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BMC Public Health. 2015 Jun 19;15:561. doi: 10.1186/s12889-015-1852-9.

A systematic review of post-migration acquisition of HIV among migrants from countries with generalised HIV epidemics living in Europe: mplications for effectively managing HIV prevention programmes and policy.

Author information

1
Centre for Sexual Health and HIV Research, Research Department of Infection and Population Health, University College London, Mortimer Market Centre, off Capper Street, London, WC1E 6JB, UK. ibidun.fakoya@ucl.ac.uk.
2
National Centre of Epidemiology, Instituto de Salud Carlos III, Madrid, Spain. dalvarez@isciii.es.
3
Ciber de Epidemiologia y Salud Publica (CIBERESP), Barcelona, Spain. dalvarez@isciii.es.
4
HIV & STI Department, Health Protection, Public Health England, England, UK. Melvina.WoodeOwusu@phe.gov.uk.
5
Department of Health and Socio-medical Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain. susana.monge@uah.es.
6
Ciber de Epidemiologia y Salud Publica (CIBERESP), Barcelona, Spain. susana.monge@uah.es.
7
National Centre of Epidemiology, Instituto de Salud Carlos III, Madrid, Spain. yrivero@isciii.es.
8
Ciber de Epidemiologia y Salud Publica (CIBERESP), Barcelona, Spain. yrivero@isciii.es.
9
HIV & STI Department, Health Protection, Public Health England, England, UK. Valerie.Delpech@phe.gov.uk.
10
HIV & STI Department, Health Protection, Public Health England, England, UK. Brian.Rice@phe.gov.uk.
11
European Centre for Disease Prevention and Control, Solna, Sweden. Teymur.Noori@ecdc.europa.eu.
12
European Centre for Disease Prevention and Control, Solna, Sweden. Anastasia.Pharris@ecdc.europa.eu.
13
European Centre for Disease Prevention and Control, Solna, Sweden. andrew.amato-gauci@ecdc.europa.eu.
14
National Centre of Epidemiology, Instituto de Salud Carlos III, Madrid, Spain. jdamo@isciii.es.
15
Ciber de Epidemiologia y Salud Publica (CIBERESP), Barcelona, Spain. jdamo@isciii.es.
16
Centre for Sexual Health and HIV Research, Research Department of Infection and Population Health, University College London, Mortimer Market Centre, off Capper Street, London, WC1E 6JB, UK. f.burns@ucl.ac.uk.
17
Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK. f.burns@ucl.ac.uk.

Abstract

BACKGROUND:

Migrant populations from countries with generalised HIV epidemics make up a significant proportion of all HIV/AIDS cases in many European Union and European Economic Area (EU/EEA) countries, with heterosexual transmission the predominant mode of HIV acquisition. While most of these infections are diagnosed for the first time in Europe, acquisition is believed to have predominantly occurred in the home country. A proportion of HIV transmission is believed to be occurring post-migration, and many countries may underestimate the degree to which this is occurring. Our objectives were to review the literature estimating the proportion of migrants believed to have acquired their HIV post-migration and examine which EU member states are able to provide estimates of probable country of HIV acquisition through current surveillance systems.

METHODS:

A systematic review was undertaken to gather evidence of sexual transmission of HIV within Europe among populations from countries with a generalised epidemic. In addition, national surveillance focal points from 30 EU/EEA Member States were asked to complete a questionnaire about surveillance methods and monitoring of the likely place of HIV acquisition among migrants.

RESULTS & DISCUSSION:

Twenty-seven papers from seven countries were included in the review and 24 countries responded to the survey. Estimates of HIV acquisition post-migration ranged from as low as 2% among sub Saharan Africans in Switzerland, to 62% among black Caribbean men who have sex with men (MSM) in the UK. Surveillance methods for monitoring post-migration acquisition varied across the region; a range of methods are used to estimate country or region of HIV acquisition, including behavioural and clinical markers. There is little published evidence addressing this issue, although Member States highlight the importance of migrant populations in their epidemics.

CONCLUSIONS:

There is post-migration HIV acquisition among migrants in European countries but this is difficult to quantify accurately with current data. Migrant MSM appear at particular risk of HIV acquisition post-migration. Countries that identify migrants as an important part of their HIV epidemic should focus on using an objective method for assigning probable country of HIV acquisition. Robust methods to measure HIV incidence should be considered in order to inform national prevention programming and resource allocation.

PMID:
26085030
PMCID:
PMC4472169
DOI:
10.1186/s12889-015-1852-9
[Indexed for MEDLINE]
Free PMC Article

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