Fast-track the end of AI​​​DS in the EU - practical evidence-based interventions. Presentation by: Julia del Amo, Instituto de Salud Carlos III, Madrid In a two-day meeting under the auspices of the Maltese Presidency of the Council of the European Union (30-31 January 2017), HIV experts from across the European Union discussed how to reverse this trend and how to prepare Europe to achieve the set target of ending AIDS by 2030.

1. Migrants: HIV among migrants,
what do we know?
Prof Julia del Amo
National Center for Epidemiology
Institute of Health Carlos III
Madrid, Spain

2. Outline
• Magnitude and trends of the HIV epidemic among
migrants in the EU
• Pre and post-migration acquisition of HIV in the EU
• Access to HIV testing & treatment in the EU

3. Who is a migrant?
3

4. 4
Who is a migrant?
Heterogeneous groups of persons with different
migration drivers
Distinct risk-contexts for HIV infection

5. Outline
• Magnitude and trends of the HIV epidemic among
migrants in the EU
• Pre and post-migration acquisition of HIV in the EU
• Access to HIV testing & treatment in the EU

6. 6

7. Magnitude and trends of the HIV
epidemic among migrants in the EU

8. Geographical origin
NATIVES
- Western Europe - South & Southeast Asia
- Central Europe - North Africa & Middle East
- Eastern Europe - North America
- Sub Sahara Africa - Caribbean
- East Asia & Pacific - Latin America
- Australia & New Zealand - Unknown
MIGRANTS
Magnitude and trends of the HIV
epidemic among migrants in the EU

9. 181 143 HIV diagnosis
reported during 2007-2012
150 455 (83%) with information
about Geographical origin
58 740 (39%) migrants
Distribution of newly HIV migrant
cases, by geographical origin,
EU/EEA, 2007-2012
53%
SSA
11%
Central & Eastern
Europe
10%
Western
Europe
Asia
5%
Other
8%12%
LA &
Caribbean
Magnitude and trends of the HIV
epidemic among migrants in the EU

10. Magnitude and trends of the HIV
epidemic among migrants in the EU

11. Trends of male HIV cases by geographical origin, EU/EEA, 2007-2012
Latin America
Central Europe
Eastern Europe
Magnitude and trends of the HIV
epidemic among migrants in the EU

12. Number of HIV diagnoses by SSA region of origin, EU/EEA, 2007-13
Why are trends in HIV diagnoses in Sub-
Saharan African migrants in Europe changing?
CROI 2016, Abstract 901
Western SSA
Eastern SSA
Central SSA

13. Outline
• Magnitude and trends of the HIV epidemic among
migrants in the EU
• Pre and post-migration acquisition of HIV in the EU
• Access to HIV testing & treatment in the EU

15. Pre and post-migration HIV acquisition
aMASE
Advancing Migrant Access to Health
Services in Europe

16. 16
Zheng et al,. Post migration acquisition of HIV: Estimates from 4 European countries
(Durban 2016)

17. Outline
• Magnitude and trends of the HIV epidemic among
migrants in the EU
• Pre and post-migration acquisition of HIV in the EU
• Access to HIV testing & treatment in the EU

18. Access to HIV testing & treatment in the EU
18

19. 19

20. 20
CD4+T-cell count at cART initiation among migrant
men and women living in Western Europe
-12.0 [-22.2;-1.8] p=0.021
-12.0 [-23.1;-0.9] p=0.034
-28.0 [-42.8;-13.2] p=0.000
-32.0 [-37.8;-26.2] p=0.000
-30.0 [-37.6;-22.4] p=0.000
-34.0 [-45.9;-22.1] p=0.000
-34.0 [-44.4;-23.6] p=0.000
-1.0 [-7.6;5.6] p=0.766
-1.7 [-24.1;20.8] p=0.884
-29.0 [-46.9;-11.1] p=0.001
-34.3 [-59.5;-9.1] p=0.008
-27.7 [-32.9;-22.4] p=0.000
-40.0 [-56.5;-23.5] p=0.000
-7.3 [-17.6;2.9] p=0.160
-54.7 [-74.2;-35.1] p=0.000
-26.3 [-38.7;-14.0] p=0.000
WEWC
EE
NAME
SSA
LA
CRB
ASIA
UNK
WEWC
EE
NAME
SSA
LA
CRB
ASIA
UNK
76.0 [73.2;78.8] p=0.000
53.3 [48.3;58.4] p=0.000
MEN(2009/12)
WOMEN(2009/12)
MEN (Ref. NAT)
WOMEN (Ref. NAT)
MEN (Ref.2004/08)
WOMEN (Ref.2004/08)
MEDIAN REGRESSION: COEF.[95%CI] p-value
-75 -50 -25 -10 0 10 25 50 75
Access to HIV testing & treatment in the EU

21. 21
Access to HIV testing & treatment in the EU
Can we “test and not treat”?

22. Action is needed
• Challenge & improve policies affecting migrants on
HIV prevention, testing and treatment in the EU
• Grant universal access to HIV prevention – including
PreP -, testing and treatment
22

23. Caption of Image 1
¡¡ Gracias por su atención !!
23
Teymur Noori, and Anastasia Pharris ECDC
Victoria Hernando, Inma Jarrin, Susana Monge
and Debora Alvarez, ISCIII