Migrants: HIV among migrants, what do we know?

Prof Julia del Amo

National Center for EpidemiologyInstitute of Health Carlos III

Madrid, Spain

Outline

• Magnitude and trends of the HIV epidemic among migrants in the EU

• Pre and post-migration acquisition of HIV in the EU

• Access to HIV testing & treatment in the EU

Who is a migrant?

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Who is a migrant?

Heterogeneous groups of persons with different migration drivers

Distinct risk-contexts for HIV infection

Outline

• Magnitude and trends of the HIV epidemic among migrants in the EU

• Pre and post-migration acquisition of HIV in the EU

• Access to HIV testing & treatment in the EU

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Magnitude and trends of the HIV epidemic among migrants in the EU

Geographical origin

NATIVES

- Western Europe - South & Southeast Asia

- Central Europe - North Africa & Middle East

- Eastern Europe - North America

- Sub Sahara Africa - Caribbean

- East Asia & Pacific - Latin America

- Australia & New Zealand - Unknown

MIGRANTS

Magnitude and trends of the HIV epidemic among migrants in the EU

181 143 HIV diagnosis reported during 2007-2012

150 455 (83%) with information about Geographical origin 58 740 (39%) migrants

Distribution of newly HIV migrant cases, by geographical origin,

EU/EEA, 2007-2012

53%SSA

11%Central & Eastern

Europe

10%Western Europe

Asia5%

Other8%12%

LA & Caribbean

Magnitude and trends of the HIV epidemic among migrants in the EU

Magnitude and trends of the HIV epidemic among migrants in the EU

Trends of male HIV cases by geographical origin, EU/EEA, 2007-2012

Latin America

Central Europe

Eastern Europe

Magnitude and trends of the HIV epidemic among migrants in the EU

Number of HIV diagnoses by SSA region of origin, EU/EEA, 2007-13

Why are trends in HIV diagnoses in Sub-Saharan African migrants in Europe changing?

CROI 2016, Abstract 901

Western SSA

Eastern SSA

Central SSA

Outline

• Magnitude and trends of the HIV epidemic among migrants in the EU

• Pre and post-migration acquisition of HIV in the EU

• Access to HIV testing & treatment in the EU

Pre and post-migration HIV acquisition

aMASEAdvancing Migrant Access to Health

Services in Europe

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Zheng et al,. Post migration acquisition of HIV: Estimates from 4 European countries (Durban 2016)

Outline

• Magnitude and trends of the HIV epidemic among migrants in the EU

• Pre and post-migration acquisition of HIV in the EU

• Access to HIV testing & treatment in the EU

Access to HIV testing & treatment in the EU

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CD4+T-cell count at cART initiation among migrant men and women living in Western Europe

-12.0 [-22.2;-1.8] p=0.021-12.0 [-23.1;-0.9] p=0.034-28.0 [-42.8;-13.2] p=0.000-32.0 [-37.8;-26.2] p=0.000-30.0 [-37.6;-22.4] p=0.000-34.0 [-45.9;-22.1] p=0.000-34.0 [-44.4;-23.6] p=0.000

-1.0 [-7.6;5.6] p=0.766

-1.7 [-24.1;20.8] p=0.884-29.0 [-46.9;-11.1] p=0.001-34.3 [-59.5;-9.1] p=0.008-27.7 [-32.9;-22.4] p=0.000-40.0 [-56.5;-23.5] p=0.000

-7.3 [-17.6;2.9] p=0.160-54.7 [-74.2;-35.1] p=0.000-26.3 [-38.7;-14.0] p=0.000

WEWCEE

NAMESSALA

CRBASIAUNK

WEWCEE

NAMESSALA

CRBASIAUNK

76.0 [73.2;78.8] p=0.000

53.3 [48.3;58.4] p=0.000

MEN(2009/12)

WOMEN(2009/12)

MEN (Ref. NAT)

WOMEN (Ref. NAT)

MEN (Ref.2004/08)

WOMEN (Ref.2004/08)

MEDIAN REGRESSION: COEF.[95%CI] p-value

-75 -50 -25 -10 0 10 25 50 75

Access to HIV testing & treatment in the EU

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Access to HIV testing & treatment in the EU

Can we “test and not treat”?

Action is needed

• Challenge & improve policies affecting migrants on HIV prevention, testing and treatment in the EU

• Grant universal access to HIV prevention – including PreP -, testing and treatment

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Caption of Image 1

¡¡ Gracias por su atención !!

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Teymur Noori, and Anastasia Pharris ECDCVictoria Hernando, Inma Jarrin, Susana Monge and Debora Alvarez, ISCIII