HIV and migration in Western industrialized countries: Common challenges and future directions

On behalf of CDC, PHAC, ECDC and IOMMarita van de Laar, Head of ProgrammeEuropean Centre for Disease Prevention and ControlWashington, 25 July 2012

Outline of presentation

1. Background ‘migration and HIV in Western industrialised countries’

2. Challenges

3. Future directions

4. Next steps

Special Satellite Session on HIV and Migration 22 July, Washington D.C. CDC, PHAC, ECDC and IOM hosted a satellite event

titled:“Responses to HIV and Migration in Western Industrialized Countries: Current Challenges,

Promising Practices, Future Directions”

74 invited participants from the US, Canada, EU and international organisations, including NGOs

Two themes of the session:1. Monitoring HIV among migrant populations2. Migrant-sensitive HIV prevention and treatment

programs and services

Background

Migrants make up approximately 11-22% of the total population in Western industrialised countries

Data suggest that migrants originating from high endemic countries are disproportionally affected by HIV compared to the general population in host countries

Migrants from countries of origin with low HIV prevalence may experience greater HIV vulnerability upon arrival in the host country

Heterosexual contact is the predominant mode of HIV transmission among migrants

Concerns that migrants from some sub-populations, such as MSM, sex workers and IDUs may be more vulnerable to HIV infection

Migrants disproportionately affected by HIV

Canada People from HIV-endemic

countries represent 2.2% of the population, but an estimated 16% of new infections in Canada (2008)

USA The foreign-born population

represents 13% of the total population, and 16.2% of new infections (2007-2010)

Compared to US-born persons with HIV, foreign –born persons with HIV were more likely to be infected through heterosexual contact

PortugalFinlandIcelandEU/EEA

GermanyNetherlands

SloveniaGreece

NorwayLuxembourg

IrelandMalta

SwedenUnited Kingdom

Belgium

0tan28a566028 0tan19a566019 0tan10a566010

European UnionProportion of persons originating from countries with generalised epidemics among heterosexually acquired HIV cases, EU/EEA 2010

Late diagnosis: Proportion of CD4 cell count < 350 and <200 by transmission mode, 201019 countries (N=15 899 cases)

0

10

20

30

40

50

60

70

All cases MSM IDU Heterosexuals from generalised

HIV epidemics

Heterosexuals other

% o

f cas

es

<350<200

What are the challenges?

Monitoring migrant health

Non-standardized definitions and varying terminologies for ‘migrant populations’

Although some countries have better data than others, there is a need to develop clearly defined and more complete data sets for key variables such as date of arrival, country of birth, country of infection and date of diagnosis to monitor trends in transmission

Data on key indicators are needed, such as:– How many migrants are getting tested for HIV?– How many migrants are HIV positive?– How many migrants are accessing HIV treatment?– How many migrants are retained in treatment?

It is difficult to develop evidence-based programs and policies targeted toward migrant populations without better data

Barriers to migrants’ access to HIV prevention, treatment and care

Stigma, discrimination and lack of information at individual and structural levels

Language and cultural barriers, lack of migrant-sensitive approach to services (particularly in areas less populated by migrant groups), anti-migrant sentiment

Policies under which some migrant groups, particularly undocumented migrants, are unable to access ART

Economic austerity leading some migrant-friendly HIV programmes to be cut

Future directions

... in relation to monitoring migrant health Partnerships in migration and HIV

– Cross-fertilisation of innovative approaches that address broader migrant health issues

– Standardising monitoring & reporting tools (UNGASS, WHO, Dublin)

– Engagement of community and migrants in the response Capture, supplement and share surveillance and

monitoring data including behavioural and SDOH aspects

“Data for action”: use the data to target prevention and treatment services

Sharing of data across jurisdictions, e.g., across regional, federal, provincial and state governments

Enhance monitoring and follow-up mechanisms; i.e. access to care, access to ARTs, adherence

Integrate HIV prevention and treatment as a broader health delivery concept to address issues of stigma, racism and discrimination

Health care coverage that includes migrants, i.e. health insurance

Trained providers/clinicians with cultural sensitivity and linguistic capacity to work with migrant populations

Integrate migrant health services with social supports (i.e. housing, transport, income)

Sensitivity to possible stigma introduced by increased visibility or targeting of migrants

.. in relation to developing migrant-sensitive programs & services

Next steps

A final report will be generated including resource materials of projects and successful approaches from each region

We will continue collaboration in an effort to raise awareness on key issues related to migrant health and HIV

ECDC will host a follow-up meeting in 2013 to take forward the issue of migrant health and HIV in Western industrialized countries

Thank You