Between the end of August and December 2013, an internet based survey named ANSWER will collect data about sexual health, sexual behavior and risk taking among Sub-Saharan African migrants (SSAm) living in Switzerland. This research is carried out by the Institut de médecine sociale et préventive (IUMSP, Lausanne) on a mandate from the Federal Offi ce of Public Health (FOPH), in cooperation with the Swiss Aids Federation (AHS) and other institutions addressing the prevention and information needs of the African population living in Switzerland

Bize, R.

Dubois-Arber, F.

Ruggia, L.

Serveur académique lausannois

SEPTEMBER 2013Medicus Mundi SchweizNetzwerk Gesundheit für alleRéseau Santé pour tousNetwork Health for AllBulletin129Reader of the aidsfocus.ch conferenceA FUTURE WITHOUT AIDS – APPROACHING A VISION61MMS BULLETIN 129/2013 MMS BULLETIN 129/2013 60 Targeting the Critical EnablersA Swiss behavioral surveillance survey among Sub-Saharan Africa migrants living in Switzerland, with and for the African community.By Luciano Ruggia, Raphaël Bize and Françoise Dubois-Arber*Between the end of August and December 2013, an internet based survey named ANSWER will collect data about sexual health, sexual behavior and risk taking among Sub-Saharan African migrants (SSAm) living in Switzerland. This research is carried out by the Institut de médecine sociale et préventive (IUMSP, Lausanne) on a mandate from the Federal Ofﬁ ce of Public Health (FOPH), in cooperation with the Swiss Aids Federation (AHS) and other institutions addressing the prevention and information needs of the African population living in Switzerland. ANSWER: AFRICAN NET SURVEY – WE RESPOND !THE MAIN aims of the ANSWER Survey are the following: ■ To establish a fi rst baseline for the HIV/STI related behavioral surveillance among the SSAm population.■ To test the methodology of an internet based approach among SSAm and of the corresponding recruitment and communica-tion strategy.■ To collect data on HIV/STI knowledge and perception, on sexual behavior, prevention, testing and access to care and treatment among this population.■ To provide the evidence needed to adapt, in-crease and improve prevention work for and with this community. SITUATIONIn Switzerland, SSAm are identifi ed as being a population with a high HIV prevalence, ac-cording to the relevant epidemiological da-ta, second only to MSM (men having sex with other men). (1) It is also recognized that there is a general lack of behavioral surveillance data for SSAm. In particular surveillance data about sexual behavior is lacking. (2)The SSAm population living in Switzerland mostly come from countries with a general-ized HIV epidemic (> 1 % HIV prevalence) and it is estimated that the HIV prevalence in SSA population living in Switzerland is high al-though no reliable prevalence studies are avail-able. For other STI, very little data is available among SSAm.In 2009, according to the Federal Offi ce of Statistics (FOS), between 70’000 and 100’000 SSAm (approximately 3 % of the foreign res-ident population) were living in Switzerland. Also according to FOS, the main nationalities represented in 2009 were the following: Eritrea 7368; Somalia 6394, Congo (Kinshasa) 5844; Angola 4362; Cameroun 4333; Nigeria 2862; Ethiopia 2803; etc. (3)They also constitute a very young popula-tion, 80 % are younger than 40 years old (there-fore highly sexually active), and living mainly in large cities (Zurich, Genève, Lausanne, Ber-ne, Fribourg, Bienne). (3) It can also be consid-ered that this population is growing and that the estimation of the FOS is missing the amount of undocumented SSA living in Switzerland.The socioeconomic differences among SSAm are extremely large, especially if we consid-er the illegal migrants and the refugees. Coun-try of origin, language and culture only add to the complex situation of this population, which should never be approached as a unique and coherent group. Stigma and discrimination towards HIV positive people still run strong among SSAm and are therefore additional fac-tors of complexity to any analytical or inter-vention effort.The HIV epidemiological data for SSAm suggest a worrying public health impact of HIV on this group. In 2002, 191 new HIV diagnosis were registered among SSAm living in Swit-zerland (43.6 % of the heterosexual transmis-sions); in 2012, 73 new diagnosis were regis-tered among them (27 % of the heterosexual transmissions). Late detection is also a major problem in this population, more than in any other group.THE QUESTIONNAIREThe questionnaire has been prepared by the IUMSP in a similar way as other behavioral surveillance surveys in Switzerland, such as the GaySurvey which targeted MSM (conduct-ed on a regular base since 1987). When pos-sible, existing indicators or questions, already used before or compatible with other surveys have been used. Contact with similar initiatives in other countries has also been established and, when possible, questions have been shared. All those elements will help with data analysis and results interpretation.Attention has been given to create a narra-tive experience in the questionnaire, helping people not to abandon it at mid-way. Commu-nity sensitive terminology has also been used whenever possible. Cognitive testing was used to check for discrepancies between what was conceived by researchers and what is actually understood by the target audience. Finally, the duration has also been measured and fi lling in the questionnaire should not take more than 30 minutes.Beside socio-demographic data, ques-tions target knowledge of HIV and STI, gen-eral health status as perceived by the respon-dent, intimate life and relationships, circumci-sion, contraception, use