Who is a migrant? 12/10/2018. HIV and migrants. Heterogeneous groups of persons with different migration drivers

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1 HIV and migrants 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 Dr Julia del Amo National Center for Epidemiology Institute of Health Carlos III Madrid, Spain Heterogeneous groups of persons with different migration drivers Heterogeneous Migrants and mobile groups populations of persons are any with person different who is moving migration or has moved across an international drivers 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 Distinct risk-contexts for HIV infections 1

2 Proportion HIV diagnoses in migrants* by country of report, EU/EEA % Sweden Malta Ireland Luxembourg Belgium Norway United Kingdom Iceland France Finland Denmark Cyprus Austria EU/EEA Average Netherlands Germany Italy Spain Portugal Czech Republic Greece Slovenia Croatia Estonia Slovakia Bulgaria Lithuania Latvia Poland Sub Saharan Africa Central and Eastern Europe Western Europe Latin America and Caribbean South and Southeast Asia Other 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Percentage of new diagnoses New HIV diagnoses, by year of diagnosis, transmission and migration status, EU/EEA, Migrant MSM Heterosexual migrants Migrant IDU Data is adjusted for reporting delay 10 New HIV diagnoses, by year of diagnosis, transmission and migration status, EU/EEA, Number of diagnoses % 36% 9% +58% Year of diagnosis MSM (born in reporting country) Heterosexual (born in reporting country) MSM (foreign born) Heterosexual (foreign born) 2

3 HIV epidemics in migrants from Latin America & Caribbean in Europe are driven by MSM TUPEC190 53% of the HIV reports from LAC were MSM; 84% of reports from South America to 46% of reports from the Caribbean Unknown region SA men Andean men MSM from all sub regions consistently show higher CD4 counts at HIV diagnosis HIV dynamics in migrants from Central, Eastern and Western Europe in the Europe Union/Economic Area (EU/EEA) THPEC174 In Western, Central and Eastern European migrants, 74%, 57% and 26% of the HIV reports MSM WE men CE men Those driving HIV in countries of origin Factors underlying high rates of HIV infection Risk behaviors and risk contexts during migration transit MSM from all sub regions consistently show higher CD4 counts at HIV diagnosis Risk behaviors and risk contexts in countries of destination amase Pre and post-migration HIV acquisition CASCADE: repeated mesurements that allow to estimate trends in CD4 and VL after seroconversion. CD4 VL AIDS Sociodemographic characteristics Stat Methods Med Res December 2017 HIV acquisition HIV Diagnosis Before or after migration? 3

4 2249 migrants living with HIV 68% men 46% MSM 36 years median age Geographical origin Western Central Eastern SSA LA & Asia Caribbean 11% 10% 5% 33% 31% 5% Other 5% MSM were more likely to Approx 72% of migrant MSM and 50% heterosexual migrants from SSA acquired HIV post migration Estimated post migration HIV acquisition probability (95% CI) by country of destination To be single To have stable residency status To have higher education & income Higher socio-economic status than heterosexuals and PWID Barriers to access testing and care in migrants Location of barriers Structural Barriers Healthcare act in synergy limiting access Community to, levels 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 They undermines public health Homophobia approaches for HIV control 4

5 Availability of ART for undocumented migrants, 2018 Status of formal PrEP implementation in Europe July, 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. 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 5