HIV testing history and access to treatment among migrants living with HIV in Europe

Abstract

IntroductionMigrants are overrepresented in the European HIV epidemic. We aimed to understand the barriers and facilitators to HIV testing and current treatment and healthcare needs of migrants living with HIV in Europe.MethodsA cross‐sectional study was conducted in 57 HIV clinics in nine countries (Belgium, Germany, Greece, Italy, The Netherlands, Portugal, Spain, Switzerland and United Kingdom), July 2013 to July 2015. HIV‐positive patients were eligible for inclusion if they were as follows: 18 years or older; foreign‐born residents and diagnosed within five years of recruitment. Questionnaires were completed electronically in one of 15 languages and linked to clinical records. Primary outcomes were access to primary care and previous negative HIV test. Data were analysed using random effects logistic regression. Outcomes of interest are presented for women, heterosexual men and gay/bisexual men.ResultsA total of 2093 respondents (658 women, 446 heterosexual men and 989 gay/bisexual men) were included. The prevalence of a previous negative HIV test was 46.7%, 43.4% and 82.0% for women, heterosexual and gay/bisexual men respectively. In multivariable analysis previous testing was positively associated with: receipt of post‐migration antenatal care among women, permanent residency among heterosexual men and identifying as gay rather than bisexual among gay/bisexual men. Access to primary care was found to be high (>83%) in all groups and was strongly associated with country of residence. Late diagnosis was common for women and heterosexual men (60.8% and 67.1%, respectively) despite utilization of health services prior to diagnosis. Across all groups almost three‐quarters of people on antiretrovirals had an HIV viral load <50 copies/mL.ConclusionsMigrants access healthcare in Europe and while many migrants had previously tested for HIV, that they went on to test positive at a later date suggests that opportunities for HIV prevention are being missed. Expansion of testing beyond sexual health and antenatal settings is still required and testing opportunities should be linked with combination prevention measures such as access to PrEP and treatment as prevention.

Disparities in access to and use of HIV-related health services in the Netherlands by migrant status and sexual orientation: a cross-sectional study among people recently diagnosed with HIV infection

“…However, migrant and non-migrant heterosexual participants were less likely to have had an HIV test before their HIV diagnosis and were more often diagnosed with a late-stage HIV infection than non-migrant MSM, indicating they are facing barriers in accessing HIV testing services. The finding that almost all participants visited a healthcare facility in the 2 years before HIV diagnosis but only in 40% an HIV test was discussed suggests that testing opportunities are being missed, as has been demonstrated at the European level [9]. In line with our findings, another study in the Netherlands found that HIV testing was often not discussed during GP consultations prior to HIV diagnosis [12].…”

“…As previous studies have shown outcomes are influenced by sexual orientation [8, 9], participants were grouped into: migrant MSM, non-migrant MSM, migrant heterosexual men, non-migrant heterosexual men, migrant women and non-migrant women. Socio-demographic characteristics and non-dichotomous outcomes were compared between groups using chi-square tests and Fisher’s exact tests for categorical variables and one-way ANOVA (normally distributed) and Kruskal Wallis tests (not normally distributed) for continuous variables.…”

The role of mobility in sexual risk behaviour and HIV acquisition among sub-Saharan African migrants residing in two European cities

“…PrEP uptake among heterosexual migrants in Europe so far has been extremely low [34,35]. Against this background, condomless sex in small sexual networks with high proportions of late diagnoses [36] may indeed serve as a relevant outcome. The odds of not using a condom in the host country was five times higher when the last sexual intercourse abroad was also condomless.…”

Evaluation of healthcare usage rate in HIV/AIDS patients in Isfahan, Iran in 2018

“…In other words, the major reasons for discontinuing ART were depression, wanting a break, and side effects [10]. In Ibidun paper, the experienced difficulties with health services in migrants living with HIV in Europe were no GP/health card/ insurance, long waiting time for an appointment/in the clinic, and lack of trust in GP confidentiality [11]. According to Laisaar et al's study, the main issues in HIV/AIDS patients engagement in HIV care in Estonia in 2013 were, as about one quarter of persons estimated to live with HIV had not been diagnosed, another quarter although aware of their HIV-positive status had not accessed HIV medical services, and more than half of HIV/AIDS patients having accessed HIV medical cares did not maintain in care.…”