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

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

This report presents the results of a survey among EU/EEA Member States in relation to the HIV epidemic among migrants and current national prevention interventions, policies and barriers to the public health response.

Executive summary

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)

Australia: Migration policies for People with HIV perpetuate criminalisation and expose them to harm

David Carter Delivers Keynote at the Australasian HIV&AIDS Conference

Health+Law’s research lead David Carter, delivered a keynote address at the recent ASHM HIV Conference in Sydney, exploring the controversial past and present of HIV criminalisation in Australia. His urgent, provocative address challenged us to consider how current legal and policy processes in migration law recreate conditions of criminalisation, producing serious health and other harms for people living with HIV. 

Talking to Health+Law researchers in an interview about legal issues, Sergio*, a man in his thirties originally from South America and living with HIV, described the experience of migration to Australia:

I didn’t have to face any court, but I [did] have to prove that I wasn’t a bad person just because I have HIV […] I [had] to prove myself to someone else, who probably is not living with HIV, that I was not a bad person, and I was a good citizen and I deserve to be here.

The migration process is a complex one – and this complexity is amplified for people living with HIV. Sergio’s reflections express a particularly grim aspect of this process for migrants, especially those living with HIV.

Indeed, as Scientia Associate Professor David Carter, Health+Law’s research lead, argued in an invited keynote at the 2024 Australasian HIV&AIDS Conference hosted by ASHM Health in September this year, the experience of people living with HIV seeking to migrate to Australia is part of Australia’s long history of the criminalisation of HIV. Speaking to delegates from Australia, New Zealand, Asia and the Pacific at Sydney’s International Convention Centre on Gadigal Country, David reminded the audience that criminalisation is a policy approach, that doesn’t just use the criminal law. To show this he set out five stages of criminalisation that are also evident in the migration process for those living with HIV.

First, as he explained, criminalisation characterises specific behaviour as harmful or carrying a risk of harm to the community. In this case the harm presented is, to quote Australian migration law, that a person’s HIV care represents a ‘significant cost to the Australian community or prejudice [to] the access of Australian citizens or permanent residents to health care or community services’.

Second, criminalisation creates a suspect population, made up of people thought to warrant suspicion because they come to be associated with the potential harm.

Third and fourth, this suspect population attracts surveillance from the state, with a hierarchy created within the suspect population whereby some members are subject to further and intensified surveillance.

Fifth, and finally, some members of this suspect population are subjected ‘to the most severe forms of the state’s coercive and punitive authority’, including investigation, more intensive supervision, detention or arrest, and in some cases, criminal or civil proceedings.

The criminalisation of HIV has a long and storied history, going back to the very early days of the AIDS crisis. Vocal members of HIV-affected communities, legal and human rights advocates and many others have argued strongly against criminalisation, viewing it as draconian and as an approach to public (health) policy with very negative consequences for HIV epidemics.

In Australia, arguments against HIV-specific criminal offences have been broadly successful, and yet the ‘temptation’ to criminalise – as the very first Australian National HIV Strategy described it – continues to emerge in some policy responses to HIV and other communicable diseases.

In 1987, when the authors of the first national HIV strategy were writing, they were warning against measures including compulsory universal HIV testing, the closure of gay venues, criminal penalties for HIV transmission, and limitations on the movement of HIV positive people, including forced quarantine. Today, HIV criminalisation is operating in Australian migration policy and law.

‘This contemporary criminalisation of HIV begins’, David argued, ‘like all criminalisation, with the characterisation of behaviour in terms of harm and risk of harm’. He continued, arguing that:

This characterisation of migrating while HIV positive as harmful establishes, and in-turn enlivens, the suspect population management and criminalising processes of our medical border […] This criminalising logic establishes an adversarial relationship between the person living with HIV and the state, and between them and members of the Australian community, whose access to health care it is alleged may be prejudiced by providing care for a person living with HIV who wishes to migrate.

