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High levels of postmigration HIV acquisition within nine European countries

Alvarez-del Arco, Deboraa,b,c; Fakoya, Ibidund; Thomadakis, Christose; Pantazis, Nikose; Touloumi, Giotae; Gennotte, Anne-Francoisef; Zuure, Frekeg,h; Barros, Henriquei; Staehelin, Corneliaj; Göpel, Sirik; Boesecke, Christophl; Prestileo, Tulliom; Volny-Anne, Alainn; Burns, Fionad,*; del Amo, Juliaa,b,c,*on behalf of the Advancing Migrant Access to Health Services in Europe (aMASE) study team

doi: 10.1097/QAD.0000000000001571

Objective: We aimed to estimate the proportion of postmigration HIV acquisition among HIV-positive migrants in Europe.

Design: To reach HIV-positive migrants, we designed a cross-sectional study performed in HIV clinics.

Methods: The study was conducted from July 2013 to July 2015 in 57 clinics (nine European countries), targeting individuals over 18 years diagnosed in the preceding 5 years and born abroad. Electronic questionnaires supplemented with clinical data were completed in any of 15 languages. Postmigration HIV acquisition was estimated through Bayesian approaches combining extensive information on migration and patients’ characteristics. CD4+ cell counts and HIV-RNA trajectories from seroconversion were estimated by bivariate linear mixed models fitted to natural history data. Postmigration acquisition risk factors were investigated with weighted logistic regression.

Results: Of 2009 participants, 46% were MSM and a third originated from sub-Saharan Africa and Latin America & Caribbean, respectively. Median time in host countries was 8 years. Postmigration HIV acquisition was 63% (95% confidence interval: 57–67%); 72% among MSM, 58 and 51% in heterosexual men and women, respectively. Postmigration HIV acquisition was 71% for Latin America and Caribbean migrants and 45% for people from sub-Saharan Africa. Factors associated with postmigration HIV acquisition among heterosexual women and MSM were age at migration, length of stay in host country and HIV diagnosis year and among heterosexual men, length of stay in host country and HIV diagnosis year.

Conclusion: A substantial proportion of HIV-positive migrants living in Europe acquired HIV postmigration. This has important implications for European public health policies.

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aNational Centre for Epidemiology, Instituto de Salud Carlos III, Madrid

bUniversidad Complutense de Madrid

cCIBERESP, Instituto de Salud Carlos III, Madrid, Spain

dResearch Department of Infection and Population Health, University College London, London, UK

eDepartment of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece

fDepartment of Infectious Diseases, CHU Saint-Pierre, Brussels, Belgium

gDepartment of Infectious Diseases Research and Prevention, Public Health Service of Amsterdam

hDepartment of Internal Medicine, Center of Infectious Diseases and Immunology, Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands

iDepartment of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal

jClinic for Infectious Diseases, Bern University Hospital, Bern, Switzerland

kDepartment of Infectious Diseases, Medical Clinic II, University Clinic Frankfurt, Frankfurt am Main

lDepartment of Medicine I, Bonn University Hospital, Bonn, Germany

mUnit of Infectious Diseases and Assistance, Coordination and Territorial Integration for Migrants’ Emergency, Civico-Benfratelli Hospital, Palermo, Italy

nEuropean AIDS Treatment Group, Brussels, Belgium.

*Fiona Burns and Julia del Amo are both senior coauthors.

Correspondence to Julia del Amo, National Centre for Epidemiology, Instituto de Salud Carlos III, Centro Nacional de Epidemiología, Avda. Monforte de Lemos 5, 28029 Madrid, Spain. Tel: +34 918222142; e-mail:

Received 17 February, 2017

Revised 2 June, 2017

Accepted 9 June, 2017

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Copyright © 2017 Wolters Kluwer Health, Inc.