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Transcultural Psychiatry
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Pre-Migration Trauma and HIV-Risk Behavior

Jennifer Steel

Karolinska Institute

Claes Herlitz

Dalarna Research Institute

Jesse Matthews

University of Pittsburgh

Wendy Snyder

University of Pittsburgh

Kathryn Mazzaferro

University of Pittsburgh

Andy Baum

University of Pittsburgh

Töres Theorell

Karolinska Institute

This study examined the relationship between pre-migration trauma and HIV-risk behavior in refugees from sub-Saharan Africa. The sample comprised 122 persons who had emigrated from sub-Saharan Africa and were currently residing in Sweden. Qualitative methods including individual interviews, focus groups, and interviews with key informants addressed questions regarding trauma experience and HIV-risk behavior. A history of pre-migration trauma was found to be associated with HIV-risk behavior. According to the participants, symptoms associated with post-traumatic stress disorder, depression, adjustment disorder, and substance use mediated the relationship between pre-migration trauma and sexual risk behavior. In contrast, a minority of the participants who reported pre-migration trauma but not psychological sequelae, or experienced post-traumatic growth, reported safer sexual practices. It appears that for some individuals, pre-migration trauma resulted in psychiatric sequelae, which may increase an individual's risk to be infected with HIV. Interventions targeted at individuals at increased risk (i.e. pre-migration trauma with unresolved psychiatric symptomatology) may facilitate the prevention of HIV and other sexually transmitted diseases in this population. Integration of multiple psychosocial and health issues is recommended for comprehensive treatment and prevention programs.

Key Words: HIV-risk behavior • immigrants • post-traumatic growth • refugees • trauma

Transcultural Psychiatry, Vol. 40, No. 1, 91-108 (2003)
DOI: 10.1177/1363461503040001006
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