Among the many negative effects of this process is that it can discourage migrants living with HIV from engaging in testing, treatment and HIV care. Interviews conducted by Health+Law as part of our national legal needs (LeNS) study confirm that this is happening. They show that many migrants living with HIV in jurisdictions across Australia experienced an alienating and hostile environment: a ‘threat environment so elevated’, as David described it in his keynote, that they frequently described withdrawing from HIV care and community life as a coping mechanism.

Unfolding the history of ‘unjust and unhelpful’ HIV criminalisation in Australia, David outlined how the current legal and policy conditions that prospective migrants living with HIV face in Australia today work to recreate conditions of criminalisation and expose both individuals and the community to multiple health harms.

You can read more about David’s keynote in The Medical Republic’s coverage of the conference.

US: Restrictive immigration policies would undermine Public Health and economic stability

Expected Immigration Policies under a second Trump administration and their health and economic implications

Introduction

Immigration was a central campaign issue during the 2024 Presidential election with President-elect Trump vowing to take strict action to restrict both lawful and unlawful immigration into the U.S. Such actions would have stark impacts on the health and well-being of immigrant families as well as major economic consequences for the nation. As of 2023, there were 47.1 million immigrants residing in the U.S., and one in four children had an immigrant parent.¹ Increased immigration boosts federal revenuesand lowers the national deficit through immigrants’ participation in the country’s economy, workforce, and through billions of dollars in tax contributions.

This issue brief discusses key changes to immigration policies that may take place under the second Trump administration based on his previous record and campaign statements, and their implications. President-elect Trump has indicated plans to restrict and eliminate legal immigration pathways, including humanitarian protections, and deport millions of immigrants, which would likely lead to separation of families, negative mental and physical impacts for immigrant families, and negative consequences on the nation’s workforce and economy.

Expected Policy Changes

Elimination of Deferred Action for Childhood Arrivals (DACA) Program

The future of the DACA program remains uncertain due to pending litigation, and President-elect Trump has indicated plans to eliminate it, which would lead to over half a million DACA recipients losing protected status. DACA was originally established via executive action in June 2012 to protect certain undocumented immigrants who were brought to the U.S. as children from removal proceedings and receive authorization to work for renewable two-year periods. During his prior term, President-elect Trump sought to end DACA but was blocked by the Supreme Court in 2020. The Biden administration issued regulations in 2022 to preserve DACA protections. In September 2023, a district court in Texas ruled the DACA program unlawful, preventing the Biden administration from implementing the new regulations while the case awaits a decision in the Fifth Circuit Court of Appeals. Under pending court rulings, while the Department of Homeland Security (DHS) is accepting first-time DACA requests, it is unable to process them. DHS is continuing to process DACA renewal requests and related requests for employment authorization. After the attempt to end DACA failed in 2020, the Trump administration saidthat it would try again to eliminate DACA protections, and, if the pending court ruling finds the program unlawful, the administration is unlikely to appeal the decision. There are over half a million active DACA recipients, a majority of whom are working and many of whom have U.S.-born children, who could be at risk of deportation if the program is eliminated.

A recent health coverage expansion to DACA recipients also is subject to pending litigation and would, if eliminated, leave many DACA recipients without access to an affordable coverage option. In May 2024, the Biden administration published regulations to extend eligibility for Affordable Care Act (ACA) Marketplace coverage with premium and cost-sharing subsidies to DACA recipients, who were previously ineligible for federally funded health coverage options. The regulation became effective November 1, 2024, allowing for enrollment during the 2025 Open Enrollment Period. In August 2024, a group of states filed a lawsuit against the federal government alleging that the ACA Marketplace coverage expansion for DACA recipients violates the Administrative Procedure Act. The case is currently under review at a district court in North Dakota and a decision is expected in the coming months. Elimination of the expansion could leave the nearly 100,000 uninsured DACA recipients it is estimated to cover without an affordable coverage option.

