Post-Migration Acquisition Of Hiv: Estimates From Four European Countries, 2007 To 2016

Background: The assumption that migrants acquire human immunodeficiency virus (HIV) before migration, particularly those from high prevalence areas, is common. Aim: We assessed the place of HIV acquisition of migrants diagnosed in four European countries using surveillance data. Methods: Using CD4(+)T-cell count trajectories modelled to account for seroconversion bias, we estimated infection year of newly HIV diagnosed migrants residing in the United Kingdom (UK), Belgium, Sweden and Italy with a known arrival year and CD4(+)T-cell count at diagnosis. Multivariate analyses identified predictors for post-migration acquisition. Results: Between 2007 and 2016, migrants constituted 56% of people newly diagnosed with HIV in the UK, 62% in Belgium, 72% in Sweden and 29% in Italy. Of 23,595 migrants included, 60% were born in Africa and 70% acquired HIV heterosexually. An estimated 9,400 migrants (40%; interquartile range (IQR): 34-59) probably acquired HIV post-migration. This proportion was similar by risk group, sex and region of birth. Time since migration was a strong predictor of post-migration HIV acquisition: 91% (IQR: 87-95) among those arriving 10 or more years prior to diagnosis; 30% (IQR: 21-37) among those 1-5 years prior. Younger age at arrival was a predictor: 15-18 years (81%; IQR: 74-86), 19-25 years (53%; IQR: 45-63), 26-35 years (37%; IQR: 30-46) and 36 years and older (25%; IQR: 21-33). Conclusions: Migrants, regardless of origin, sex and exposure to HIV are at risk of acquiring HIV post-migration to Europe. Alongside accessible HIV testing, prevention activities must target migrant communities.