Factors Associated With Access to HIV Testing and Primary Care Among Migrants Living in Europe: Cross-Sectional Survey

Abstract

BackgroundThere is a heavy and disproportionate burden of human immunodeficiency virus (HIV) infection among migrant communities living in Europe. Despite this, the published evidence related to HIV testing, prevention, and treatment needs for migrants is sparse.ObjectiveThe aim of this study was to identify the factors associated with access to primary care and HIV testing among migrant groups living in Europe.MethodsA Web-based survey (available in 14 languages) was open to all people aged 18 years and older, living outside their country of birth in the World Health Organization (WHO) European area. Community organizations in 9 countries promoted the survey to migrant groups, focusing on those at a higher risk of HIV (sub-Saharan Africans, Latin Americans, gay or bisexual men, and people who inject drugs). Multivariable analysis examined factors associated with access to primary care and previous history of an HIV test.ResultsIn total, 559 women, 395 heterosexual men, and 674 gay or bisexual men were included in the analysis, and 68.1% (359/527) of women, 59.5% (220/371) of heterosexual men, and 89.6% (596/664) of gay or bisexual men had tested for HIV. Low perceived risk was the reason given for not testing by 62.3% (43/69) of gay or bisexual men and 83.3% (140/168) of women and heterosexual men who reported never having tested for HIV. Access to primary care was >60% in all groups. Access to primary care was strongly positively associated with living in Northern Europe compared with Southern Europe (women: adjusted odds ratio, aOR 34.56 [95% CI 11.58-101]; heterosexual men: aOR 6.93 [95% CI 2.49-19.35], and gay or bisexual men: aOR 2.53 [95% CI 1.23-5.19]), whereas those with temporary residency permits were less likely to have access to primary care (women: aOR 0.41 [95% CI 0.21-0.80] and heterosexual men: aOR 0.24 [95% CI 0.10-0.54] only). Women who had experience of forced sex (aOR 3.53 [95% CI 1.39-9.00]) or postmigration antenatal care (aOR 3.07 [95% CI 1.55-6.07]) were more likely to have tested for HIV as were heterosexual men who had access to primary care (aOR 3.13 [95% CI 1.58-6.13]) or reported “Good” health status (aOR 2.94 [95% CI 1.41-5.88]).ConclusionsAccess to primary care is limited by structural determinants such as immigration and health care policy, which varies across Europe. For those migrants who can access primary care and other health services, missed opportunities for HIV testing remain a barrier to earlier testing and diagnosis for migrants in Europe. Clinicians should be aware of these potential structural barriers to HIV testing as well as low perception of HIV risk in migrant groups.

Usage of purchased self-tests for HIV infections among migrants living in the UK, France and the Netherlands: a cross-sectional study

“…[9] However, a Chinese study showed that 20% of Chinese MSM reported prior HIVST usage. [10] The differences between the HIVST usage prevalence 6 between Europe and China might be explained by Europe's legal restrictions on selling HIVST, whereas China has a national policy supporting HIVST. In Europe, only the UK and France have recently approved HIVST for sale (UK: April 2015; France: September 2015).…”

“…Detailed information on the aMASE study is provided elsewhere. [5,6] Briefly, the cross-sectional aMASE community survey aimed to identify the structural, cultural, and financial barriers to HIV prevention, diagnosis, and treatment in migrant populations. The community survey was promoted between April 2014 and July 2015 via social marketing and community participatory methods in nine countries (Belgium, France, Germany, Greece, Italy, the Netherlands, Portugal, Spain, and the United Kingdom), although migrants aged 18 or older living in all countries of the World Health Organization (WHO) European area were eligible.…”

Overcoming Barriers to HIV Prevention and Healthcare Among Sub-Saharan African Migrants in Spain

“…Fakoya and colleagues explored factors associated with access to HIV testing and primary care among migrants living in nine European countries—including Spain—in their study recently published in this journal [1]. The authors highlighted the importance of continued HIV knowledge and awareness initiatives aimed at migrant communities.…”

“…Fakoya and colleagues reported additional individual-level obstacles to HIV prevention and testing such as lack of knowledge about HIV and low perception of risk [1]. The existence of HIV was questioned or denied by a significant number of migrants who participated in our program: 13% (487/3759; 2007-2017), being most of them SSAM.…”

Overcoming Barriers to Healthcare Access and HIV Prevention among Migrants in Spain

“…Fakoya and colleagues explored factors associated with access to HIV testing and primary care among migrants living in Europe in their study recently published in this journal 1 . Authors concluded that access is limited by structural determinants such as immigration and healthcare policy, emphasizing that clinicians and other professionals should be aware of these structural barriers and the low perception of HIV risk in migrant groups.…”