Study: migrants start HIV treatment later

According to a study of over 150,000 people living with HIV in western Europe, migrants from other parts of the world tend to start cART (combination antiretroviral treatment) later than those born in western Europe.

The study, conducted by the Migrant Health Working Group for the Collaboration of Observational HIV Epidemiological Research in Europe (COHERE), looked at the median CD4 counts of people starting HIV treatment in 11 countries and compared them by patients' geographical origin.

In western Europe, 41% of people diagnosed with HIV were born in another country. Some factors that affect migrants' healthcare are social exclusion, language barriers, economic instability, geographic mobility, policies governing access to publicly-funded health care, and uncertainty about healthcare eligibility.

Men from Caribbean countries were most likely to start treatment with a lower CD4 cell count compared to western Europeans. Compared to native western European men with a CD4 count over 500 cells/mm³, Caribbean men were 45% less likely to start ART, Eastern European men were 30% less likely, and African men were 25% less likely.

The effect was shown for both men and women, though the differences in CD4 cell count between women born in western Europe and migrant women are not as large, probably because women are routinely tested for HIV during pregnancy and start ART then.

“Later cART [combination antiretroviral therapy] initiation in migrants can result in worse health outcomes, but is also of public health concern, as it facilitates ongoing transmission of HIV within the community,” write the researchers in a forthcoming article for AIDS. “Addressing existing barriers to access HIV testing and care, and ensuring universal and free access to cART is important if we are to advance the elimination of inequities and in the control of the HIV epidemic in Western Europe.”