The session focuses on migrants in Europe, which are as significantly affected by HIV, representing almost half of all new diagnoses observed in the EU/EAA in 2022. They often present late to seek HIV care compared to the natives, leading to a higher risk of death compared to native populations. Additionally, migrants in Europe face an increased risk of AIDS-defining illnesses. Further studies have revealed impaired outcomes in antiretroviral therapy (ART) for migrants, including high rates of viral failure, lower proportion of ART usage in migrants, and reduced retention in care. Moreover, migrants may also encounter intersectional stigma related to HIV and migration, as well as broader racial and cultural discrimination.

In Sweden, approximately 8500 people are experiencing HIV, with 65% of them being foreign-born, which is further reported to be the highest proportion of migrants with HIV in Europe. Further, migrant patients have access to care and antiretroviral treatment (ART), with a high number benefiting from ART. Despite Sweden leading in migrant ART treatment provision, migrants do not achieve the same viral level suppression as Swedish-born individuals, with 93% of migrants achieving viral suppression in 2019 compared to 96% of Swedish-born individuals. Notably, Sweden was among the first countries to meet the UNAIDS targets, with 90% diagnosed, 90% on ART, and 90% receiving treatment. The session further highlights the electronic health questionnaire introduced in Sweden in 2011. It consisted of nine items and answers on a Likert scale and was evaluated annually. The questionnaire encompasses patient-reported outcomes and experiences, addressing physical, psychological, and sexual health, experiences on ART side effects, ART adherence, and patient satisfaction and engagement with care.

A study was conducted in 2020 aimed to compare self-reported health outcomes, ART adherence and experience of side effects in Swedish-born and migrants. The cross-sectional study included data from the National cross-sectional registry study — InfCareHlV registry on adult participants with HIV. It also included Health Questionnaire data, sociodemographic data, and biomarkers (CD4-cell count, HIV RNA). Migrants were defined as individuals born abroad according to ECDC’s criteria. Further, regions in the study were based on WHO classifications, and outcomes were classified into satisfied and not satisfied for analysis purposes.

The results indicate that 35% of adults living with HIV in Sweden were Swedish-born; among the foreign-born individuals, the majority originated from the African region (35%), followed by the European and Southeast regions. Furthermore, the participation rate for the health questionnaire was 28%, with 5.2% declining to perform the questionnaire. While more Swedish-born individuals participated, over 50% of respondents were born abroad. The study further observed that women were underrepresented in the questionnaire cohort. Further, migrant respondents resided in Sweden for a median of 11 years compared to 8 years of the total cohort study. Furthermore, the migrant group had a longer median duration of 13 years with HIV and had been on antiretroviral treatment for a median of 11 years.

The study revealed that regarding self-reported health outcomes, migrants reported higher satisfaction with their physical health than Swedish-born individuals, with 68% expressing either being satisfied or very satisfied compared to 55% of Swedish-born individuals. The result remained consistent with further stratification of confounding variables. Additionally, no differences were observed in self-reported psychological health or satisfaction concerning sexual life in both groups. However, migrants were observed twice as likely to miss doses of ART compared to Swedish-born individuals, with patients from African and American regions reporting the highest rates of missed doses, with the prevalence of 1 out of 5 individuals reporting missed doses in the prior week compared to 7% of Swedish-born. Factors associated with ART-impaired adherence were younger age, experiencing HIV for a longer time, and not being satisfied with sexual life or mental health. Additionally, migrants were more likely to experience side effects from ART (14%) compared to Swedish-born (10%). Factors associated with the adverse events were individuals who were less satisfied with their physical health and felt less involved in their care, more likely to experience side effects from the ART. 

Overall, the study suggested that self-reported health outcomes were equal to or better in migrants with HIV in Sweden. However, impaired adherence was more prevalent, with up to 1 in 5 reporting missed doses. Thus, understanding the reasons for adherence becomes crucial to further supporting patients, considering the significance of adherence for achieving viral suppression and minimizing viral blips and low-level viremia. Additionally, addressing side effects associated with cultural differences and language barriers and improving the number of migrant participants to perform the questionnaire is crucial; this helps to identify the unmet needs of the population and thus achieve a goal of 90 -95% participation rate for a comprehensive health-related quality-of-life assessment. The session further highlights the need for interventions from society and patients to reduce the stigma associated with seeking HIV from general practitioners, which may be a cause for impaired adherence.

European Society of Clinical Microbiology and Infectious Diseases (ESCMID) 2024, 27th April–30th April 2024, Barcelona, Spain