Marita van de Laar, Head of Programme European Centre for Disease Prevention and Control

1. HIV and migration in Western industrialized countries: Common challenges and future directionsOn behalf of CDC, PHAC, ECDC and IOM Marita van de Laar, Head of ProgrammeEuropean Centre for Disease Prevention and Control Washington, 25 July 2012

2. Outline of presentation • Background ‘migration and HIV in Western industrialised countries’ • Challenges • Future directions • Next steps

3. Special Satellite Session on HIV and Migration 22 July, Washington D.C. • CDC, PHAC, ECDC and IOM hosted a satellite event titled: “Responses to HIV and Migration in Western Industrialized Countries: Current Challenges, Promising Practices, Future Directions” • 74 invited participants from the US, Canada, EU and international organisations, including NGOs Two themes of the session: • Monitoring HIV among migrant populations • Migrant-sensitive HIV prevention and treatment programs and services

4. Background • Migrants make up approximately 11-22% of the total population in Western industrialised countries • Data suggest that migrants originating from high endemic countries are disproportionally affected by HIV compared to the general population in host countries • Migrants from countries of origin with low HIV prevalence may experience greater HIV vulnerability upon arrival in the host country • Heterosexual contact is the predominant mode of HIV transmission among migrants • Concerns that migrants from some sub-populations, such as MSM, sex workers and IDUs may be more vulnerable to HIV infection

5. Migrants disproportionately affected by HIV European Union Proportion of persons originating from countries with generalised epidemics among heterosexually acquired HIV cases, EU/EEA 2010 Canada • People from HIV-endemic countries represent 2.2% of the population, but an estimated 16% of new infections in Canada (2008) USA • The foreign-born population represents 13% of the total population, and 16.2% of new infections (2007-2010) • Compared to US-born persons with HIV, foreign –born persons with HIV were more likely to be infected through heterosexual contact

6. Late diagnosis: Proportion of CD4 cell count < 350 and <200 by transmission mode, 201019 countries (N=15 899 cases)

7. What are the challenges?

8. Monitoring migrant health • Non-standardized definitions and varying terminologies for ‘migrant populations’ • Although some countries have better data than others, there is a need to develop clearly defined and more complete data sets for key variables such as date of arrival, country of birth, country of infection and date of diagnosis to monitor trends in transmission • Data on key indicators are needed, such as: • How many migrants are getting tested for HIV? • How many migrants are HIV positive? • How many migrants are accessing HIV treatment? • How many migrants are retained in treatment? • It is difficult to develop evidence-based programs and policies targeted toward migrant populations without better data

9. Barriers to migrants’ access to HIV prevention, treatment and care • Stigma, discrimination and lack of information at individual and structural levels • Language and cultural barriers, lack of migrant-sensitive approach to services (particularly in areas less populated by migrant groups), anti-migrant sentiment • Policies under which some migrant groups, particularly undocumented migrants, are unable to access ART • Economic austerity leading some migrant-friendly HIV programmes to be cut

10. Future directions

11. ... in relation to monitoring migrant health • Partnerships in migration and HIV • Cross-fertilisation of innovative approaches that address broader migrant health issues • Standardising monitoring & reporting tools (UNGASS, WHO, Dublin) • Engagement of community and migrants in the response • Capture, supplement and share surveillance and monitoring data including behavioural and SDOH aspects • “Data for action”: use the data to target prevention and treatment services • Sharing of data across jurisdictions, e.g., across regional, federal, provincial and state governments • Enhance monitoring and follow-up mechanisms; i.e. access to care, access to ARTs, adherence

12. .. in relation to developing migrant-sensitive programs & services • Integrate HIV prevention and treatment as a broader health delivery concept to address issues of stigma, racism and discrimination • Health care coverage that includes migrants, i.e. health insurance • Trained providers/clinicians with cultural sensitivity and linguistic capacity to work with migrant populations • Integrate migrant health services with social supports (i.e. housing, transport, income) • Sensitivity to possible stigma introduced by increased visibility or targeting of migrants

13. Next steps • A final report will be generated including resource materials of projects and successful approaches from each region • We will continue collaboration in an effort to raise awareness on key issues related to migrant health and HIV • ECDC will host a follow-up meeting in 2013 to take forward the issue of migrant health and HIV in Western industrialized countries Thank You