Assessing the Risk of HIV and Hepatitis C among Internally Displaced Persons in Georgia

Abstract

Background: Georgia is leading one of the world's first hepatitis C (HCV) elimination programs alongside interventions to combat a HIV epidemic concentrated among high-risk groups. Although progress has been substantial, neither strategy accounts for the nearly 150,000 internally displaced persons residing in collective centers (CC-IDPs) who are susceptible to deeply integrated risk environments that could promote infection. Achieving dedicated goals for HCV elimination and HIV suppression requires a clear understanding of the risks facing CC-IDPs.

Objectives: This literature review aims to consolidate what is known about the socio-economic and physical/mental health status of IDPs living in collective centers in Georgia, and to assess their vulnerability to HIV and HCV in light of local and global epidemiological trends.

Methods: Sources were compiled from journal publications, reports by government ministries and transnational organizations, and the Integrated Household Survey database (2009-2018; updated annually by the National Statistics Office of Georgia) through manual searches in PUBMED, Google Scholar and Search, ProQuest, and digital repositories of government offices.

Findings: Reports indicate that CC-IDPs are more susceptible to poverty, poor living conditions, mental illness, disability, substance use, and in some cases infectious disease; although, the correlation is not always present and subject to variability. These factors were linked to increased transmission and acquisition of HIV/HCV in both displacement and non-displacement contexts abroad. The geographic concentration of HIV/HCV in areas with greater clusters of CC-IDPs, and shared characteristics with local high-risk groups, indicate the possibility of inordinate transmission among CC-IDPs in Georgia.

Conclusions: The disproportionate prevalence of psychosocial and clinical harms among CC-IDPs testifies to the serious potential of a greater burden of HIV and hepatitis C. Going forward, targeted research is needed to inform interventions and clarify the health status of CC-IDPs in Georgia.

Figure 1

Comparison of living conditions between IDPs and non-IDPs. All measures are stratified by geography and two time periods representing the post-election period (2013–2018) and the post-conflict period preceding the election (2009–2012). (a) Percent difference of access to private or shared bathrooms and kitchens, or the lack of either in the respondent’s residence, between IDPs and non-IDPs. (b) Percent difference in dwelling size. (c) Change in the difference between IDP and non-IDP dwelling size over time, calculated as the percent difference of (b) between the two time periods. (d) Status of home repairs according to the urgency of repairs and the severity of repair. (e) Percent difference in home ownership. (f) Percent difference in the self-perceived value of the respondent’s home according to what they believed others would pay to purchase their home.

Figure 2

Causal loop diagram of factors that contribute to the risk of HIV/HCV infection. The diagram represents an informative, but not exhaustive, illustration of how various individual and environmental factors influence one another and the risk of infection. Blue and red arrows represent direct and indirect relationships, respectively. Reinforcing loops are signified, and further marked by bolded, thick arrows.