of condoms, residence status and integration in Switzerland, percep-tion on HIV discrimination, drug use, etc.AN INTERNET BASED RESEARCHIt is generally recognized that the SSAm com-munity is diffi cult to reach and that conduct-ing a survey in this population raises diffi cult methodological questions. Any approach will have advantages and limitations that need to be clearly recognized and discussed.For our survey we decided to use an inter-net based questionnaire, which is increasing-ly used in behavioural surveillance in hard to reach populations. The choice of using an internet based ap-proach was taken after discussing with SSAm about their own use of internet and their opin-ion about this approach. SSAm make an inten-sive use of internet, although sometime in dif-ferent ways to those an educated Swiss person would. Clearly computer and internet are used as a communication instrument, to keep in con-tact with the family in the country of origin or in order to communicate with other communi-ty members. SSAm do not necessarily “read” much text on internet, but they watch a lot of videos with all kinds of contents. Social net-works are also extremely important and widely used for the auto-organization inside the com-munity.COMMUNICATION CAMPAIGNIn order to overcome some of the mentioned obstacles and to reach a maximum number of respondents, we have designed a communica-tion campaign fi tting the research design. Firstly, we will focus on internet by pro-ducing a series of videos of well-known Af-rican personalities in the SSAm communi-ty in Switzerland, carrying the message of the importance of taking part in this survey. We strongly believe that, because of the impor-tance of oral communication among Africans, those videos will better carry the message than any lengthy written text. A specifi c facebook (FB) group dedicated to the survey will be set up. This FB page will be used to distribute the videos, to link other existing groups as well as to provide information about all events related to the survey, either at national or at local lev-el. The FB page will be animated and moderat-ed during all the data collection period.Secondly, in order to reach people using in-ternet in a less intensive or different way, an in-formation campaign will be set up focusing on sport, culture, religious and other events aimed at the African community or in settings (health 63MMS BULLETIN 129/2013 MMS BULLETIN 129/2013 62 Targeting the Critical Enablersconsultations, hairdressers, internet cafés, etc.) frequented by them. This will be mainly orga-nized locally by AHS branches and by the Af-rimedia mediators (cultural mediators of the AHS). An information leafl et will be produced to support those actions.COMMUNITY MOBILIZATIONA central point of the project is a strong in-volvement of the community in all phases of the project. Getting SSAm involved in this sur-vey won’t be an easy task, because of the frag-mented composition of this population (lan-guages, cultures, countries of origin, socio-eco-nomic status, etc.). In order to achieve a strong involvement, we set up fi rst a Steering Group, charged of dis-cussing and validating all the strategic elements of the project. The Steering Group is compo-sed of a well balanced mix of professionals and of community representatives. This group star-ted to meet regularly at the initial development phase of the project and will continue to do so until the very end, including supporting the dis-semination of the project’s results. Other forms of involvement are the impli-cation of SSAm in the different testing phases of the questionnaire (cognitive testing, fi eld test) as well as for the translations and for the communication work. The promotion phase of the survey will also rely on a strong fi eld acti-vity conducted by the mediators of the Afrime-dia program during events aimed at the SSAm community or in specifi c settings.* LUCIANO RUGGIA, Federal Ofﬁ ce of Public Health (FOPH), BernFRANÇOISE DUBOIS-ARBER and RAPHAËL BIZE, Insti-tute of social and preventive medicine (IUMSP), Laus-anne University Hospital, 1004 Lausanne, Switzerland.References1. Federal Ofﬁ ce of Public Health (FOPH). National Programme for HIV and Other Sexually Trans-mitted Infections 2011–2017, Bern, 2010 (www.bag.admin.ch/hiv_aids/05464/05465/12491/index.html?lang=en)2. Manzanares, L.; Ruggia, L., Le VIH/sida et autres infections sexuellement transmissibles auprès des populations migrantes: Un état des lieux. Bern, 2011 (www.bag.admin.ch/hiv_aids/05464/05484/05487/index.html?lang=en)3. Federal Ofﬁ ce of Statistics. Statistique de la popu-lation résidante de nationalité étrangère (PETRA), 1991-2009. Neuchâtel, 2009 (www.bfs.admin.ch/bfs/portal/fr/index/infothek/erhebungen__quellen/blank/blank/petra/01.html)The questionnaire ANSWER is available in different languages (English / German / French / Italian / Portuguese / Somali / Tig-rinya) at the following address: www.afric-answer.chIn order to maximize the participation rate, we ask every member of the SSAm com-munity or any person working with them to help disseminate the information and the link about our survey.Questions and enquiries at: luciano.ruggia@bag,admin.ch RESULTSThe end of the data collection is planned for December 31st, 2013. This will be followed by an analytical phase and the full report will be published by the IUMSP during 2014. Dissem-ination of results is also planned, including dis-semination among the SSAm community itself. 

Answer : African net survey - we respond !

https://serval.unil.ch/resource/serval:BIB_52B79F319258.P001/REF.pdf

Answer : African net survey - we respond !

Abstract

Similar works

Full text

Available Versions

Serveur académique lausannois