Changes to Public Charge Policy

President-elect Trump could reinstate changes to public charge policy that he made during his first term, which led to increased fears and misinformation among immigrant families about accessing programs and services, including health coverage. Under longstanding immigration policy, federal officials can deny entry to the U.S. or adjustment to lawful permanent resident (LPR) status (i.e., a “green card”) to someone they determine to be a public charge. During his prior term, President-elect Trump issued regulations in 2019 that broadened the scope of programs that the federal government would consider in public charge determinations to newly include the use of non-cash assistance programs like Medicaid and the Children’s Health Insurance Program (CHIP). Research suggests that these changes increased fears among immigrant families about participating in programs and seeking services, including health coverage and care. Prior KFF analysis estimated that the 2019 changes to public charge policy could have led to decreased coverage for between 2 to 4.7 million Medicaid or CHIP enrollees who were noncitizens or citizens living in a mixed immigration status family. The Biden administration rescinded these changes. However, as of 2023, a majority of immigrant adults said in a KFF survey that they were “not sure” about public charge rules, and roughly one in ten (8%), rising to about one in four (27%) of likely undocumented immigrant adults, said they have avoided applying for assistance with food, housing, or health care in the past year due to immigration-related fears (Figure 1). As of November 2024, President-elect Trump has not indicated whether his administration plans to reinstate his first term changes to public charge policy.

Expanded Interior Enforcement Actions

President-elect Trump has indicated that his administration plans to carry out mass detentions and deportations of millions of immigrants, including long-term residents, which could lead to family separations and negative mental and physical health consequences. President-elect Trump has stated that he will declare a national emergency and use the U.S. military to carry out mass deportationsof tens of millions of undocumented immigrants residing in the U.S., many of whom have been living and working in the country for decades. Such a policy could lead to family separations as well as mass detentions, which can have negative implications for the mental health and well-being of immigrant families and also put their physical health at risk. Tom Homan, who was the director of U.S. Immigration and Customs Enforcement (ICE) during the first Trump administration and has been selected as the incoming administration’s “border czar”, has said that it is possible to carry out mass deportations without separating families by deporting an entire family unit together, even if the child may be a U.S. citizen. As was the case during his first term, he may also carry out workplace raids as part of mass deportation efforts. Research shows that such raids can lead to family separations, poor physical and mental health outcomes for immigrant families, negative birth and educational outcomes for the children of immigrants, and financial hardship due to employment losses. Prior KFF research shows that restrictive immigration policies implemented during the first Trump administration, including detention and deportation led to increased fears and stress among immigrant families and negatively impacted the health and well-being of children of immigrants, most of whom are U.S. citizens.

Mass deportations could also negatively impact the U.S. workforce and economy, where immigrants make significant contributions. Immigrants have similar rates of employment as their U.S.-born counterparts and play outsized roles in certain occupations such as agriculture, construction, and health care. Research has found that immigrants do not displace U.S.-born workers and help foster job growth through entrepreneurship and the consumption of goods and services. Further, federal data show that unemployment rates for U.S.-born workers have not decreased between 2022 and 2023 and have remained similar to those for immigrant workers. In addition, immigrants, including undocumented immigrants, pay billions of dollars in federal, state, and local taxes each year. Mass deportation of immigrants could lead to workforce shortages in key sectors which could have negative economic consequences including an increase in the cost of essential goods such as groceries. Vice President-elect Vance has stated that immigrants are responsible for the U.S. housing crisis. While some studies show a link between immigration and rising housing costs, in general, economists are skeptical of immigration being a primary driver. Mass deportation of immigrants could also worsen housing shortages since immigrants make up a significant share of construction workers. Workplace raids can exacerbate existing labor shortages and have a negative impact on the local economies of the communities where they take place. Further, research shows that without the contributions undocumented immigrants make to the Medicare Trust Fund, it would reach insolvency earlier, and that undocumented immigrants result in a net positive effect on the financial status of Social Security. There also is likely to be a significant cost to taxpayers for the government to carry out large-scale detention and deportations.

