Epidemiology and ambulant psychosocial care of immigrants with HIV and AIDS

Situation in Germany

Currently 4,5 million immigrants live in Germany a total of 7.3% of the population. With only (approximately) 2 million the female portion is clearly lower than the male with 2.5 million. Approx. 3 quarters of immigrants reside up to 8 years in Germany and a quarter from 9 till well over 30 years.

Situation in Frankfurt and the Rhein-Main-Area

Frankfurt am Main has over 600.000 inhabitants and is a multiculture city, 30% of the people, that are living there, are from foreign countries. In the Rhein-Main-Area are living estimate to value 8.000 to 10.000 migrants they have not a clear status of resident. 2.000 of them are juveniles, young people. 950 childrens and juveniles are living in hotels in the redlight-district.

Outpatient Population

Up to the 31. december 1996, 4590 HIV-postive and AIDS-infected outpatients have been medically treated at the Frankfurt University Hospital. Alltogether 1396 patients died on AIDS between 1984 and 1996.

1053 of the above 4590 patients are from of 64 countries. This is 22% of the HIV population and 237 of them deseased. The two largest groups are come from European Mediterranean and North American countries. 2% of the outpatients are from the endemic areas of Africa and Asia. 80% of the immigrant HIV population are masculine and 20% feminine. The legal position and psychosocial problems of special cases have been evaluated by casuistries.

Outpatients and CDC-Classification

Medical disease stages

Within the German population there is a clear difference between the affected groups. 70% of homo- and bisexual men are in the advanced stages. 47% of them have had AIDS defined manifestations and 23% find themselves with a serious immune deficiency in the B2-B3 stages of the HIV infection. HIV and AIDS patients with drug addictions predominate the early stages. In the stages A3-B1 of the CDC-Classification are 53% with a light immune deficiency. 24% are in stages B2-B3 and 6% of drug addicts have had an AIDS defined manifestation, stage C1-C3.

Distribution of all Countries

In epidemiological groups there is a different observation. It shows a clear increase of the HIV-infection being transmitted by heterosexuals in new admissions. Unprotected sexual contact with drug addicts and with risk groups in the epidemiology areas are the biggest risk factors for increasing the transmission of the HIV virus within the heterosexual community.

The largest groups

The largest group of immigrants are originally from Mediterranean countries as well as west and northern Europe. The two largest groups are from Italy and the USA, both with the same amount of patient groups, however with totally different combinations. The group of Italian immigrants consists of 34% HIV-positive homosexual men, 45% drug addicts and 16% heterosexuals together with transmission risk. The other group of immigrants - from the USA - consist of 79% HIV-positive homosexual men, 11% drug addicts and 6% HIV-positive with a heterosexual transmission risk.

Specielly problems from patients of foreign countries

There are special problems for HIV-positive and AIDS-infected patients from foreign countries who are illegally living in germany. Because of instability the medical treatment is a problem hardly to be solved. All medical doctors are obliged to help sick people and are not allowed to reject medical treatment. The disclosing of the identity is connected to the fear of deportation.

A comparable medical treatment of the AIDS infection in the home country of the patient is not guaranteed. To pay for necessary medication a patient will be forced to work as a prostitute again. To solve these problems with the intention of prevention all points of view should be considered and the chance e.g. of an anonymous payment of bills should be discussed as well. This makes it easier for the prevention on the one hand and for the integration of the individual person on the other hand. It also guarantees an appropriate medical treatment.

In a certain (sub-)cultural context of migration HIV and AIDS are often taboo. The relief and digestion of the desease are impossible for the individual. Furthermore language barriers prevent the necessary information to get to the patient to guarantee a sucessfull HIV prevention as well as medical, care taking and psychosocial help. The appropriate official to talk to or coordination service for these questions considering HIV and AIDS is not available.

Psychosocial stress

Half of all patients of the outpatient department of infection show a psycho and social stress level. Compared to gay men, drug addicts show a higher percentage of suicidal stress. Psychosocial stress is also found in factors like integration into the working process and problems with partners.

63% of the HIV-infected patients being taken care of by the outpatient department show symptoms of fear and panic. This complex of symptoms dealing with fear and panic includes sudden sweating, head aches, lack of sleep, permanent stress and the appearance of strong diffuse (feelings of fear) anxiety state. The patients also complain about long lasting cramping of their bodies as well as diarrhea. These symptoms of anxiety and panic often lead to the persons´ concerned temporary inability to deal with their everyday life. 95% of the patients know these concrete feelings of anxiety are because of AIDS.

Gay men are more frequently enclosed in social security systems than drug addicts. 63% of the outpatients are afraid of financial difficulties in connection with HIV and AIDS. This implies fear of social decline caused by insufficient social insurance and also the anxiety about falling out of the social security systems. These phenomena are not well examined for HIV-positive and AIDS-infected patients up to now and it is often difficult to discuss about that in the clinical athmosphere because of linguistic barriers. A quick consultance of experienced translators in the case of informing the outpatients of the diagnosis and antiretroviral treatment is very difficult because of the multitude of languages and it is connected with large-scale organization.

Summary and prospect

The distribution of all the migrants referred to the risk groups show 49% of the outpatients have a homo- and bisexual, 21% of the outpatients have a heterosexual transmission risk and 21% are intravenous drug users.

The distribution of risk groups referred to sex show that 61% of the male immigrants are homosexual or bisexual men, 12 % are heterosexuals and 19% drug addicts. It shows also that 30% of the female immigrants are drug addicts and 58% have a heterosexual transmission risk. Within the immigrant HIV heterosexual population 46% are masculine and 54% feminine. There is a significant difference when comparing this to the native HIV heterosexual population.

The spectrum of psychosocial strain ranges from residential problems, illegality, persecution, discrimination and insecurity over treatment to the undertaking of treatment costs. Within the system of treatment and HIV prevention, culture specific projects of HIV prevention and advise over AIDS is lacking.

Represented in this social-sponsoring-project are selfhelp potential groups, translation services, information of the regulations pertaining to residential problems and to the guarantee of medical treatment, as well as a coordinations center for immigrants with HIV and AIDS in the Rhein-Main-Area.

Contact: Praxis Psychosoziale Beratung