Advertisement

Infection

, Volume 46, Issue 5, pp 659–667 | Cite as

Refugees and family-reunified immigrants have a high incidence of HIV diagnosis and late presentation compared with Danish born: a nationwide register-based cohort study

  • Laura Deen
  • Susan Cowan
  • Christian Wejse
  • Jørgen Holm Petersen
  • Marie Norredam
  • ESCMID Study Group for Infections in Travellers and Migrants
Original Paper
  • 74 Downloads

Abstract

Purpose

Migrants represent a considerable proportion of HIV diagnoses in Europe and are considered a group at risk of late presentation. This study examined the incidence of HIV diagnoses and the risk of late presentation according to migrant status, ethnic origin and duration of residence.

Methods

We conducted a historically prospective cohort study comprising all adult migrants to Denmark between 1.1.1993 and 31.12.2010 (n = 114.282), matched 1:6 to Danish born by age and sex. HIV diagnoses were retrieved from the National Surveillance Register and differences in incidence were assessed by Cox regression model. Differences in late presentation were assessed by logistic regression.

Results

Both refugees (HR = 5.61; 95% CI 4.45–7.07) and family-reunified immigrants (HR = 10.48; 95% CI 8.88–12.36) had higher incidence of HIV diagnoses compared with Danish born and the incidence remained high over time of residence for both groups. Migrants from all regions, except Western Asia and North Africa, had higher incidence than Danish born. Late presentation was more common among refugees (OR = 1.87; 95% CI 1.07–3.26) and family-reunified immigrants (OR = 2.30; 95% CI 1.49–3.55) compared with Danish born. Southeast Asia and Sub-Saharan Africa were the only regions with a higher risk of late presentation. Late presentation was only higher for refugees within 1 year of residence, whereas it remained higher within 10 years of residence for family-reunified immigrants.

Conclusions

This register-based study revealed a higher incidence of HIV diagnoses and late presentation among migrants compared with Danish born and the incidence remained surprisingly high over time.

Keywords

Migrants Ethnic minority Refugee HIV infection Late presentation 

Notes

Funding

None.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Standards

The project was approved by the Danish Protection Agency (No 2012-41-0065). Further ethical approval regarding registry-based research is not required in Denmark. The data set was made available and analysed in an anonymous form by remote online access to the data set stored at Statistics Denmark.

Supplementary material

15010_2018_1167_MOESM1_ESM.docx (27 kb)
Supplementary material 1 (DOCX 28 KB)