Ending Birthright Citizenship

President-elect Trump has stated that he will sign an executive order to end birthright citizenship for the children of some immigrants despite it being a guaranteed right under the U.S. Constitution, which would negatively impact the health care workforce and economy. This proposed action would limit access to health coverage and care for the children of immigrants since they may not have lawful status. It could also have broader ramifications for the nation’s workforce and economy, potentially exacerbating existing worker shortages, including in health care. KFF analysis of federal data shows that adult children of immigrants have slightly better educational and economic outcomes than adult children of U.S.-born parents and make up twice the share of physicians, surgeons, and other health care practitioners as compared to their share of the population (13% vs. 6%) (Figure 2). Other research also has found that children of immigrants contribute more in taxes on average than their parents or the rest of the U.S.-born population, and that their fiscal contributions exceed their costs associated with health care, education, and other social services.

Reinstatement of “Remain in Mexico” Policy

President-elect Trump has stated that he will reinstate the “Remain in Mexico” border policy and that he may use military spending to carry out stricter border enforcement, which would leave an increased number of asylum seekers facing unsafe conditions at the border. The first Trump administration implemented Migrant Protection Protocols, often referred to as the “Remain in Mexico” policy, in 2019. Under this policy, asylum seekers were required to remain in Mexico, often in unsafe conditions, while they awaited their immigration court hearings. The Biden administration ended this policy in 2022, following some legal challenges, although it implemented a series of increasingly restrictive limits on asylum eligibility in 2023 and 2024 in response to a high number of border encounters. President-elect Trump said he plans to reinstate the Migrant Protection Protocols. He also has indicated that he will deploy the National Guard, as well as active duty military personnel, if needed, to the U.S.-Mexico border, although details of the plan remain unclear. Heightened military presence at the border can lead to increased fears among immigrant families living in border areas and using part of the military budget for border security could face legal challenges.

Restrictions on Humanitarian Protections

President-elect Trump said he plans to significantly limit the entry of humanitarian migrants into the U.S. during his second term by restricting refugee limits, shutting down the CBP One application for asylum seekers, and eliminating Temporary Protected Status (TPS) designations for immigrants from some countries. During his first term, President Trump set the annual refugee admissions ceiling at its lowest levels, ranging from 50,000 in 2017 to a historic low of 18,000 in 2020. The Biden administration increased the limit to 65,000 in 2021, a level close to the annual ceilings prior to the first Trump term, and further increased the limits in 2022 and 2024 in response to humanitarian concerns. It is likely that President-elect Trump will reduce the admissions ceiling for refugees in his second term. The President-elect has also said that he will close the CBP One application created by the Biden administration which allows asylum seekers to seek lawful entry to the U.S. by making an interview appointment with the DHS. While there have been implementation challenges with the CBP One application, shutting down the application could lead to “mass cancellation of appointments” and possibly an increase in attempts to cross the border outside of ports of entry. President-elect Trump also has indicated that he will roll back TPS designations for some immigrants, including those from Haiti. TPS designations protect immigrants from countries deemed unsafe by the DHS from deportation and provide them with employment authorization but do not provide a pathway to long-term residency or citizenship. As of March 2024, over 860,000 immigrants from 16 countries were protected by TPS. Loss of TPS would put people at risk for deportation, which could contribute to family separation which in turn can have negative impacts on the mental and physical health of immigrant families, and broader negative consequences for the workforce and economy.

Endnotes

KFF analysis of 2023 American Community Survey 1-year Public Use Microdata Sample.

Research papers explore challenges in HIV care for migrants and refugees, highlighting social and structural barriers

Report reveals how nations downplay migrants HIV care

A study has revealed how countries across the world have downplayed the health of international migrants who face barriers while accessing HIV care along the migration routes.

In many countries, the study shows that people on the move are confronted with stigma related to migration status, racialism, discrimination and unfavourable policies that run health care systems.

The study focused on migrants who are not aware of their HIV status but are either infected with or are vulnerable to acquiring HIV, and migrants who know their positive status and require linkage and adherence to HIV treatment.

“Migration is a common phenomenon and will remain an important health determinant when attempting to successfully strengthen health systems, including the access to continuity of HIV care,” the journal published by Lancet notes.

The worst hit are the undocumented migrants who due to fear of deportation and stigma may never seek HIV care from a health facility.

