographics, language, interpreter use, and RHS scores were extracted from electronic health records of 115 CYPSAR-U screened using either the RHS-13 (West London Clinic, WLC) or RHS-15 (North London Clinic, NLC) and analysed descriptively. Semi-structured discussions with 10 healthcare professionals who administered the RHS across both clinics were examined using content analysis. Results In WLC, 48 CYPSAR-U (median age 16 years, 87.5% male) mainly originated from Eritrea (21.3%), Sudan (17.0%), and Ethiopia (12.8%), while in NLC, 67 CYPSAR-U (median age 17 years, all male) were primarily from Iran (20.9%), Sudan (20.9%), Eritrea (13.4%), and Iraq (13.4%). In the WLC RHS assessments were mostly conducted in English (52.1%) or Arabic (33.3%), with interpreters in 85.4% of consultations. At the NLC all were in English with an interpreter. At the WLC, 56% of young people scored above the clinically significant threshold of the RHS, requiring further assessment and support. At the NLC, 67% scored above the RHS clinically significant threshold. Most frequently endorsed symptoms were low mood and excessive thoughts. Clinicians reported that the RHS supported early identification, facilitated multidisciplinary communication, and helped build rapport with young people. However, challenges included linguistic and cultural barriers, interpreter variability, time pressures, and difficulties in comprehension for some CYPSAR-U. Conclusion Within the two evaluated services, the RHS provided a structured approach to support early identification of emotional distress among CYPSAR-U and facilitated communication between healthcare professionals across services. However, challenges related to cross-cultural communication and interpretation were identified. These findings highlight the importance of using the RHS alongside clinical judgement and embedding it within trauma-informed care pathways in similar service contexts.