References

  1. 1.
    Statistics Denmark. Immigrants in denmark. Statistics Denmark, Copenhagen; 2015.Google Scholar
  2. 2.
    Norredam M, Nielsen SS, Krasnik A. Migrants’ utilization of somatic healthcare services in Europe—a systematic review. Eur J Public Health. 2010;20:555–63.CrossRefPubMedGoogle Scholar
  3. 3.
    Norredam M. Migrants’ access to healthcare. Dan Med Bull. 2011;58(10):B4339PubMedGoogle Scholar
  4. 4.
    WHO. HIV/AIDS Key facts [Internet]. [cited 2016 Oct 14]. Available from: http://www.who.int/mediacentre/factsheets/fs360/en/.
  5. 5.
    European Centre for Disease Prevention and. Control ECDC. Assessing the burden of key infectious diseases affecting migrant populations in the EU/EEA. Tech. Rep. 2014.Google Scholar
  6. 6.
    Mocroft A, Lundgren JD, Sabin ML, d’Arminio Monforte A, Brockmeyer N, Casabona J, et al. Risk factors and outcomes for late presentation for HIV-positive persons in Europe: results from the collaboration of observational HIV Epidemiological Research Europe Study (COHERE). PLoS Med. 2013;10.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Christiansen A, Cowan SHIV. 2016. EPI-News No. 36. [Internet]. 2017 [cited 2017 Sep 28]. Available from: https://www.ssi.dk/English/News/EPI-NEWS/2017/No 36–2017.aspx.
  8. 8.
    Sobrino-Vegas P, Moreno S, Rubio R, Viciana P, Bernardino JI, Blanco JR, et al. Impact of late presentation of HIV infection on short-, mid- and long-term mortality and causes of death in a multicenter national cohort: 2004–2013. J Infect. 2016;72:587–96.CrossRefPubMedGoogle Scholar
  9. 9.
    Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365:493–505.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Sabin CA, Smith CJ, Gumley H, Murphy G, Lampe FC, Phillips AN, et al. Late presenters in the era of highly active antiretroviral therapy. Aids. 2004;18:2145–51.CrossRefPubMedGoogle Scholar
  11. 11.
    Spallek J, Zeeb H, Razum O. What do we have to know from migrants’ past exposures to understand their health status? a life course approach. Emerg Themes Epidemiol BioMed Central Ltd. 2011;8:6.CrossRefGoogle Scholar
  12. 12.
    Alvarez-Del Arco D, Monge S, Azcoaga A, Rio I, Hernando V, Gonzalez C, et al. HIV testing and counselling for migrant populations living in high-income countries: a systematic review. Eur J Public Health. 2013;23:1039–45.CrossRefPubMedGoogle Scholar
  13. 13.
    Schäfer G, Kreuels B, Schmiedel S, Hertling S, Hüfner A, Degen O, et al. High proportion of HIV late presenters at an academic tertiary care center in northern Germany confirms the results of several cohorts in Germany: time to put better HIV screening efforts on the national agenda? Infection. 44. Berlin Heidelberg: Springer; 2016. pp. 347–52.Google Scholar
  14. 14.
    Hernando V, Alvárez-del Arco D, Alejos B, Monge S, Amato-Gauci AJ, Noori T, et al. HIV Infection in Migrant Populations in the European Union and European Economic Area in 2007–2012. JAIDS. 2015;70:204–11.PubMedGoogle Scholar
  15. 15.
    Norredam M, Agyemang C, Hoejbjerg Hansen OK, Petersen JH, Byberg S, Krasnik A, et al. Duration of residence and disease occurrence among refugees and family reunited immigrants: Test of the “healthy migrant effect” hypothesis. Trop Med Int Heal. 2014;19:958–67.CrossRefGoogle Scholar
  16. 16.
    Antinori A, Coenen T, Costagiola D, Dedes N, Ellefson M, Gatell J, et al. Late presentation of HIV infection: a consensus definition. HIV Med. 2011;12:61–4.CrossRefPubMedGoogle Scholar
  17. 17.
    Division UNS. Standard country and area codes classifications (M49). Available from: https://unstats.un.org/unsd/methodology/m49/.
  18. 18.
    AM HFD. The changing face of the HIV epidemic in Western Europe: what are the implications for public health policies? Lancet. 2004;364:83–94.CrossRefGoogle Scholar
  19. 19.
    Chadborn TR, Delpech VC, Sabin CA, Sinka K, Evans BG. The late diagnosis and consequent short-term mortality of HIV-infected heterosexuals. 2006;2000–4.Google Scholar
  20. 20.
    European Centre for Disease Prevention. and Control (ECDC). HIV/AIDS surveillance in Europe 2014. 2015.Google Scholar
  21. 21.
    Op de Coul ELM, van Sighem A, Brinkman K, Benthem BH van, Ende ME van der, Geerlings S, et al. Factors associated with presenting late or with advanced HIV disease in the Netherlands, 1996–2014: results from a national observational cohort. BMJ Open. 2016;6:e009688.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Hachfeld A, Ledergerber B, Darling K, Weber R, Calmy A, Battegay M, et al. Reasons for late presentation to HIV care in Switzerland. J Int AIDS Soc. 2015;18:1–8.CrossRefGoogle Scholar