Although documented migrants have the right to access health care in some countries, they might still face barriers while accessing HIV care.

In some countries, documented migrants reportedly faced verbal abuse and discrimination in healthcare settings and were denied access to treatment even when they had the right to it, or were charged higher fees.

According to the study, the migration trajectory, including a pre-migration period in departure countries and transition periods before arriving at destination countries, presents HIV-related risks for migrants.

“Along this trajectory, migrants are likely to face different risk-inducing social, physical, political, and economic environments. Migrants’ departure countries might contribute to their overall determinants of HIV including specific vulnerabilities, practices around safer sex, and health-care seeking,” it reads in part.

The study cites a case where migrants arriving from countries with a patriarchal culture where sex is considered taboo, such as Arab countries, have been reported to experience a high burden of gender-related stigma associated with a high likelihood of acquiring HIV and delayed testing.

Additionally, the report says that experiences and familiarity with healthcare systems in departure countries might also shape migrants’ practices around seeking HIV care in transition or destination countries.

In the context of forced displacement, the research states that challenges related to accessing HIV care during the transition stage are major points of concern, especially where some migrants have to reside in refugee facilities in transition countries for long periods, which might substantially delay their access to HIV care.

These 2 research papers are part of the Lancet SERIESHIV in Migrant Populations Online first accessible freely after registration:

Humanising and optimising HIV health care for refugees and asylum seekers

Interventions to ensure access to and continuity of HIV care for international migrants: an evidence synthesis

Italy: Legal issues and language difficulties restrict healthcare access for migrants in Southern Italy

Healthcare access in Southern Italy: the challenges faced by migrant communities

For many migrants in Southern Italy, protecting their health remains an uphill battle. The REACH OUT project, along with extensive field research, has revealed how access to care and the prevention of sexually transmitted infections are affected by a complex mix of social, cultural and economic factors.

Economic and legal difficulties, as well as language and cultural barriers, are among the primary obstacles preventing migrants in Southern Italy from accessing healthcare services.

Funded by the European Union and conducted in collaboration with Maastricht University and the University of Padua, the REACH OUT project has uncovered important data* on the health vulnerabilities of migrants in Southern Italy.

The project focuses on the prevention and access to care for HIV, hepatitis B and C, and other STIs, identifying real-world barriers that hinder the effective implementation of healthcare interventions in challenging contexts. One of the key findings is the role of Social Determinants of Health (SDH)– such as legal status, income, education level, and discrimination – which significantly impact healthcare access and infection risk.

Economic challenges are a major barrier: 67% of migrants interviewed live below the poverty line, with monthly incomes of less than 630 euros. Moreover, nearly half (48%) lack access to healthcare services, often due to limited awareness of their rights or complications in navigating administrative processes. This problem is especially severe in reception centers and informal settlements like Borgo Mezzanone, where healthcare registration is often absent.

Language and cultural barriers further compound the issue. Difficulties in translating sexual health information into various languages, combined with the stigma sorrounding STIs, create additional challenges in promoting preventive practices. While many migrants are aware of STIs and some prevention methods, shame and religious beliefs often prevent them from adopting protective behaviours.

Mental health data is equally concerning: 61.9% of migrants exhibited signs of psychological distress, while 30% reported having experienced intimate partner violence. Issues such as anxiety and depression are common, often stemming from prolonged stays in Italy without legal stability or social integration. Though these psychological factors do not directly block access to healthcare, they often isolate individuals, making them less likely to seek out healthcare services and support.

This research highlights the crucial need to improve communication about healthcare rights for migrants and to strengthen access to services for more inclusive protection. At INTERSOS, we are committed to using these insights to refine and expand our field initiatives, working closely with communities to build trust, provide targeted healthcare, and support long-term structural changes that enhance the quality of life for migrants in Italy.

*The data referenced here were gathered through three studies conducted by graduate researchers from Maastricht University and the University of Padua: Marije Pot, Martina Bugelli, and Antonia Laß.

