364P
AN OVERVIEW OF PSYCHOSOCIAL, LEGAL & ETHICAL ISSUES AFFECTING HIV+ REFUGEES FROM FIVE AFRICAN / FRANCOPHONE NATIONS PRESENTING TO A PUBLIC, URBAN, REFERRAL CLINIQUE FOR MEDICAL AND PSYCHO-SOCIAL SERVICES
DS Thompson1, G Isabelle2
¹Biomedical Ethics Unit, McGill University; Lawyer – Barreau du Québec; 2Centre of Resources, Interventions, Services in Sexual Health, Montreal, Québec
Objectives: 1) To provide a descriptive overview of the psychosocial and health status needs of patients who are convention refugee applicants and who are diagnosed HIV+ by Citizenship and Immigration Canada; 2) To elucidate some of the many medical, legal and ethical difficulties confronting refugee patients as they access services; 3) To generate practical information that can inform best clinical practises, data collection, staff training and community based support; and 4) Suggest possible hypotheses for future research.
Methods: Through chart abstraction, this population (N=±15) is described in terms of demographic, immigration and clinical variables. Interviews were conducted with physicians, psychiatrist, psychologist, social worker, psycho-social support staff. Workers in a community based organisation offerring support services and referrals were also interviewed. The interviews addressed workers' perceptions of potential ethical issues arising re: patient care, research, patient competency for ongoing legal proceedings, data collection concerning mental health problems, etc. Two group interviews (No=2 ´ 10) were conducted with HIV+ refugees as were 10 individual interviews to examine patient comprehension of HIV and its related treatments, to elicit comments concerning the HIV testing and diagnosis experience, and to identify key stressors in patients' lives.
Results and Conclusions: When this abstract was drafted, the research was underway. Results will be available by the CAHR conference 2005. A final report will contain a descriptive statistical anaysis of demographic, medical and psycho social factors identified via chart abstraction. It will discuss findings re: patient concerns and perceived obstacles in accessing medical, psycho social, legal and community services. It will describe patient reported processes for making descisions re: treatment, clinical trials, and legal procedures. A better understanding of these patients may lead to review of best practises via a process of applied ethics. This may generate changes in data collection, staff training, improved best practises and more effective support and referrals in the hospital and community milieux.