Access to HAART in HIV-Infected Immigrants: A Retrospective Multicenter Italian Study

Abstract

Since 1996, AIDS has declined in the Italian population, but cases in foreign patients, including both recent immigrants and long-term residents, have increased from 3.9% in 1995-1996 to 15.4% in 2001-2002. This increase can only be partly explained by a higher migratory flow and might reflect a delayed access to health facilities and to antiretroviral therapy in migrants. We performed a survey for the year 2003 of HIV-infected immigrants to Italy from countries outside the European Union to verify which factors might influence a lack of access to highly active antiretroviral therapy (HAART). Italian centers of infectious diseases were requested to send sociodemographic and clinical data of HIV-infected immigrant patients. A total of 553 HIV-infected immigrants (49.9% women) were evaluated, representing 6.5% of all HIV-infected patients from these centers. The mean duration of residency in Italy was 6.6 +/- 5.0 years. The country of origin was Africa (64.5%), North and South America (24.2%), Eastern Europe (7.0%), and Asia (3.8%). A total of 407 of 553 patients (73.6%) were taking antiretroviral drugs at the time of screening. Females presented a younger age (p = 0.001), a lower frequency of Centers for Disease Control (CDC) stage B/C (p = 0.008) and a more frequent heterosexual exposure to HIV (p < 0.001), while no differences were observed for time of first positive serology (p = 0.7). CD4 cell count (p = 0.9) and log plasma HIV-RNA (p = 0.1). Characteristics of HAART patients were compared to those of nontreated patients, despite a CD4 cell count less than 350 cells/mm(3). No significant difference was found for gender, country of origin, risk factor, and years of Italian residence, while legal immigrants (p = 0.018) and registered in the National Health Service (p = 0.014) were significantly more likely to receive HAART compared to illegal immigrants.

Recent Immigrants Show improved Clinical Outcomes at a Tertiary Care HIV Clinic

“…Recent immigrants to Canada face several obstacles including language barriers, cultural differences, uncertain immigration status, and employment and housing issues (3,(7)(8)(9)). An HIV diagnosis adds an additional stress, and gaining access to care and treatment provides additional challenges.…”

Levels of self-reported depression and anxiety among HIV-positive patients in Albania: a cross-sectional study

“…Patients who had not obtained ART abroad were more likely to have a history of diagnosis of anxiety and/or depression. These observations may be related to patients’ lack of faith in the medical treatments in Albania or greater availability of mental health services outside of Albania (45,46). However, more in-depth exploration on the impact of obtaining ART abroad on the mental health of patients with HIV/AIDS is necessitated.…”

Health systems’ responses to 25 years of HIV in Europe: Inequities persist and challenges remain

“…Yet in western Europe, although there is wide access to HAART, with exceptions [143], inequities remain. In particular, IDUs, immigrants, prisoners and people with low income and education levels are less likely to have access to antiretrovirals [116,143,144]. Studies from Spain, Italy and France show that even when these groups have access to HAART, they are less likely to adhere to treatment-with reasons cited including poor understanding of treatment regimens, failures in communication with clinicians or poor social support [145][146][147][148][149][150].…”