Migration
and AIDS
Situation in Germany
Currently 4.5 million immigrants live
in Germany, a total of 7.3 per cent of the population. With only (approximately)
2 million the female proportion is clearly lower than the male with 2.5
million. Approx. three quarters of all immigrants reside up to 8 years
in Germany and a quarter from 9 until well over 30 years.
Situation in Frankfurt and the Rhein-Main-Area
Frankfurt am Main has over 600,000
inhabitants and is a multicultural city. Foreigners ac-count for 30 per
cent of its population. In the Rhein-Main-Area there is an estimated number
of 8,000 to 10,000 migrants without a clear status of residence. 2,000
of them are young people; 950 children and juveniles are living in hotels
in the redlight-district.
Outpatient Population
Up to the 31st of December 2000 a total
of 6,500 HIV-postive and AIDS-infected outpatients have been medically
treated at the Frankfurt University Hospital. Altogether 1,600 patients
died of AIDS between 1984 and 2000. Of the above mentioned 6,500 patients
1,300 were foreigners, stemming from 64 different countries. This is 20
per cent of the HIV population, 270 of them deceased. The two largest groups
are from the European Mediterranean and North America; 2 per cent of the
outpatients are from the endemic areas of Africa and Asia. 80 per cent
of the immigrant HIV population are masculine and 20 per cent feminine.
The le-gal position and psychosocial problems of special cases have been
evaluated in case stud-ies.
Outpatients in
ambulant medical treatment
Particularly affected groups and CDC-Classification
(medical disease stages)
Within the German population there
was a clear difference between the affected groups. 70 per cent of homo-
and bisexual men were in the advanced stages. 47 per cent of them had AIDS-defining
manifestations and 23 per cent showed symptoms of a serious immune defi-ciency
related to the stages B2 or B3 of the HIV infection. HIV and AIDS patients
with drug addictions were predominantly found in the early stages. In the
stages A3 up to B1 of the CDC-Classification (first stages of immune deficiency)
were 53 per cent of the patients. 24 per cent were in the stages B2 or
B3, and 6 per cent of the treated drug addicts had an AIDS-defining manifestation
and were in the stages C1 up to C3.
Distribution of
all countries
In epidemiological groups there is
a different observation. With regard to new admissions there is a clear
increase of the HIV-infection among heterosexuals. Unprotected sexual con-tacts
with drug addicts or risk groups in the epidemiology areas are the biggest
risk factors for increasing the transmission rate of HIV within the heterosexual
community.
The largest risk
groups
Most of the immigrants originally came
from the Mediterranean, and western and northern European countries. The
two largest groups come from Italy and the USA, both with the same risk
groups, however with a totally different distribution. The group of Italian
immigrants consists of 34 per cent HIV-positive homosexual men, 45 per
cent drug addicts and 16 per cent patients with a heterosexual transmission
risk. The group of immigrants from the USA comprises 79 per cent HIV-positive
homosexual men, 11 per cent drug addicts, and 6 per cent HIV-positive heterosexual
patients.
Patients from
foreign countries
HIV-positive and AIDS-infected patients
from foreign countries who live in Germany illegally face special problems.
Because of the instability of their status, their medical treatment is
a problem which can hardly be solved. All medical doctors are obliged to
help sick people and are not allowed to refuse medical treatment. However,
disclosing their identity for those pa-tients brings with it the fear of
being deported.
A comparable medical treatment of the
AIDS infection in the country of origin of the patient can not be guaranteed.
In order to pay for the necessary medication, a patient might be forced
to work as a prostitute. To solve these problems with the intention of
prevention, all points of view should be considered and the opportunity,
e.g. of an anonymous payment of bills, should be discussed as well. This
could help to faciliate prevention on the one hand and the integration
of the individual person on the other hand. It would also guarantee appropri-ate
medical care.
For migrants with a certain (sub-)cultural
background HIV and AIDS are often topics which are taboo. That makes it
impossible for the individual to get relief and to cope with the dis-ease.
Furthermore, language barriers prevent the patient from getting the information
neces-sary to prevent the spreading of HIV, and make it impossible to obtain
medical care, home care and psychosocial assistence. Appropriate officials
or coordination services for these questions considering HIV and AIDS are
not available.
Psychosocial stress
Fifty percent of all patients of the
outpatient department of infectious diseases show symp-toms of psychological
and social stress. Compared to gay men, drug addicts show a higher percentage
of suicidal tendencies. Psychosocial stress is also caused by such factors
as in-tegration into the working process and problems with partners.
63 per cent of the HIV-infected patients
treated in the outpatient department show symptoms of fear and panic. This
complex of symptoms dealing with fear and panic includes sudden sweating,
headaches, lack of sleep, permanent stress and the appearance of strong
diffuse feelings of fear or anxiety. The patients also complain about long
lasting cramps and/or diar-rhea. These symptoms of anxiety and panic often
lead to a patient`s temporary inability to deal with everyday life. 95
per cent of the patients state that they suffer from these feelings of
anxiety because they fear to get AIDS.
Gay men are more frequently enclosed
in social security systems than drug addicts. 63 per cent of the outpatients
are afraid of financial difficulties in connection with HIV and AIDS. This
implies fears of social decline caused by insufficient social insurance
and also the fear of dropping out of the social security system altogether.
These phenomena concerning HIV-positive and AIDS-infected patients have
not been well examined yet. Furthermore, linguistic barriers make it often
difficult to talk about these topics in hospital. That is due to the fact
that a quick consultation of experienced translators in order to inform
outpatients about their di-agnosis and antiretroviral treatment is very
difficult because of the multitude of languages, and the large-scale organization
required.
Summary and prospects
With reference to the risk groups,
the distribution of all migrants shows that 49 per cent of the outpatients
have a homo- and bisexual transmission risk, 21 per cent of the outpatients
have a heterosexual risk of transmission and 21 per cent are intravenous
drug users.
The distribution of risk groups shows
that 61 per cent of the male immigrants are homosex-ual or bisexual men,
12 per cent are heterosexuals and 19 per cent are drug addicts. It also
shows that 30 per cent of the female immigrants are drug addicts and 58
per cent have a heterosexual transmission risk. Within the immigrant HIV
heterosexual population, 46 per cent are masculine and 54 per cent feminine.
There is a significant difference when compar-ing this to the German heterosexual
HIV-population.
The spectrum of psychosocial strain
comprises a wide variety of problems, such as residen-tial problems, illegal
status, persecution, discrimination and insecurity concerning treatment
or the coverage of treatment costs. The system of treatment and HIV prevention
is lacking specific projects of HIV prevention for different cultural groups
and does not provide sufficient information about AIDS for them.
The social-sponsoring project „Migration
and AIDS“ provides addresses of self-help groups, translation services,
information about the legislation concerning residence permits, the legal
status of a person and the right to medical treatment; it also functions
as a coordinating cen-ter for immigrants with HIV and AIDS in the Rhein-Main-Area.
Via the Internet information about HIV
and AIDS in eighteen different languages is provided.
http://praxis-psychosoziale-beratung.de
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