HIV Transmission Patterns Among Immigrant Latinos Illuminated by the Integration of Phylogenetic and Migration Data

Abstract

Latinos represent a growing proportion of HIV cases in North Carolina (NC). Understanding how immigrants are involved in local HIV transmission is important to guide interventions. We used phylogenetics to characterize Latino involvement in local HIV transmission chains. Transmission clusters were identified from maximum-likelihood phylogenies constructed with HIV pol sequences from 177 Latinos and 1,496 non-Latinos receiving care in NC. Highly supported clusters involving one or more Latinos were characterized. Migration data were obtained from interviews and chart review. Factors associated with cluster membership were identified using log-binomial regression. Most Latinos were male (76%), immigrants (83%), and had HIV-1B (99%). Immigrants were more likely to report heterosexual risk (67% vs. 23%) than U.S.-born Latinos (p < 0.01). We identified 32 clusters that included one or more Latinos; these involved 53 Latinos (30%) and 41 non-Latinos. Immigrant and U.S.-born Latinos were equally likely to be in clusters, but immigrants were more likely to be in clusters with another Latino (78% vs. 29%; p = 0.02). Cluster composition by ethnicity and risk behavior varied by cluster size; larger clusters contained fewer immigrants and more men who have sex with men (MSM). Factors associated with immigrant membership in local transmission clusters included age <30 years [RR 2.34 (95% CI 1.47-3.73)], Mexican origin [RR 2.55 (95% CI 1.29-6.88)], and residing in the United States longer before diagnosis [RR 1.53 (95% CI 1.09-2.15), per 10 years]. While some Latinos immigrate with HIV infection, many immigrants are involved in transmission networks after arrival, particularly MSM. HIV testing and prevention interventions must consider this heterogeneity and may be better targeted by integrating phylogenetic analyses.

HIV Transmission Dynamics Among Foreign-Born Persons in the United States

“…Previous studies in the United States indicating that immigrant populations are more than likely infected with HIV after immigration have focused on specific populations, have been limited in their geographic scope, and have used methods other than transmission network analysis. 3,14,19,20,21, Our findings using national data corroborate and expand on findings from these smaller studies.…”

“…13 Another study focusing on HIV transmission patterns among Hispanics/Latinos in North Carolina showed that foreign-born Hispanics/Latinos were more likely to be in clusters with other Hispanics/Latinos compared to U.S.-born Hispanics/Latinos. 14 …”

The ethical and epistemological pitfalls of translating phylogenetic HIV testing: from patient-centered care to surveillance

“…Many of the articles analyzed explicitly problematize the role of immigration in local HIV dynamics (Dennis et al, 2015;González-Alba et al, 2011;2013;Lai et al, 2020), often refracting the general problematization of immigration through the rationale that molecular HIV surveillance is a useful public health tool in as much as it "estimate[s] the impact of immigration on national and local HIV dynamics" (González-Alba et al, 2011), or how certain so-called risk groups with immigrant backgrounds contribute to "the import of other HIV strains" (Lai et al, 2020). The articles often position molecular HIV surveillance as a solution to the "problem" of immigration and HIV, often framing this position through a recourse to "targeted HIV preventive measures" (Dennis et al, 2015;González-Alba et al, 2011), such as linkage to care and HIV testing within risk networks.…”

“…Moreover, the article concludes that South American transgender women often "do not practice safe sex" and that these women "could have a bridging role in the spread of HIV among both Italian MSM and heterosexuals" (Lai et al, 2020). Other articles from both Spain and the USA echo this emphasis on the active role of immigrant MSM and transgender women (Dennis et al, 2015;González-Alba et al, 2011), with a sub-theme being a focus on whether they acquired HIV in their countries of origin or destination. These articles relate their focus to the transmission dynamics occurring in these immigrants' destination countries and to the role immigrants play in onward HIV transmission there (Dennis et al, 2015;Lai et al, 2020), thus alluding to immigrants' active role in local HIV dynamics.…”

Enhanced immigration enforcement in the USA and the transnational continuity of HIV care for Latin American immigrants in deportation proceedings

“…Phylogenetic studies highlight the role of migration in bridging the HIV epidemic between North and South America 2 , and suggest that most Latinx immigrants acquire HIV after arrival to the US 3 . Economic, social, and political forces in the country of origin, during transit, and in the US often put migrants at risk of physical and emotional harm 4,5 .…”