  23. 23.
    Helleberg M, Engsig FN, Kronborg G, Laursen AL, Pedersen G, Larsen O, et al. Late presenters, repeated testing, and missed opportunities in a Danish nationwide HIV cohort. Scand J Infect Dis. 2012;44:282–8.CrossRefPubMedGoogle Scholar
  24. 24.
    Brännström J, Svedhem Johansson V, Marrone G, Wendahl S, Yilmaz A, Blaxhult A, et al. Deficiencies in the health care system contribute to a high rate of late HIV diagnosis in Sweden. HIV Med. 2016;17:425–35.CrossRefPubMedGoogle Scholar
  25. 25.
    Sulis G, El Hamad I, Fabiani M, Rusconi S, Maggiolo F, Guaraldi G, et al. Clinical and epidemiological features of HIV/AIDS infection among migrants at first access to healthcare services as compared to Italian patients in Italy: a retrospective multicentre study, 2000–2010. Infection. 2014;42:859–67.CrossRefPubMedGoogle Scholar
  26. 26.
    Hønge BL, Jespersen S, Aunsborg J, Mendes DV, Medina C, Té D da. S, et al. High prevalence and excess mortality of late presenters among HIV-1, HIV-2 and HIV-1/2 dually infected patients in Guinea-Bissau - A cohort study from West Africa. Pan Afr Med J. 2016;25:1–13.CrossRefGoogle Scholar
  27. 27.
    Jeong SJ, Italiano C, Chaiwarith R, Ng OT, Vanar S, Jiamsakul A, et al. Late Presentation into Care of HIV Disease and Its Associated Factors in Asia: Results of TAHOD. AIDS Res Hum Retroviruses. 2016;32:255–61.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Blondell SJ, Kitter B, Griffin MP, Durham J. Barriers and Facilitators to HIV Testing in Migrants in High-Income Countries: a systematic review. Aids Behav. 2015;19:2012–24.CrossRefPubMedGoogle Scholar
  29. 29.
    Alberer M, Malinowski S, Sanftenberg L, Schelling J. Notifiable infectious diseases in refugees and asylum seekers: experience from a major reception center in Munich, Germany. Infection. 2018;46:375–83.CrossRefPubMedGoogle Scholar
  30. 30.
    European Centre for Disease Prevention and Control (ECDC), WHO Regional Office for Europe. Migrant health: access to HIV prevention, treatment and care for migrant populations in EU/EEA countries. Stockholm, ECDC 2009; p 35.Google Scholar
  31. 31.
    Internation Organization for Migration (IOM). Assisting Quota Refugees for Resettlement to Denmark. 2006. Available from: https://www.iom.int/jahia/webdav/site/myjahiasite/shared/shared/mainsite/projects/showcase_pdf/Denmarkcases.pdf
  32. 32.
    Frederiksen HW, Norredam M. Sundhedsforhold hos nyankomne indvandrere—En rapport fra Forskningscenter for Migration, Etnicitet og Sundhed. Forskningscenter for Migration, Etnicitet og Sundhed (MESU), København, 2012;3–53. (In Danish).Google Scholar
  33. 33.
    Frederiksen HW, Krasnik A, Nørredam M. Policies and practices in the health-related reception of quota refugees in Denmark. Dan Med J. 2012;59:A4352.PubMedGoogle Scholar
  34. 34.
    United Nations High Commissioner for Refugees. Policy Statement on HIV Testing and Counselling in Health Facilities for Refugees, Internally Displaced Persons and other Persons of Concern to UNHCR. 2009;21. Available from: http://www.who.int/hiv/pub/vct/unhcr.pdf?ua=1.
  35. 35.
    Fakoya I, Álvarez-del Arco D, Woode-Owusu M, Monge S, Rivero-Montesdeoca Y, Delpech V, et al. A systematic review of post-migration acquisition of HIV among migrants from countries with generalised HIV epidemics living in Europe: implications for effectively managing HIV prevention programmes and policy. BMC Public Health BMC Public Health. 2015;15:561.CrossRefPubMedGoogle Scholar
  36. 36.
    Quota refugees [Internet]. Danish Immigr. Serv. [cited 2016 Oct 14]. Available from: https://www.nyidanmark.dk/en-us/coming_to_dk/asylum/quota_refugees.htm.

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Section of Immigrant Medicine, Department of Infectious DiseaseCopenhagen University HospitalHvidovreDenmark
  2. 2.Department of Infectious Disease EpidemiologyStatens Serum InstitutCopenhagen SDenmark
  3. 3.Department of Public Health, Centre for Global HealthAarhus UniversityAarhus CDenmark
  4. 4.Department of Infectious DiseasesAarhus University HospitalAarhus NDenmark
  5. 5.Section of Biostatistics, Department of Public HealthUniversity of CopenhagenCopenhagen KDenmark
  6. 6.Danish Research Centre for Migration, Ethnicity and Health (MESU), Department of Public Health, Section for Health Services ResearchUniversity of CopenhagenCopenhagen KDenmark

Personalised recommendations