A systematic review of post-migration acquisition of HIV among migrants from countries with generalised HIV epidemics living in Europe: mplications for effectively managing HIV prevention programmes and policy

Abstract

BackgroundMigrant populations from countries with generalised HIV epidemics make up a significant proportion of all HIV/AIDS cases in many European Union and European Economic Area (EU/EEA) countries, with heterosexual transmission the predominant mode of HIV acquisition. While most of these infections are diagnosed for the first time in Europe, acquisition is believed to have predominantly occurred in the home country. A proportion of HIV transmission is believed to be occurring post-migration, and many countries may underestimate the degree to which this is occurring. Our objectives were to review the literature estimating the proportion of migrants believed to have acquired their HIV post-migration and examine which EU member states are able to provide estimates of probable country of HIV acquisition through current surveillance systems.MethodsA systematic review was undertaken to gather evidence of sexual transmission of HIV within Europe among populations from countries with a generalised epidemic. In addition, national surveillance focal points from 30 EU/EEA Member States were asked to complete a questionnaire about surveillance methods and monitoring of the likely place of HIV acquisition among migrants.Results & discussionTwenty-seven papers from seven countries were included in the review and 24 countries responded to the survey. Estimates of HIV acquisition post-migration ranged from as low as 2 % among sub Saharan Africans in Switzerland, to 62 % among black Caribbean men who have sex with men (MSM) in the UK. Surveillance methods for monitoring post-migration acquisition varied across the region; a range of methods are used to estimate country or region of HIV acquisition, including behavioural and clinical markers. There is little published evidence addressing this issue, although Member States highlight the importance of migrant populations in their epidemics.ConclusionsThere is post-migration HIV acquisition among migrants in European countries but this is difficult to quantify accurately with current data. Migrant MSM appear at particular risk of HIV acquisition post-migration. Countries that identify migrants as an important part of their HIV epidemic should focus on using an objective method for assigning probable country of HIV acquisition. Robust methods to measure HIV incidence should be considered in order to inform national prevention programming and resource allocation.

High levels of postmigration HIV acquisition within nine European countries

“…Our results are consistent with previous publications but provide new information to guide public health policy and practice. Fakoya et al [13] described in a systematic review that HIV acquisition after migration could range from 2% in Switzerland among people from countries with a generalized epidemic [23] to 62% among migrant black Caribbean MSM in the UK [24]. Overall differences between countries were highly significant, but after adjustment for differences in the distribution of transmission category and length of stay, differences became clearly non-significant.…”

“…how to best determine timing of HIV infection and different methodologies have adopted [12][13][14][15]. Further, all published studies to date have been confined to one city or one country and most have addressed heterosexually transmitted HIV among people from SSA [12,15,17].…”

Pre-exposure prophylaxis for MSM and transgender persons in early adopting countries

“…For example, in the U.S., black MSM represent a group at very high risk of acquiring HIV infection [33-35], however, PrEP uptake has been disproportionately low compared to non-black MSM [36-38] which may be attributable to assortative mixing (preferentially choosing partners from within one's ethnic group, thereby concentrating risk per contact) and limited social mobility, disparities in health care access, and distrust of culturally-insensitive health care systems [39, 40]. Some data suggest that 85% of the infections among migrant MSM in Europe occur post-migration [41], but there is limited evidence [42] about PrEP uptake among specific racial and ethnic MSM subgroups in Europe and Australia. Transgender women also bear a disproportionate HIV burden.…”

First HIV prevalence estimates of a representative sample of adult sub-Saharan African migrants in a European city. Results of a community-based, cross-sectional study in Antwerp, Belgium

“…Consequently, surveillance data provide little indications for prevention planning. While there is a pressing need for tailored and targeted interventions aiming to prevent new HIV infections since increasing evidence is showing that sub-Saharan African migrants are acquiring HIV in Europe [3]. …”