Migration tracking is a mess.
Julia drew our attention to the fact that data on movements of refugees and migrants are flawed. Poor sources of migrant tracking data can often inflate the number of migrants and increase the political and media-led ‘fear’. In the highlighted cases, migration data was coming from border controls and security companies. But other sources of migration data come from censuses or household surveys, visas, the IOMs displacement tracking matrix and the rather novel method of ‘Big Data’ such as facebook.
Why do we need to know HIV and migration data?
In the EU, the total number of new HIV diagnoses from 2007-16 in migrant MSM has increased by 58%. The trends for migrant heterosexuals and IDU have declined. Del Amo discussed her recent study data (also presented at AIDS 2018) from Spain looking at the drive in HIV epidemics from Latin American and Caribbean migrants (who would have most-likely acquired HIV post-migration) which found that whilst these were driven by MSM - those from all sub-regions consistently showed higher CD4 counts at HIV diagnosis. This perhaps highlights better rates of testing for migrants but that prevention education and interventions are needed in this group.
I feel that this links back to the question of how to quantify the number of migrants in the country so that we are able to better understand the level of need. Undocumented migrant MSM may face double the challenges as they encounter stigma regarding their migrant status and sexuality. This also begs the question of how available is ART for undocumented migrants?
In my practice, we have a charitable fund made available for some patients that are ineligible for treatment, but we are a large inner-city hospital with access to resources that others may not be able to access.
And what about PrEP?
Julia went on to present data from the aMASE (Advancing Migrant Access to Health Services in Europe) study, in particular a sub-study by Alvarez Del Arco et al. (2017) looking at pre-and-post migration HIV acquisition in Europe, which found that of 63% of the 2249 HIV positive participants who had been diagnosed within the preceeding 5 years, had acquired HIV post-migration which is contrary to previous assumptions (in particular within groups originating from high-prevalence areas such as sub-Saharan Africa) that HIV was being acquired pre-migration (this number has actually declined).
Of the sub-Saharan African (SSA) migrants - 40% of post-migration acquisition occurred in heterosexual individuals. This was further discussed by Del Amo as she highlighted data from the ANRS PARCOURS study looking at post-migration HIV acquisition of SSA migrants living in France between 2012-13 which discovered that in this cohort, HIV was acquired post-migration in one-third to a half of the population. Heterosexual transmission in this cohort was driven by forced-sex and transactional-sex as a result of social hardship.
The significance of this data is that there is clearly a need for PrEP in migrant populations. Both documented and undocumented migrants are at risk. In some countries, some are still able to access PrEP through clinical trials, but in Australia for those without Medicare or Private Health Insurance they are at a disadvantage. I felt this was an important point to consider.
Thinking points:
What I gained from this talk was a reminder that migrants are among the most vulnerable groups in society.
Although Australian Immigration requires compulsory HIV testing for permanent visas, high rates of post-migration HIV acquisition serve to emphasise the importance of quality health systems for migrants and protection for undocumented or temporary migrants.
Migrants are often unsure of their rights to access care and we need to seek out where these groups are, particularly the undocumented migrants, and ensure that they have access to education, prevention and treatment.
1 Migrant crisis: Migration to Europe explained in seven charts". BBC News. 4 March 2016. Retrieved 29 May 2017.
2 http://https://refugeesmigrants.un.org/definitions
Author bio: A nurse with varied Public Health experience - from managing malaria and measles outbreaks in the Congo, a Tuberculosis Hospital in PNG or research into healthcare delivery with the Australian Institute of Health Innovation; to care of HIV patients in Sydney, and now HIV and Immunology research at St Vincent’s Hospital Translational Research Centre. I am passionate about health systems strengthening, health education and promotion, infectious disease control and research. I am currently studying an MSc in Public Health.
