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HIV and migrants

Dr Julia del AmoNational Center for Epidemiology

Institute of Health Carlos IIIMadrid, Spain

Julia del Amo has received research grants awarded to her institution from Companies BMS, Gilead, ViiV and epidemiology teaching fees from ViiV, Gilead and MSD

Who is a migrant? Who is a migrant?

Heterogeneous groups of persons with different migration drivers

Who is a migrant?

Heterogeneous groups of persons with different migration drivers

Distinct risk-contexts for HIV infections

Migrants and mobile populations are any person who is moving or has moved across an international border or within a State away from his/her habitual place of residence, regardless of:

(1) The persons’ legal status(2) Whether the movement is voluntary or involuntary(3) What the causes for the movement are; or(4) What the length of stay is

UNAIDS definition for the report People on the Move

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Proportion HIV diagnoses in migrants* by country of report, EU/EEA 2016

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Poland

Latvia

Lithuania

Bulgaria

SlovakiaEstonia

Croatia

Slovenia

Greece

Czech Republic

PortugalSpain

Italy

Germany

Netherlands

EU/EEA Average

AustriaCyprus

Denmark

Finland

France

Iceland

United KingdomNorway

Belgium

Luxembourg

Ireland

Malta

Sweden

Percentage of new diagnoses

Sub‐Saharan Africa

Central and Eastern Europe

Western Europe

Latin America and Caribbean

South and Southeast Asia

Other

Source: ECDC/WHO (2017). HIV/AIDS Surveillance in Europe 2017– 2016 data

40%

10

New HIV diagnoses, by year of diagnosis, transmission and migration status, EU/EEA, 

2007‐2016

Source: ECDC/WHO (2017). HIV/AIDS Surveillance in Europe 2017– 2016 data

Data is adjusted for reporting delay

Migrant MSM

Heterosexual migrants

Migrant IDU

New HIV diagnoses, by year of diagnosis, transmission and migration status, EU/EEA, 

2007‐2016

Source: ECDC/WHO (2017). HIV/AIDS Surveillance in Europe 2017– 2016 data

0

1000

2000

3000

4000

5000

6000

7000

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Number of diagn

oses 

Year of diagnosis

MSM (born in reporting country) MSM (foreign‐born)

Heterosexual (born in reporting country) Heterosexual (foreign‐born)

‐2%

+58%

‐36%

‐9%

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HIV epidemics in migrants from Latin America & Caribbean in Europe are driven by MSM

TUPEC19053% of the HIV reports from LAC 2004‐2015 were MSM; 84% ofreports from South America to 46% of reports from the Caribbean

SA men

Andeanmen

Unknown region

MSM from all sub‐regions consistently show higher CD4 counts at HIVdiagnosis

In Western, Central and Eastern European migrants, 74%, 57% and 26%of the HIV reports MSM

WE men

CE men

MSM from all sub‐regions consistently show higher CD4 counts at HIVdiagnosis

HIV dynamics in migrants from Central, Eastern and Western Europe in the Europe Union/Economic Area (EU/EEA)

THPEC174Factors underlying high rates of HIV

infection

Those driving HIV in 

countries of origin

Risk behaviors and risk contexts during migration transit

Risk behaviors and risk contexts in countries of destination

Pre and post-migration HIV acquisition

aMASE

HIV Diagnosis

CASCADE: repeatedmesurements that allow

to estimate trends in CD4 and VL afterseroconversion.

• CD4• VL• AIDS• Sociodemographic characteristics

HIV acquisition

Before or after migration?

Stat Methods Med Res December 2017

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2249 migrants living with HIV

68% men

46% MSM

36 years median age

Geographical origin

CentralWestern Eastern SSA AsiaLA & Caribbean

11% 10% 5% 33% 31% 5%

Other

5%

Estimated post‐migration HIV acquisition probability (95% CI) by country of destination

Approx 72% of migrant MSM and 50% heterosexual migrants from SSA acquired HIV post‐migration

MSM were more likely to…

To be single  

To have stable residency status

To have higher education & income

Higher socio-economic status than heterosexuals and PWID

Location of barriers• Structural• Healthcare • Community levelsBarriers act in synergy limiting access to, or acceptance of, HIV

testing, treatment uptake and responses

Nature of barriers• Socio-economic inequalities• Legal• Stigma and discrimination• Cultural & linguistic & gender• Psychological “low risk perception”• Homophobia

They undermines public health approaches for HIV control

Barriers to access testing and care in migrants

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Availability of ART for undocumented migrants, 2018

Source: ECDC. From Dublin to Rome: ten years of responding to HIV in Europe and Central Asia: Stockholm, ECDC; 2014

Source: ECDC. Dublin Declaration monitoring 2018; validated unpublished data.

Status of formal PrEP implementation in Europe

July, 2018

Source: ECDC. Dublin Declaration monitoring 2018; validated unpublished data.

HIV challenges for migrant populations

• Better understanding of HIV transmission dynamics at local level

• Global & inclusive HIV prevention and treatment strategies in origin & destination

• Increase HIV&STI testing & linkage to care

• PrEP & comprehensive STIs approaches

• Universal access to ART in Europe … including PrEP Thank you