Abstract
BackgroundThe assumption that migrants acquire human immunodeficiency virus (HIV) before migration, particularly those from high prevalence areas, is common.AimWe assessed the place of HIV acquisition of migrants diagnosed in four European countries using surveillance data.MethodsUsing CD4+ T-cell count trajectories modelled to account for seroconversion bias, we estimated infection year of newly HIV-diagnosed migrants residing in the United Kingdom (UK), Belgium, Sweden and Italy with a known arrival year and CD4+ T-cell count at diagnosis. Multivariate analyses identified predictors for post-migration acquisition.ResultsBetween 2007 and 2016, migrants constituted 56% of people newly diagnosed with HIV in the UK, 62% in Belgium, 72% in Sweden and 29% in Italy. Of 23,595 migrants included, 60% were born in Africa and 70% acquired HIV heterosexually. An estimated 9,400 migrants (40%; interquartile range (IQR): 34–59) probably acquired HIV post-migration. This proportion was similar by risk group, sex and region of birth. Time since migration was a strong predictor of post-migration HIV acquisition: 91% (IQR: 87–95) among those arriving 10 or more years prior to diagnosis; 30% (IQR: 21–37) among those 1–5 years prior. Younger age at arrival was a predictor: 15–18 years (81%; IQR: 74–86), 19–25 years (53%; IQR: 45–63), 26–35 years (37%; IQR: 30–46) and 36 years and older (25%; IQR: 21–33).ConclusionsMigrants, regardless of origin, sex and exposure to HIV are at risk of acquiring HIV post-migration to Europe. Alongside accessible HIV testing, prevention activities must target migrant communities.
Highlights
Ca 22.3 million (4.4%) people living in the EuropeanUnion (EU) today are non-EU citizens, of whom an www.eurosurveillance.org estimated 2.4 million migrated to the EU in 2017 alone [1]
Using CD4+ T-cell count trajectories modelled to account for seroconversion bias, we estimated infection year of newly HIVdiagnosed migrants residing in the United Kingdom (UK), Belgium, Sweden and Italy with a known arrival year and CD4+ T-cell count at diagnosis
Predictors of post-migration human immunodeficiency virus (HIV) acquisition among migrants diagnosed in the United Kingdom, Belgium, Sweden and
Summary
Ca 22.3 million (4.4%) people living in the EuropeanUnion (EU) today are non-EU citizens, of whom an www.eurosurveillance.org estimated 2.4 million migrated to the EU in 2017 alone [1]. The European Centre for Disease Prevention and Control (ECDC) reported that more than two in five people diagnosed with HIV in 2018 in the EU/European Economic Area (EEA) were born outside the country in which they were diagnosed, with considerable variation across Europe [4] It is often assumed migrants acquired HIV in their country of origin [5], if prevalence is elevated in these settings. An estimated 9,400 migrants (40%; interquartile range (IQR): 34–59) probably acquired HIV post-migration. This proportion was similar by risk group, sex and region of birth. Time since migration was a strong predictor of post-migration HIV acquisition: 91% (IQR: 87–95)
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