Featured news from NHIVNA
HIV-related news from NAM
Across western Europe, migrants from all parts of the world start HIV treatment later
Roger Pebody, 2017-02-13 07:20:00
An analysis of over 150,000 people living with HIV in eleven
western European countries shows that people born abroad are more likely to
start HIV treatment with a lower CD4 cell count, especially men coming from African or Caribbean countries.
“Later cART [combination antiretroviral therapy] initiation
in migrants can result in worse health outcomes, but is also of public health
concern, as it facilitates ongoing transmission of HIV within the community,” write the researchers in an
article published online ahead of print in AIDS.
In western Europe, 41% of people diagnosed with HIV were
born in a different country. Barriers to healthcare for migrants include social
exclusion, language difficulties, economic instability, geographic mobility and
policies which restrict access to publicly subsidised health
services. Confusion and uncertainty about eligibility discourages some migrants
from engaging with healthcare or means that healthcare professionals deny care
to people who are in fact eligible.
Data were pooled from 24 observational cohort studies of
people with HIV attending routine clinical care in Austria, Belgium, Denmark,
France, Germany, Greece, Italy, the Netherlands, Spain, Switzerland and the
United Kingdom. Data were collected from 1997 to 2013.
All cohorts recorded information on participants’
geographical origin. Two exceptions were the Swiss and UK cohorts – in these
cases, ethnicity was used as a proxy for geographical origin (for example
assuming that people of black Caribbean ethnicity were born in the Caribbean,
or that white people were born in the country they were diagnosed in). This is
obviously imprecise but excluding these studies from the data did not
substantially change the results.
Of the 110,592 men included, 22% were migrants. Significant
numbers of men came from sub-Saharan Africa (9.4% of all men), Latin America
(3.8%) and western European and other western countries (2.5%).
Of the 41,082 women included, 52% were migrants. Large
numbers came from sub-Saharan Africa (39.4% of all women) as well as the
The researchers looked at median CD4 counts for individuals
starting HIV treatment, according to geographical origin. As the data stretch
back two decades, the averages are lower than might be expected today.
Findings differed between men and women. The average CD4 counts for men starting treatment were:
- Native men: 230 cells/mm3
- Eastern Europe: 230 cells/mm3
- Latin America: 220 cells/mm3
- Western Europe and other western countries: 206 cells/mm3
- Asia & Oceania: 194 cells/mm3
- North Africa and the Middle East: 190 cells/mm3
- Sub-Saharan Africa: 161 cells/mm3
- Caribbean: 161 cells/mm3.
The lower probability of starting treatment was particularly
marked for migrant men who were diagnosed or entered the cohort with a high CD4
count. Compared to native men with a CD4 cell count over 500 cells/mm3,
Caribbean men with the same CD4 cell count were 45% less likely to start ART,
Eastern European men were 30% less likely, and African men 25% less likely.
The differences were not as large for women. The researchers
say this is probably due to women being tested and starting ART during pregnancy.
Median CD4 counts for women starting HIV treatment were:
- Eastern Europe: 236 cells/mm3
- Native women: 235 cells/mm3
- Caribbean: 225 cells/mm3
- North Africa and the Middle East: 223 cells/mm3
- Western Europe and other western countries: 220 cells/mm3
- Sub-Saharan Africa: 205 cells/mm3
- Latin America: 203 cells/mm3
- Asia & Oceania: 185 cells/mm3.
“Addressing existing barriers to access HIV testing and
care, and ensuring universal and free access to cART is important if we are to
advance the elimination of inequities and in the control of the HIV epidemic in
Western Europe,” conclude the researchers.