UK: Former health minister calls for compulsory HIV tests for migrants arriving from “high-prevalence countries”

Test migrants for HIV, former minister says, as UK rates rise

A former health minister says in a co-authored blog post that the UK increase can be attributed to undiagnosed migrants arriving from sub-Saharan Africa.

A former health minister has called for the UK to introduce HIV tests for migrants entering the UK.

Neil O’Brien claimed that there were a large number of people arriving in the UK with HIV who were unaware of their diagnosis and therefore went untreated.

The Conservative MP for Harborough, Oadby & Wigston said that HIV tests should be compulsory to get a visa when arriving from “high-prevalence countries” to reduce the risk of transmission from undiagnosed people.

O’Brien, who served as the public health minister between September 2022 and November 2023, said this would be a much more targeted approach than other countries that required HIV tests to get a permanent visa, such as Australia and New Zealand.

O’Brien wrote on his Substack blog that introducing HIV tests for migrants was essential to meet the government’s strategy to end new HIV transmission in the UK by 2030.

The number of newly diagnosed patients had fallen consistently since 2005 but data for 2022 and 2023 revealed that progress had suddenly gone backwards.

This has been driven by a rise in the number of newly diagnosed individuals who were born outside the UK and Europe, particularly among people from Africa. People from east Africa followed by southern Africa have the highest rates of HIV, according to data from the UK Health Security Agency (UKHSA).

O’Brien linked this change in HIV diagnosis trends to changes in the UK’s immigration system, which has led to a significant increase in the number of people from sub-Saharan Africa.

The UKHSA disputed the suggestion that a large number of people were arriving in the UK with HIV without knowing about it. It pointed to statistics showing that last year 53 per cent of cases in England that were reported to the UKHSA had already been diagnosed abroad. This was the first time that the proportion of diagnoses made overseas had exceeded the proportion of diagnoses first made in England.

In 2023 about 330,000 visas were issued to migrants from sub-Saharan Africa, compared with about 50,000 a year in the 2010s.

O’Brien suggested that the additional cost should be paid for by applicants, which he said would be small compared with visa fees, the immigration health surcharge and other costs of travel.

He said the system would work similarly to that for tuberculosis (TB), which requires all people applying for a visa from a list of 102 countries to have a TB test if they are coming for more than six months.

More than 50 countries require an HIV test for at least some visas. In Australia, anyone applying for permanent residency must undergo an HIV test to meet the health requirement for a visa. Those entering on shorter visas also need to have an HIV test in some circumstances.

Visa applicants intending to stay in New Zealand for more than a year must also have a HIV test.

New report documents key challenges for migrants on the move in the Darien region

PAHO Report Highlights Urgency of Improving Access to Health for Migrant Populations in Darien Region

Washington, DC (PAHO) – A report released today by the Pan American Health Organization (PAHO) documents the key challenges facing migrants in the Darien region and calls on countries in the Americas to collaborate to strengthen disease surveillance and improve policies and programs to ensure the health of migrants.

The new report, Challenges in access to health for migrants transiting the Darien region , reveals that migrants face significant health challenges as they cross the vast jungle territory between the Colombian and Panamanian border, including lack of access to emergency medical care, adverse environmental conditions, increased risk of violence and exploitation, and exposure to infectious diseases.

“In the Americas, millions of migrants continue to be disproportionately affected by health problems due to lack of access to care, and this is particularly the case in the dangerous Darien crossing,” said PAHO Director Dr. Jarbas Barbosa.

“It is essential that countries, partners and donors come together to address the number of variants that are hampering access to timely care for migrant populations,” he added.

Over the past two years, migration in the Darien region has continued to increase, with populations moving across borders from the south to the center and ultimately to North America. This phenomenon is not only due to political and economic instability in Latin America and the Caribbean, exacerbated by the COVID-19 pandemic, but also to conflicts and challenges in other parts of the world.

In the first three months of 2024, more than 135,000 people passed through this area, mainly from Colombia, Ecuador, Haiti, Peru and Venezuela, but also from Afghanistan, Angola, Bangladesh, China and India, to name a few.

