Refugees (and newly arrived migrants from similar settings)

Overview

  • Consider engaging an accredited interpreter for all discussions with refugees, migrants and others born outside Australia.
  • The prevalence of chlamydia and gonorrhoea infections is very low in newly arrived refugees settling in Australia and other developed countries. 
  • Chronic hepatitis B infection is common in source countries for migration and found in 6-16% of refugee cohorts in Australia. 
  • Syphilis infection has a higher incidence in many parts of Africa and Asia and has been detected in refugees settling in Australia (prevalence rate between 5-8%).
  • Undiagnosed HIV infection is very rare in newly settled refugees due to pre-migration screening processes. This includes blood-borne virus screening in Immigration Detention Centres.

Testing advice

InfectionConsideration
Syphilis

If clinical suspicion of syphilis, refer to the syphilis guideline.

Hepatitis B

Vaccinate if not immune.
Serological testing after completing vaccination is not recommended, except if HIV positive, sexual partners/household contacts of people with hepatitis B.

Gonorrhoea Offer if at risk due to history of sexual assault or unprotected sex. Consider
self-collection of samples for testing. If NAAT test result is positive, take swab at relevant site(s) for culture, before treatment. Cultures are the preferred test for samples from non-genital sites.
Chlamydia Offer if at risk due to history of sexual assault or unprotected sex. Consider
self-collection of samples for testing.
HIV

Repeat test if patient exposed within previous 12 weeks (window period).

NAAT - Nucleic Acid Amplification Test

Specimen collection

Clinician collected |
Self-collection

Clinical indicators for testing

  • All refugees should be offered individualised post-arrival health screening which takes into account past screening and risk assessment
  • Screening for chronic hepatitis B and syphilis should be offered to all
  • NAAT screening for chlamydia and gonorrhoea should be offered to newly arrived individuals considered at risk due to history of sexual assault or unprotected sex
  • Repeat HIV testing should be offered for adolescents and adults settling from regions of prevalence >1% (i.e. sub-Saharan Africa, Thailand) in whom the pre-migration test was months previously, or if other risks are identified on history, as per the HIV National Testing Policy
  • Young persons aged 15-29 years in Australia for longer periods should be offered testing consistent with guidelines for young people, e.g. annual chlamydia testing.
  • It is not recommended to routinely test for herpes and genital warts with serology. Consider testing for herpes and genital warts only if there are clinical signs and symptoms.

Special considerations

  • Gender based violence is common in conflict zones and refugee camps. Full STI testing should be offered to any person disclosing a history of sexual assault or gender based violence regardless of age. Consider pregnancy and/or need for emergency contraception.
  • Anecdotal reports suggest male to male sex is occurring in Immigration Detention Centres in Australia.
  • Most women from refugee backgrounds have never had a cervical smear and should be offered opportunistic testing. Be mindful of access to gynaecological care if on-going management required.

Follow up

Even if all test results are negative, use the opportunity to:

  • Educate about condom use and risk minimisation
  • Vaccinate against hepatitis B if non-immune on testing
  • Discuss and activate reminders for regular screening tests according to risk - especially if their behaviors indicate the need for more frequent screening and risk assessment
  • Discuss and activate reminders for regular testing according to risk, especially if their behaviours indicate the need for more frequent testing
  • Discuss contraception if warranted.

Auditable outcomes

  • 80-90% of people of refugee background are offered individualised post-arrival health screening, taking into account past screening and risk assessment
  • 80-90% of people of refugee background are offered screening for chronic hepatitis B and syphilis.

References

  1. Hoad VC, Thambiran A. Evaluating the chlamydia and gonorrhoea screening program in the Humanitarian Entrant Health Service, Western Australia. Med J Aust 2012;197(1):47-9.
  2. Stauffer WM, Painter J, Mamo B, Kaiser R, Weinberg M, Berman S. Sexually transmitted infections in newly arrived refugees: is routine screening for Neisseria gonorrheae and Chlamydia trachomatis infection indicated? The American journal of tropical medicine and hygiene 2012;86(2):292-5.
  3. Paxton GA, Sangster KJ, Maxwell EL, McBride CR, Drewe RH. Post-arrival health screening in Karen refugees in Australia. PloS one 2012;7(5):e38194.
  4. Tiong AC, Patel MS, Gardiner J, Ryan R, Linton KS, Walker KA, et al. Health issues in newly arrived African refugees attending general practice clinics in Melbourne. Med J Aust 2006;185(11-12):602-6.
  5. Martin JA, Mak DB. Changing faces: A review of infectious disease screening of refugees by the Migrant Health Unit, Western Australia in 2003 and 2004. Med J Aust 2006;185(11-12):607-10.
  6. Pottie K, Greenaway C, Feightner J, Welch V, Swinkels H, Rashid M, et al. Evidence-based clinical guidelines for immigrants and refugees. Canadian Medical Association Journal 2011;183(12):E824-E925.
Last Updated: Monday, 16 February 2015