BACKGROUND: The systematic discrimination to which the Roma are subject over time had a significant impact on their health status, which is in a much more unfavorable position than that of non-Roma in many European countries. Infectious diseases consist an important part of Roma morbidity. Of these, blood-borne and sexually transmitted diseases, especially hepatitis B (HBV) and C (HCV) and HIV infection, have a particular burden on public health. The lack of reliable data on the prevalence of infectious diseases is recognized internationally as a major barrier to the development of effective programs to prevent and control their spread.
PURPOSE: The aim of the thesis, which concerns the adult Roma population living in settlements in Greece, is to assess:
1. the living conditions and the factors affecting their health status
2. regarding viral HBV and HCV and HIV infection:
a. the treatment cascade,
b. the HBV vaccination coverage rate,
c. the knowledge and attitudes in relation to the above diseases and to evaluate the relevant awareness-raising activities,
3. the self-assessment of their health status and the self-reported diagnosed chronic diseases, and
4. the use of health services and the possible barriers to accessing them in Greece.
METHODOLOGY: Data were derived from the Hprolipsis Nationwide Health Survey, which collected data on Roma living in communities from December 2014 to January 2016 and the sample was based on quota random sampling with a target population of approximately 500 adults. The data were collected from four regions of Greece. In each of the regions three types of Roma settlements were selected a. Type 1 (houses), b. Type 2 (houses and shacks/mixed) and c. Type 3 (shacks). All Roma adults were invited to participate in the study, maintaining the desired and predefined gender and age distribution. After providing participants with relevant information and having their signed consent, a questionnaire was filled out and a blood sample was taken to test serological markers of HBV and HCV and HIV infection. For the statistical analysis, apart from descriptive statistics, multivariable logistic or ordinal logistic regression or mixed effects models were applied, depending on the nature of the response variable.
RESULTS: The study included 534 Roma (287 women and 247 men), with a median age (interquartile range) of 35 (25, 48) years. More than half (50.7%) had never been to school, less than 30% were working permanently or temporarily, and just 35.8% said they never had food insecurity. Only 4.1% of the participants stated that they had all four basic household facilities (water, electricity, heating and toilet inside the house) in their household. HBV prevalence was estimated at 7.5% with 95% CI (5.50, 10.07), and regarding the HBV treatment cascade, of the 39 participants with HBsAg(+), 9 (23.1%) stated that they had been previously diagnosed and 2 (5.1%) had received some treatment. The prevalence of anti-HCV in men (no women tested positive) was estimated at 2.9% with 95% CI (1.40, 5.90). Regarding the HCV treatment cascade, of the 7 participants with anti-HCV(+), 1 (14.3% ) stated that he had already been diagnosed and received some treatment. None of the participants tested positive for HIV.
Twenty six per cent of the participants answered "I don't know" to the HBV, HCV and HIV infection knowledge questions and about 40% had a low general level of knowledge. Approximately 50% stated that they had a piercing/tattoo, 80% that they did not use condoms when having sex with their partner and that they had never been tested for the diseases in question, and 5% that they had previously been diagnosed with a Sexually Transmitted Disease (STD). According to the results of the evaluation of the awareness raising activities in a subset of the participants (N=94), the high general level of knowledge increased from 7.9% to 42.6% for all three diseases in total.
About 62% of the participants answered that they had good/very good health, 26% that they had average health, and 12% that they had poor/very poor health. Approximately half of the participants overall and 29% of those with good/very good self-rated health reported having at least one chronic disease. High blood pressure (15.7%), high cholesterol (11.8%), depression (10.1%) and respiratory diseases (9.2%) were the most common self-reported as diagnosed chronic diseases.
In the last year, about 65% of the participants had seen a doctor and 10% needed to be hospitalized. Approximately 50% of the participants were uninsured and 37% needed access to the health system but did not have it. Financial cost (74.4%) and distance from the health facility/lack of transport (18.6%) were the two most frequently stated reasons. According to the results from the multivariable analysis, a number of demographic and socio-economic variables that are among the social determinants of health appeared to be significantly related to the above health indices.
CONCLUSIONS-RECCOMMENDATIONS: The data obtained from the Hprolipsis study can contribute decisively to the better planning of public health policies for Roma living in settlements in Greece and at the same time form the basis for monitoring the situation and evaluating the programs implemented. The use of the conceptual framework for social health determinants and approaches based on the direct involvement of Roma communities should be central pillars of future health policies and programs designed for this group.