Amsterdam 2015
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| Abstract #2113 - Migration and HIV | ||||
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Session: 22.1: Migration and HIV (Parallel) on Wednesday @ 16.30-18.00 in C002 Chaired by Christiana Noestlinger, Dolores Albarracin Authors: Presenting Author: Mrs Jasna Loos - Institute of Tropical Medicine, Belgium |
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| Additional Authors: | ||||
| Aim: Sub-Saharan African Migrants (SAM) are the second largest group affected by HIV in Belgium and Western Europe. Evidence shows that SAM are increasingly acquiring HIV in European host countries. This calls for a renewed focus on primary prevention, yet we lack evidence on the HIV epidemic’s magnitude and its drivers among SAM. The study’s aim was to provide HIV-prevalence estimates, explore HIV transmission dynamics, and inform future prevention. | ||||
| Method / Issue: This community-based participatory research adopted venue-based Time-Location Sampling among SAM in Antwerp city, Belgium. Trained community researchers collected behavioral and biological data through self-administered anonymous electronic questionnaires and oral fluid collection devices. Samples were analyzed adopting the national AIDS Reference laboratories’ algorithm: participants with an indicative oral fluid specimen and two reactive ELISA tests (Genscreen and Vironostika) were considered HIV-positive. Data were analyzed using SPSS Statistics 22. Population estimates were calculated accounting for cluster sampling and a weighting factor (Karon&Wejnert, 2012). Uni- and bivariate analysis, stratified by gender, were employed to assess associations between independent variables and HIV-status, risk and prevention behavior. | ||||
| Results / Comments: Between December 2013 and August 2014, N=725 SAM (57% men, 43% women) were recruited in 51 community settings (bars, churches, events, public places). HIV-prevalence was 6,1% (IQR:3.3%-11%) among women and 3% (IQR:1.6%-5.7%) among men. HIV-status was significantly associated with self-reported STI diagnosis in the last year (p=0.030) and risky sexual behavior while having travelled in Europe (p=0.002). 71% had ever tested for HIV and 40% in the last year. Among those found HIV-positive, women more often (60% IQR:27%-97%) than men (48% IQR:23%-73% p=0.053) did not report their HIV-status. 34% lived in a vulnerable situation (i.e. undocumented status, no stable housing or financial problems). Vulnerability was significantly associated with forced sex (p=0.044), partner violence (p=0.004), sexual partners’ assumed concurrency (p=0.038), transactional sex (p=0.003), having paid for sex (p=0.000) and having had three or more casual sexual partners (p=0.001) in the last year. Condom use was significantly associated with being male (p=0.018), being younger than 30 years (p=0.000), vulnerable living situation (p=0.043) and the assumption of unsafe sexual behavior, e.g. last partner was casual (p=0.000), partners’ assumed concurrency (p=0.007), transactional sex (p=0.005) and having paid for sex (p=0.026). HIV-testing and knowing ones partner’s HIV status were favored prevention strategies by SAM older than 30 years (p=0.018), in a relationship (p=0.032) and with low sexual risk behavior (p=0.023). | ||||
| Discussion: This study provides the first HIV-prevalence estimates for a representative sample of SAM residing in a West-European city. It demonstrates the association between migration-related vulnerability, reduced sexual agency and sexual risk taking. SAM adopt ive HIV-preventive strategies based on sexual risk perception, which may not reflect their actual risk. Prevention needs of the diverse SAM communities call for combination prevention adopting a community-based participatory approach, targeting priority places, promoting HIV-testing in combination with consistent condom use while taking into account the broader migration context and gender-specific approaches. | ||||
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