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Men from Latin America and central Europe now outnumber sub-Saharan Africans in HIV diagnoses in European migrants
Gus Cairns, 2017-02-13 20:20:00
figures from the European Centre for Disease Control (ECDC), presented at the recent HIV in Europe HepHIV2017 meeting in Malta, show that while
in the last ten years in Europe the proportion of people with HIV who are not
from the country where they are diagnosed has hardly changed, the makeup of the
migrant population has. Although sub-Saharan Africans still form the largest
regional population, diagnoses (in countries that document ethnicity
adequately) in migrants from Latin America and the Caribbean, and
intra-European migrants from central and eastern Europe, now comfortably
outnumber new diagnoses in sub-Saharan Africans.
Julia del Amo told the conference that the annual number of HIV diagnoses has been falling in sub-Saharan Africans since 2008 and is now in
migrant groups in which HIV is increasing most diagnoses are in men and most of
those in men who have sex with men. HIV diagnoses among Latin American men seem
to have peaked around 2010-11 and may be starting to decline. But diagnoses in
migrants from central Europe – the former communist countries from Poland south
to the Balkans, plus Turkey – are continuing to rise, as are the smaller number
of migrants from eastern Europe (the former USSR). In addition, migrants from western
European countries also form a considerable proportion of diagnoses among
non-natives, though these are not increasing significantly.
Brönnström from Sweden’s Karolinska Institute said that in terms of prevalence,
the proportion of people living with HIV in European countries who are
migrants varies from 1% in Romania to 75% in Sweden, and in all countries but Sweden
and France, sub-Saharan Africans now form a minority of those migrants.
as a whole, the proportion of HIV diagnoses that occur in people not born in the country
of diagnosis is 38%, and this proportion has hardly changed in the last ten
years. But Julia
del Amo said that while diagnoses in sub-Saharan Africans (most of them in the
UK) fell from 2250 in 2007 to 1600 in 2012, diagnoses among people from Latin
America and the Caribbean rose from 730 in 2007 to 1300 in 2010 before falling
to 900 in 2012. Diagnoses in people from central Europe rose from 300 in 2007
to 600 in 2012, and from eastern Europe from 100 to 300 in the same period. Diagnoses
among migrants from western Europe have stayed steady at about 800 a year
during that time.
and 2013, a total of 252,609 people were diagnosed in Europe. Six per cent (14,621) were from Latin America and the Caribbean (LAC) and 8% (19,452) from a European
country other than the one they were diagnosed in.
per cent of diagnoses in people from LAC countries were in Spain or Portugal (reflecting
these countries’ ties with the region), 20% in the UK, and 18% in France. A
third of diagnoses in people from other European countries were in the UK, 13%
in Germany, 10% in Spain and 7% in France.
Five times as
many men from the South American continent (as opposed to the Caribbean or
central America) were diagnosed as women, and of those men, more than three-quarters
were men who have sex with men (MSM). Diagnoses in men from South America increased from 320 in 2004 to
1070 in 2013. After this, there are signs of a fall, with 850 diagnoses in
2012. In contrast, diagnoses from central America and the Caribbean were
somewhat less likely to be among men, and male diagnoses have not increased
since 2004. Among women, the majority of women diagnosed from this part of the
world were from the Caribbean; and female diagnoses from that region fell from
225 in 2004 to 120 in 2013.
migrants, diagnoses in men increased from 960 to 1950 between 2004 and
2013. The majority of these were from western Europe but the biggest
proportional increase, from 160 to 610, was in men from central Europe.
Three-quarters of men from western Europe and over half from central Europe
were MSM, but only one quarter from eastern Europe. Diagnoses in women from
central and eastern Europe rose too, from (taking both regions together) 140 in
2004 to 660 in 2012. Diagnoses in women from western Europe fell, from 150 to
proportion of migrants diagnosed late fell in migrants from western Europe but
rose in migrants from central and eastern Europe: the average CD4 count at
diagnosis rose from approximately 350 to 450 cells/mm3 in migrants
from western Europe but fell from 430 to 320 cells/mm3 in central
and eastern Europeans.
Some of this
may be due to delays in establishing treatment eligibility, and Julia del Amo
commented on the disarray in Europe on treatment policy for immigrants with
HIV, and particularly undocumented immigrants. In the Nordic countries, for
instance, Sweden provides access to antiretroviral therapy to undocumented migrants, but other
countries do not; in the Baltic
countries, Lithuania and Estonia do but Latvia does not; in central Europe, Hungary
does (despite its hostility to migrants in other ways), but other countries do
not; and among western European countries, most do but Germany and Austria do
Sweden, Johanna Brönnström exposed a paradox. Sweden was the first country in
the world to show that it had achieved the UNAIDS 90-90-90 target of 71.9%
people with HIV on treatment and virally suppressed. And yet in Europe it also
has one of the highest proportions of people diagnosed late; over 50% of people
diagnosed with HIV in Sweden have a CD4 count of below 350 cells/mm3,
as opposed to 30-40% in the UK. This is mainly due to the fact that such a high
proportion of people diagnosed with HIV in Sweden are migrants – 75% compared
with the EU average of 37% (47% in the UK) – and Sweden is one of the few
countries where the majority of migrants with HIV are still people from
It might be
assumed that this shows that people are mainly becoming infected with HIV in
their country of origin and only testing when they reach the safety of Sweden.
This is true in the majority of cases, but computer modelling of CD4 counts,
which allows back-calculation to the estimated time of infection, shows that
doctors tend to underestimate the proportion of migrants with HIV who actually
caught HIV in Sweden. Whereas physicians estimated that only 8.5% of migrants
with HIV caught it after migrating to Sweden, the CD4 trajectories showed that
the true figure was closer to 20%.