Who is a migrant? Who is a migrant? Heterogeneous groups of persons - - PDF document

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Who is a migrant? Who is a migrant? Heterogeneous groups of persons - - PDF document

Jun 29, 2023 343 likes •402 views

12/10/2018 Julia del Amo has received research grants awarded to her institution from Companies BMS, Gilead, ViiV and HIV and migrants epidemiology teaching fees from ViiV, Gilead and MSD Dr Julia del Amo National Center for Epidemiology

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HIV and migrants

Dr Julia del Amo National Center for Epidemiology Institute of Health Carlos III Madrid, 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 Slovakia Estonia Croatia Slovenia Greece Czech Republic Portugal Spain Italy Germany Netherlands EU/EEA Average Austria Cyprus Denmark Finland France Iceland United Kingdom Norway 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

1000 2000 3000 4000 5000 6000 7000

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Number of diagnoses

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

TUPEC190

53% of the HIV reports from LAC 2004‐2015 were MSM; 84% of reports from South America to 46% of reports from the Caribbean SA men Andean men

Unknown region

MSM from all sub‐regions consistently show higher CD4 counts at HIV diagnosis In Western, Central and Eastern European migrants, 74%, 57% and 26%

  • f the HIV reports MSM

WE men CE 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

Factors underlying high rates of HIV infection Those driving HIV in countries of

  • rigin

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: repeated mesurements that allow

to estimate trends in CD4 and VL after seroconversion.

  • 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

Central Western Eastern SSA Asia LA & 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 levels

Barriers 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