Post on 07-Jun-2020
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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