title: High-risk sex and displacement among refugees and surrounding populations in 10 countries: the need for integrating interventions.
abstract: BACKGROUND
  Between 2004 and 2012, the United Nations High Commissioner for Refugees conducted behavioural surveillance surveys in 27 separate communities in 10 countries.
  
  
  METHODS
  Random systematic or two-stage cluster sampling was used among participants of age 15-49 years, using a modified standard questionnaire. We conducted descriptive data analysis and multivariable logistic regression to identify factors independently associated with multiple sexual partnerships.
  
  
  RESULTS
  Of 27 sites surveyed comprising 24 219 individuals, 11 refugee and surrounding communities were paired. Recent displacement comprised less than 10% of participants. Visiting neighbouring communities varied from 8.6 to 74.4%. Multiple sexual partnerships varied from 2.7% in Sudan to 32.5% in Tanzania. Condom use during last sex was low in most of the communities (<5%). The prevalence of forced sex was similar in paired sites, with intimate partner violence being the most frequent, ranging between 1.0 and 4.6% in camps and 0.8 and 3.6% in communities, with the exception of Nepal (10.8 and 9.8%). Being away from home for more than 1 month and having lived in community for less than 12 months was associated with multiple partnerships in six and five of 16 sites, respectively.
  
  
  CONCLUSIONS
  In the largest study of paired sites of refugees in protracted refugee camps and surrounding nationals, data showed no consistent difference in levels of risky sexual behaviour and there was much variation among the different groups. The prevention strategies should be targeted in a highly integrated manner for both the communities. Forced sex among women was reported at similar levels among refugees and nationals, with intimate partner violence being the most common. These findings should reduce stigma and discrimination against refugees.
authors.affiliation: United Nations High Commissioner for Refugees, Geneva, Switzerland.
authors.forename: Paul B
authors.initials: PB
authors.lastname: Spiegel
authors.forename: Marian
authors.initials: M
authors.lastname: Schilperoord
authors.forename: Maysoon
authors.initials: M
authors.lastname: Dahab
mesh_terms: D000293:Adolescent; D000328:Adult; D003625:Data Collection; D005260:Female; D006801:Humans; D008297:Male; D012036:Refugees; D047568:Unsafe Sex; D055815:Young Adult