Surveying ECDC report presents the results of survey on HIV prevention and barriers among migrants in the EU/EEA

Background

In 2023, migrants accounted for almost half of new HIV diagnoses in the European Union and European Economic Area (EU/EEA) remaining a key population affected by HIV across the European region. Migrants living with HIV face numerous intersecting stigmas related to their HIV and migration status, as well as broader racial and cultural discrimination. Moreover, access to health services for undocumented migrants is not universally guaranteed in the EU/EEA, which hinders HIV prevention, testing and treatment services for this group and could contribute to HIV transmission in these communities, including post-migration acquirement of HIV.

For this report, migrants are defined as ‘people born abroad’ (i.e. those born outside the reporting country, regardless of place of HIV acquisition or diagnosis). This categorisation encompasses a broad range of individuals, some of whom may also be included in other key populations such as men who have sex with men, people who inject drugs, or sex workers. It includes those who have migrated from within the EU/EEA as well as those who have come from outside the region and will be diverse in terms of socio-demographic and socio-economic characteristics including ethnicity, nationality, migration status, gender, income, and educational level.

Methods

ECDC monitors the implementation of the 2004 Dublin Declaration [1,2]. Between February and May 2024, ECDC implemented an online survey among EU/EEA Member States to collect the most recent data from 2023. The survey contained specific questions in relation to the HIV epidemic among migrants, in addition to questions relating to the current national prevention interventions, policies and barriers to the public health response. This report presents the results of the survey.

Status of implementation of combination prevention

Combination prevention is an approach that combines biomedical, behavioural, and structural interventions and strategies for HIV prevention, working on different levels, including individual, community, and societal/national levels, into one comprehensive programme. Key findings include:

• Twenty-seven countries of the EU/EEA reported having a national HIV prevention strategy to reduce the number of new HIV infections. Of those, 89% (24 countries) reported that their strategy specifically mentioned migrants as a key population to whom actions and services are targeted.
• Only seven countries reported medium-to-high coverage of condom and lubricant provision programmes targeting migrants.
• Pre-exposure prophylaxis (PrEP) availability in the EU/EEA has improved significantly since 2016. While data on the number of migrants accessing PrEP was generally limited, other findings suggest that PrEP may be inaccessible to many migrants: 13 countries reported difficulties in reaching both documented and undocumented migrants with PrEP, and three more countries reported difficulties in reaching only undocumented migrants. Seven countries reported that PrEP was not accessible for undocumented migrants, and in at least five more countries, it was accessible only at cost or through private providers.
• The vast majority of countries reported no restrictions on access to testing for undocumented migrants. They also reported the availability of different testing interventions which might facilitate access to testing for undocumented migrants. However, no data to support this assumption were available. It should also be noted that self-testing and community-based testing were not universally provided across EU/EEA countries and these need to be scaled up to reach key migrant populations.

Progress in reaching the continuum of HIV care targets

The continuum of HIV care is a conceptual framework that provides a snapshot of the critical stages in achieving viral suppression among people living with HIV. Only five out of 30 countries provided full data to monitor all stages of the continuum of care for migrants. Key findings include:

• There is progress for migrants along the continuum of HIV care across the EU/EEA, but limited available data suggest that only some countries were meeting one or more of the Joint United Nations Programme on HIV/AIDS (UNAIDS) 95-95-95 targets to be achieved by 2025:
  • Approximately 93% of migrants living with HIV in the EU/EEA knew their HIV status (based on
    reporting from six countries).
  • Of migrants diagnosed with HIV, 84% had initiated antiretroviral treatment (ART), (based on
    reporting from nine countries).
  • Of the migrants on treatment, 95% were virally suppressed (based on reporting from nine
    countries).
• As of 2023, only Luxembourg was meeting the 2025 substantive target of 86% viral suppression among all migrants estimated to be living with HIV, followed by Belgium, which was within 5% of the target.

Conclusions and recommendations

Progress has been made in the implementation of combination prevention and in reaching the continuum of HIV care targets for migrant populations in the EU/EEA. Recommendations include implementing migrant-tailored, nonstigmatising, linguistically and culturally appropriate HIV prevention programmes for all migrant populations, scaling up testing services, in particular community-based efforts including self- and home testing, and strengthening links between HIV support services and other services such as social services to meet patient needs.

Only five countries within the EU/EEA reported data for all stages of the continuum of care. Countries should continue to improve monitoring and surveillance data for HIV in migrant populations, to inform decision-making on the provision and targeting of prevention, testing and care services.

The full report can be downloaded here: HIV and migrants in the EU/EEA – Monitoring the implementation of the Dublin Declaration on partnership to fight HIV/AIDS in Europe and Central Asia: 2024 progress report (2023 data)