Health in refugees and migrants who self-identify as sexual or gender minority

Abstract Background In 2019, 80 million individuals were forcibly displaced. Yet, there is little knowledge on the health of refugees and migrants who self-identify as sexual- or gender minority (SGM). The aim was to examine health and health-related behaviors in refugee and migrant individuals who identify as SGM, and in comparison, to their heterosexual peers. Methods This study included 168,952 persons aged 16-84 who answered the Swedish National Public Health Survey in 2018 and 2020. Participants were grouped into White heterosexual, White SGM, migrant heterosexual, migrant SGM, refugee heterosexual, and refugee SGM. Outcomes included mental health (f.e. mental ill-health, suicidal ideation), general health, risky behaviors (f.e drug and alcohol use), and experiences of violence. Associations were analyzed using logistic and linear regression adjusting for sex, age, and educational level. Results Being an SGM, regardless of refugee or migrant minority status, was associated with worse general health and mental ill-health compared to heterosexual peers including suicidal ideation in refugee SGM (OR 2.42, 95 % CI 1.44-4.08). Both refugees and migrants had for example lower odds of drug and risk alcohol use compared to heterosexual peers but higher odds of risk gambling (OR 1.88, 1.49-2.37 for refugee SGM). Transgender refugees had high odds for risk gambling (OR 8.62, 1.94-38.40) and exposure to physical violence (OR 7.46, 2.97-18.70). Conclusions In this national population-based study, SGM have worse mental and general health regardless of being refugee or migrant minority. SGM refugees did not have worse health compared to migrant and White SGM and their heterosexual peers. While more research is needed, our study shows the need for public health personnel to be aware of potentially worse health and adverse experiences in SGM individuals, regardless of ethnic origin including refugees. Key messages • Our study provides evidence for poorer health outcomes in diverse SGM-groups. • Policies tackling health in refugees and SGM are still inadequate.


Background:
Youth with Turkish migration background (TRMB) are repeatedly classified as a vulnerable group.Digital health information, which is prepared and made available by various providers in a variety of ways, may represent an opportunity to promote the health of these adolescents.Empirical findings on wheter young people have access to digital health information and what role digital health information plays in their everyday lives are hard to find.

Methods:
In the project ELMi, a project of the HLCA Consortium, funded by the BMBF, female adolescents with TRMB were interviewed.Individual interviews as well as a focus group discussion were conducted and evaluated according to the Qualitative Content Analysis.

Results:
Female adolescents with TRMB have technical access to digital health information.They use New Media to obtain health information.When searching for digital health information, it is important for the adolescents to be able to find factual and comprehensibly formulated information quickly.Germanlanguage homepages are preferred by them.Parallel to the digital platform they regard female persons from their own social network as contact persons for health questions.They draw on their health-related knowledge and experience in order to be able to obtain answers to their own questions.

Conclusions:
Digital health information and the health-related knowledge and experience of the female social network are considered as a health related resource.German-language electronic information with low-threshold content can represent an opportunity SGM, migrant heterosexual, migrant SGM, refugee heterosexual, and refugee SGM.Outcomes included mental health (f.e.mental ill-health, suicidal ideation), general health, risky behaviors (f.e drug and alcohol use), and experiences of violence.Associations were analyzed using logistic and linear regression adjusting for sex, age, and educational level.

Results:
Being an SGM, regardless of refugee or migrant minority status, was associated with worse general health and mental illhealth compared to heterosexual peers including suicidal ideation in refugee SGM (OR 2.42,.Both refugees and migrants had for example lower odds of drug and risk alcohol use compared to heterosexual peers but higher odds of risk gambling (OR 1.88, 1.49-2.37 for refugee SGM).Transgender refugees had high odds for risk gambling (OR 8.62,) and exposure to physical violence (OR 7.46,.

Conclusions:
In this national population-based study, SGM have worse mental and general health regardless of being refugee or migrant minority.SGM refugees did not have worse health compared to migrant and White SGM and their heterosexual peers.While more research is needed, our study shows the need for public health personnel to be aware of potentially worse health and adverse experiences in SGM individuals, regardless of ethnic origin including refugees.

