High levels of post-migration HIV acquisition within nine European countries.

OBJECTIVE We aimed to estimate the proportion of post-migration 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-July 2015 in 57 clinics (9 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. Post-migration HIV acquisition was estimated through Bayesian approaches combining extensive information on migration and patients' characteristics. CD4 counts and HIV-RNA trajectories from seroconversion were estimated by bivariate linear mixed models fitted to natural history data. Post-migration acquisition risk factors were investigated with weighted logistic regression. RESULTS Of 2009 participants, 46% were men who have sex with men (MSM) and a third originated from Sub-Saharan Africa (SSA) and Latin America & Caribbean (LAC), respectively. Median time in host countries was 8 years. Post-migration HIV acquisition was 63% (95% CI: 57%-67%); 72% among MSM, 58% and 51% in heterosexual men and women, respectively. Post-migration HIV acquisition was 71% for LAC migrants and 45% for people from SSA. Factors associated with post-migration 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. CONCLUSIONS A substantial proportion of HIV-positive migrants living in Europe acquired HIV post-migration. This has important implications for European public health policies.