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Four in ten people diagnosed with HIV in Europe are migrants
Gus Cairns, 2015-06-24 07:50:00
Nearly four out of every ten people with HIV in the European Economic Area (EEA) is a migrant to the country in which they are diagnosed, a recent report by the Spanish Centre for Epidemiology shows. The EEA comprises the countries of the EU plus Norway and Iceland.
Between 2007 and 2012 60,446 out of 156,817 new cases of HIV (38%) were in people who were not native to the country where they were diagnosed. Nearly all HIV-positive migrants are concentrated in the richer countries of western Europe, with only 5% of diagnoses in central Europe and 1% in eastern Europe being migrants.
The UK remains the European country with the highest number of HIV diagnosed in migrants: 6358 diagnosed in the UK in 2012 were known not to have been born there, though this represents a decline of 1000 since 2007. France comes next on the list with 4066 in 2012, though their diagnoses have fallen even further since 2007, by 1600. In contrast, the next six countries on the list – Italy, Spain, Germany, Belgium, Greece and Poland – have all seen increases in HIV diagnoses in migrants, with doublings in Italy and Greece, probably reflecting the new wave of trans-Mediterranean migration.
It is important to note that these figures did not include 30,000 people whose country of origin could not be established. This report also cannot establish whether people caught HIV in their native country or after they migrated.
The proportion of newly-diagnosed people who are migrants fell from 40% to 35% between 2007 and 2012, the report shows. This is largely due to falls in HIV prevalence among people of sub-Saharan African origin. While the majority of newly-diagnosed migrants is still from sub-Saharan Africa, the proportion is falling, especially in women. The number of new diagnoses in African women fell by 37% between 2007 and 2012.
However largely because African women still form the largest single group of migrants diagnosed with HIV, 43% of migrants with HIV in 2012 were women compared with 16% of non-migrants, and 53% of newly-diagnosed people of non-native origin in the EEA were sub-Saharan Africans.
Twenty-one per cent were from other European countries, of whom 9%, 7% and 4% were from western, central and eastern Europe respectively. Twelve per cent came from Latin America, 5% from south and southeast Asia, 4% from the Caribbean, 3% from north Africa and the middle east, and small numbers from east Asia, North America, Australia and New Zealand.
In contrast to sub-Saharan Africa, the proportion of people with HIV from some other parts of the world has increased, even if populations from other areas remain smaller than people of African origin. Between 2007 and 2010 there was a considerable increase in the proportion of newly-diagnosed people, both men and women, that came from Latin America. This has significantly declined in the last few years however, partly due to austerity-related changes in healthcare entitlement in Spain, the country with by far the highest number of HIV-positive migrants from this region.
More recently there have been significant increases, especially among men, in the proportion diagnosed who come from the former-Communist countries of central Europe, and among women from both central and eastern Europe. In men there are also smaller but increasing proportions from south and south-east Asia and from north Africa and the Middle East.
Many of these are gay men and other men who have sex with men (MSM) and HIV diagnoses among MSM increased by 28%, in line with a general increase in MSM diagnoses, between 2007 and 2012. In terms of immigrants from eastern Europe, a ‘non-negligible’ proportion of these are people who inject drugs (PWIDs), reflecting, according to the authors, an upsurge in cases of HIV in PWIDs in Romania and Greece during these years.
In 2012 for the first time since at least 1999, the number of new diagnoses among migrant MSM was larger (2459) than it was among sub-Saharan African women (2354). Throughout the EEA almost exactly 50% of non-migrant people with new HIV diagnoses in 2012 was an MSM. Areas of origin where the proportion who are MSM is lower than 50% include central Europe, south and southeast Asia, the Caribbean, north Africa and the middle east, eastern Europe and sub-Saharan Africa; in contrast more than 50% of diagnoses were in MSM in migrants from east Asia, Latin America, western Europe, and the small number of migrants from North America, Australia and New Zealand.
Migrants diagnosed with HIV tend to be younger than non-migrants. The average age at HIV diagnosis in the EEA was 38 in men and 34 in women. Among nearly all groups of migrants it was lower. In men, migrants from central and eastern Europe and Latin America had an average age of 32-33; in women, migrants from central and eastern Europe were aged 29-30 on average.
Nearly all groups of migrants, with the exception of those from high-income countries, were more likely to be diagnosed late (defined as with a CD4 count of less than 350 cells/mm3). In non-migrants in the EEA the average CD4 count on diagnosis was 379 cells/mm3; in migrants it was 304 cells/mm3, and in women lower than this at 290 cells/mm3. Sub-saharan African men remain the group who are diagnosed with the lowest CD4 counts, at 240 cells/mm3. In women, south and south-east Asians were most likely to be diagnosed late, at 259 cells/mm3. Sub-Saharan Africans were 60% more likely to be diagnosed late than non-migrants, and so were Latin Americans. Some smaller groups were at even more risk and even though numerically there were fewer of them, both east Asians and south and southeast Asians were more than twice as likely to be diagnosed late than non-migrants.
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