Key messages:
Our study provides evidence for poorer health outcomes in diverse SGM-groups.

Methods:
We obtained a dataset regarding part of the people these NGOs facilitated in accessing the vaccination booking.We had information regarding age, sex, country of origin, nationality and type of document.

Results:
These populations were from different ethnic backgrounds, in majority males and below 50 years old on average.We found an association between the continent of origin and holding any document and between age and holding any document, both at a significant level (p < 0.05).Coming from Asia, as opposed to coming to any other continent, and being younger, i.e. under 25 years of age, were associated with holding any type of document.

Conclusions:
We reflect on the need of rethinking the services for this population, having in mind article 25 of the Universal Declaration of Human Rights, but also, more practically, that often these people work in our elderly homes as caregivers or as cleaners in our offices.Therefore, making it easier to access health services would be in any country's interest, especially during a pandemic.Policy efforts directed at facilitating migrant access to health services would ultimately help create a safer community for both migrants and residents, for whom migrants often work as strategic employees.Key messages: Irregular migrants have not been included in national vaccination plans everywhere, despite WHO and other entities recommendations.
An integrated national plan for irregular migrants vaccination would be useful for protecting other vulnerable populations such as elderly.
Abstract citation ID: ckac131.522Understanding clinician barriers to providing equitable healthcare for ethnic minority populations Newham University Hospital, Barts Health NHS Trust, London, UK Contact: Rebecca.newell1@nhs.net

Background:
It has long been recognised that ethnic minority groups have worse health outcomes in the UK.Social determinants of health (SDH) contribute significantly to these inequalities.However, inequalities persist, even after controlling for these determinants.As well as being less likely to engage with healthcare services, ethnic minority groups are more likely to report poor experiences.The majority of healthcare in the UK is delivered through patient: clinician interactions (PCI), therefore a good working relationship with patients is paramount.Recent focus has been placed on ensuring ''cultural competence''.Whilst this is important, we suggest also examining the culture within healthcare itself.Healthcare professionals are not immune to bias, preconceptions and the stresses of work and this must be taken into account.A seminal piece of work on this is the ''culture of medicine'' framework proposed by Boutin-Foster et al, which examines the impact of these factors.

Aims and Methodology:
This paper aims to examine barriers within PCI that impact healthcare for ethnic minorities.A formal literature review was conducted and 131 relevant studies were identified.Grounded theory was used for analysis and data was categorised into themes with Boutin-Foster's framework used as a structure.

Results:
The review found that the concept of implicit bias was paramount in PCI.Three major barriers resulting from this bias are suggested: its impact on clinical decision making, the impact on clinician-patient communication and finally the resultant lack of trust in clinicians and poor perceived quality of care by ethnic minority groups.

Conclusions:
Clinician implicit bias is a major barrier to equitable healthcare for ethnic minority populations.A solution we propose is to acknowledge our own preconceptions.Awareness of our own culture, preconceptions and the pressures around us will allow us to find solutions to these barriers, including further research and education.

Key messages:
Clinician implicit bias within the ''Culture of Medicine'' is a barrier to equitable healthcare for ethnic minority populations.Awareness of our own culture and preconceptions is paramount to addressing these barriers.
Policies tackling health in refugees and SGM are still inadequate.The death toll of the COVID-19 pandemic has been hugely downsized by the advent of the currently available vaccines, at least in high-income countries.Nevertheless, there is a huge gap between countries and within countries with respect to vaccination access and coverage.In June 2021, several nongovernmental non-profit organizations responded to a call issued by Regione Lazio to help organize and enrol for vaccination vulnerable people such as irregular migrants and migrants living in temporary or informal settlements.Through a huge effort, non-profit voluntary organizations Nonna Roma and Intersos enabled the vaccination of thousands of immigrants from different countries, age and residence status.