EACS 2015: Majority of Migrants with HIV in Europe May Have Acquired Virus in New Country

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A study presented at the 15th European AIDS Conference last month in Barcelona found evidence that the majority of migrants living with HIV in Europe, and who were diagnosed less than 5 years ago, probably acquired the virus in their host country rather than the one in which they were born. The aMASE (Advancing Migrant Access to Health Services in Europe) study found that the proportion of people with a documented or probable date of HIV infection later than their move to, or within, Europe was higher than those with a documented or probable pre-migration infection date, and that this applied to all risk groups, all areas of origin, and both sexes.

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One important caveat is that for a large minority of people -- in the case of people from sub-Saharan African, as many as 48% -- the date of infection could not be established. Another caveat is that this was an Internet survey and might favor replies from people with more recently infection. Nonetheless, the findings are striking; among men who have sex with men in particular, the vast majority acquired HIV in their host country rather than in their country of origin.

The aMASE survey is an initiative of Eurocoord -- a European Union (EU)-funded network of researchers and clinics who pool patient data contained within 4 existing European patient cohorts (EuroSIDA, COHERE, CASCADE, and PENTA).

Débora Álvarez del Arco told the conference that of approximately 29,000 new HIV diagnoses reported in the EU in 2013, only 57% of people were diagnosed in the country in which they had been born. Of the remainder, 13% came from sub-Saharan Africa, 9% from other counties within Europe, 5% from Latin America and the Caribbean, 4% from North America, Australasia, and the Middle East, and 12% were of unknown origin. Half of the countries in the EU and European Economic Area report that some groups of migrants in their country are at increased risk of HIV.

The aMASE survey was designed to see if migrants were at more risk of HIV in their home country or their host country. Computer interviews were conducted between 2013 and 2015 with 2249 migrants living in 9 European countries. In order of the number interviewed, most interviewees were living in Spain, the UK, Belgium, Portugal, Greece, Switzerland, the Netherlands, Italy, and Germany. They had to have been born elsewhere than the country in which they were living, be over age 18, have been diagnosed with HIV less than 5 years ago, and have been in their host country for more than 6 months.

The questionnaire asked participants when and where they were diagnosed, asked about HIV risk behaviors before and after migrating, and also asked for permission for researchers to contact the clinic where they had been diagnosed -- whether in their host country or birth country -- and to conduct an independent interview with their clinician to confirm diagnosis and probable date of infection.

Of 1784 respondents with enough data to estimate an infection date, 703 had had an HIV-negative test result within 3 years prior to testing HIV-positive, while 532 had no data to directly assign place of HIV acquisition but a good estimate could be made on the basis of behavioral data -- for instance, that the respondent had had sex with men before migrating but not after, or injected drugs after migrating but not before.

On the basis of these data, the respondents were divided into 5 groups according to their probable infection time. The first group were people for whom it could not be established whether they had acquired HIV before or after migrating. The second and third groups were people who had, on the basis of diagnosis date, definitely acquired HIV ether before they moved, or after. The fourth and fifth were groups who had probably acquired HIV before or after they moved; for these the date of infection was less certain but was narrowed down to before or after moving by reports of risk behavior, CD4 count, or AIDS symptoms, or a reported but not clinically confirmed positive HIV test before moving.

The respondents’ average age was 38 and 68% were men. In two-thirds of the men, the main risk factor was sex with other men, a quarter reported only having sex with women, 6% reported injecting drugs, and 3% reported no risk factor. The vast majority (97%) of women reported sex with men as their risk factor and 2% injecting drugs.

In terms of national origin, 33% came from sub-Saharan Africa, 32% from Latin America or the Caribbean, 5% from Asia, 4% from North America, Australasia, or the Middle East. The other 26% were migrants within Europe: 11% were from Western Europe, 10% from Central Europe, and 5% from Eastern Europe.

In 68% of participants, the date of their HIV diagnosis could be confirmed.

In all national categories and for both sexes, it was estimated that more people had probably acquired HIV in their host country than in their birth country. The area where there was least predominance of host-country infections was sub-Saharan Africa: 22% of people from African had probably acquired HIV in their home country and 31% in their host country, with nearly half (47%) having an infection date that could not be determined.

In the other national categories -- who were predominantly men who had sex with men -- the difference was much more striking. 68% of people from Latin America and the Caribbean had probably acquired HIV after migrating, as had 57% of Asians, 58% of Eastern Europeans, 60% of Central Europeans, and 69% of Western Europeans. The proportion of people in these categories who had probably already been living with HIV when they migrated were 8%, 18%, 12%, 8%, and 12% respectively, while in 20%-32% the date of infection could not be determined.

Among heterosexuals, both men and women, 36% had acquired HIV in their host country, and only 18% of women and 13% of men had definitely acquired HIV in their home country. For men who have sex with men, 72% acquired HIV after migrating and only 11% before. And for people who injected drugs, 67% acquired HIV after migrating and only 15% before.

Álvarez del Arco told the conference that the figures showed that people from Western Europe and Latin America and the Caribbean had a particularly high probability of acquiring HIV post-migration, as did men who have sex with men. She and audience members called for more research into migrant vulnerability to HIV in the countries to which they migrate.

11/2/15

Reference

D Alvarez-del Arco, I Fakoya, S Monge, et al.HIV Acquisition among Migrants Living in Europe: Results from aMASE - Advancing Migrant Access to Health Services in Europe. 15th European AIDS Conference. Barcelona, October 21-24, 2015. Abstract PS3/5.