While migrants are particularly vulnerable to health problems, caused by a lack of access to preventative care and medication for pre-existing conditions, the harsh terrain of the Darien region also exposes them to extreme weather, wild animals, violence and exploitation.

The report shows that levels of vulnerability among populations in transit have also increased in recent years due to an increase in the number of migrants with disabilities, women travelling alone, pregnant women and women with children under one year old, in addition to the number of unaccompanied children and adolescents.

Due to the lack of health care along the route, migrants are often deprived of vital antenatal care, as well as care for chronic diseases such as diabetes, hypertension and HIV. The lack of specialized services, including sexual and reproductive health, and mental health issues also compound migrants’ health problems.

Lack of access to health services, sanitation, basic hygiene and safe water, as well as consumption of unsafe and micronutrient-poor street foods and nights spent sleeping outdoors, have also increased the incidence of skin lesions, respiratory infections and foodborne diseases among children under five – the leading cause of death in this age group in both countries.

To help address these issues, the report makes six recommendations:

Strengthen coordination and partnerships between countries to ensure a more coherent and rapid response to health situations;
Improving access to health services for migrants in transit, as well as for host populations;
Strengthen health surveillance and information management in accordance with the International Health Regulations (IHR);
Strengthening institutional and community capacities to combat preventable diseases and deaths;
Support countries in developing and strengthening policies, programmes and frameworks to address migrant health;
Help create plans to promote preparedness, response and recovery in the context of a migrant health crisis.

PAHO continues to work with countries in the Americas to support the development of migration response plans to improve access to health for migrant and local populations, improve health surveillance, and strengthen partnerships and networks.

The Organization also works with host countries to implement health promotion campaigns on issues related to dengue prevention, sexual and reproductive health and other health topics, as well as to develop campaigns to combat xenophobia, stigma and discrimination.

Peru: Congress approves exceptional health coverage for migrants and refugees with TB and HIV

Peru approves groundbreaking law to extend health coverage for migrants with HIV and TB

In a milestone decision, the Peruvian Congress has passed legislation that extends temporary health insurance coverage to migrants diagnosed with HIV and tuberculosis (TB). This law allows non-resident foreigners to access healthcare services through the public health insurance system (known by the Spanish acronym SIS) while they complete their immigration processes.

This law, which incorporates proposals from Law Bills 5253, 5554, and 7260, represents a significant step in reducing barriers for migrant populations, ensuring timely medical attention without the need for official residency documentation. Now, migrants affected by HIV or TB can receive vital healthcare services, including medical consultations and diagnostic exams, regardless of their immigration status.

The legislative breakthrough follows over two years of advocacy led by the Grupo Impulsor, a coalition that includes UNAIDS, alongside partners such as USAID’s flagship initiative Local Health System Sustainability Project (LHSS), IOM, UNHCR, the Peruvian Observatory of Migration and Health of the Peruvian University Cayetano Heredia (OPEMS-UPCH), Colectivo GIVAR, VENEACTIVA, the Peruvian TB Social Observatory, and Partners in Health.

Likewise, providing timely treatment for migrants with HIV or TB not only improves their quality of life but also reduces the risk of transmission, making it a crucial public health measure benefiting everyone. It also saves money: early care is far more cost-effective, preventing advanced cases that strain the health system.

A cost-benefit analysis reveals that Peru could save around 5 million soles ($1.33 million USD) annually by preventing new infections and another 54 million soles ($14.58 million USD) through avoiding productivity losses linked to AIDS and TB-related deaths.

Migrants living with HIV in Peru remain among the most discriminated groups in the country, with 70.7% reporting stigma, according to the Ministry of Justice and Human Rights. They also face heightened vulnerability due to xenophobia, violence, and exploitation—nearly half of them have experienced physical violence or sexual exploitation. Accessing healthcare is a major challenge, with only 2% of migrants with HIV covered by public health insurance, leaving the rest to pay out-of-pocket costs that many cannot afford.

“By extending health insurance to migrants, Peru is not only addressing these barriers but also aligning with global commitments, like the Sustainable Development Goals (SDGs), aimed at eradicating epidemics such as AIDS and TB by 2030”, says Luisa Cabal, UNAIDS Regional Director for Latin America and the Caribbean. “This legislative victory not only marks a turning point in health policy but also sets a precedent for future reforms, ensuring a more inclusive and equitable healthcare system for all.”

Protecting everyone’s rights protects public health.

Netherlands: Study explores factors influencing the uptake of HIV testing among heterosexual migrants

Barriers and enablers that influence the uptake of HIV testing among heterosexual migrants in the Netherlands

Background

Heterosexual migrant men and women in the Netherlands often face barriers to accessing health services, including HIV testing, that may lead to late-stage HIV diagnoses. This study explored factors of influence in the usage of HIV testing among heterosexual migrants.

Methods

Qualitative evaluation with semi-structured interviews at the Amsterdam-based AIDS Healthcare Foundation (AHF) Checkpoint and one focus group discussion (FGD) conducted during June-July 2023 with 19 participants: interviews with 12 heterosexual migrants from low- or middle-income countries (LMICs) and FGD (n = 5) and interviews (n = 2) with 7 key informants from the (public) health sector. Recorded interviews were transcribed and thematically analyzed, using the framework of Andersen’s Expanded Behavioral Model of Health Services Use.

Results

In total, 55 themes emerged from the interviews and the FGD. Examples include insufficient availability of information on HIV and testing services, and difficulty in accessing these services (e.g. the barrier of the online appointment system of the Centre for Sexual Health (CSH)). HIV test participants expressed free, rapid testing, no appointment required, and a positive experience during their HIV test as enablers to test in the future. Results from key informants showed that poor health literacy and lack of clarity on the healthcare system’s guidelines were barriers for heterosexual migrants in accessing information on HIV and testing services. It also revealed past initiatives and interventions that were successful in reaching at-risk groups such as the integration of HIV testing into sexually transmitted infection (STI) testing, but that were subsequently discontinued due to financial constraints.

Conclusion

Factors contributing to a low HIV test uptake were participants’ perception of limited accessibility of CSH facilities, insufficient available information on HIV (testing) services, and low perception of HIV risk. Unclear policies on accessing HIV/STI testing services at CSHs, and potential missed opportunities for HIV testing at general practitioners were contributing factors identified by key informants.

For the full text of the study, see: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0311114

France: New government wants to reform the law that gives free medical assistance for immigrants after three months

New French interior minister announces plan for tougher immigration policy

France’s newly appointed interior minister Bruno Retailleau signalled a rightward shift for French interior policy on Monday at his first public speech in office. Addressing police unions at the Cour de l’Hôtel de Beauvau, he vowed to end “illegal” migration and “restore order” in the country.

Concerning immigration, the senior senator with The Republicans (Les Républicains) party called for a much tougher policy in an interview on national TV, proposing to regularize as few people as possible while deporting as many as possible. He also urged legislative changes, such as a reform to the law that gives free medical assistance for immigrants after three months in the country, aiming to replace it with a much-reduced protection regime. Beyond this, he is targeting the “Circulaire Valls,” a law instated in 2012 under former President François Hollande which ended the criminal offense of illegal residence, preventing law enforcement from taking individuals in an irregular situation into custody. This would be contrary to decisions by the Court of Justice of the European Union (CJEU) on the Return directive and subsequent Cassation Court decisions.

Another proposed change consists of revoking a 1968 bilateral agreement with Algeria, signed in the context of decolonization, which grants special status and benefits for Algerian immigrants to France. However, the fact that the agreement is governed by international law, not French law, might make it more difficult to make it void. A cancellation would immediately affect Algerians and their rights in France. Moreover, Retailleau called for bilateral agreements with Maghreb countries to better retain migrants outside of Europe, following the examples of Italy’s agreement with Albania and the agreement between the EU and Tunisia.

Retailleau is a senior politician with plenty of experience who was first elected to the National Assembly in 1994, represented the Vendée department for the past 20 years and finally served as president of the LR senatorial group since 2014. He is part of France’s recently elected government following a snap general election in response to President Macron’s loss of support in public polls.