HIV Transmission Dynamics Among Foreign-Born Persons in the United States

Abstract

Background In the United States (U.S.), foreign-born persons are disproportionately affected by HIV and differ epidemiologically from U.S.-born persons with diagnosed HIV infection. Understanding HIV transmission dynamics among foreign-born persons is important to guide HIV prevention efforts for these populations. We conducted molecular transmission network analysis to describe HIV transmission dynamics among foreign-born persons with diagnosed HIV. Methods Using HIV-1 polymerase nucleotide sequences reported to the U.S. National HIV Surveillance System for persons with diagnosed HIV infection during 2001–2013, we constructed a genetic distance based transmission network using HIV-TRACE and examined the birth region of potential transmission partners in this network. Results Of 77,686 people, 12,064 (16%) were foreign-born. Overall, 28% of foreign-born persons linked to at least one other person in the transmission network. Of potential transmission partners, 62% were born in the United States, 31% were born in the same region as the foreign-born person, and 7% were born in another region of the world. The majority of transmission partners of male foreign-born persons (63%) were born in the United States, whereas the majority of transmission partners of female foreign-born (57%) were born in their same world region. Discussion These finding suggests that a majority of HIV infections among foreign-born persons in our network occurred after immigrating to the United States. Efforts to prevent HIV infection among foreign-born persons in the U.S. should include information of the transmission networks in which these individuals acquire or transmit HIV in order to develop more targeted HIV prevention interventions.

Molecular network-based intervention brings us closer to ending the HIV pandemic

“…Valverde et al's study, which focused on HIV transmission dynamics among US immigrants who were disproportionately affected by HIV, revealed that the majority of new HIV infections appeared subsequent to the immigration of related individuals to the USA. Consequently, the transmission network information regarding HIV acquirement and transmission routes among these individuals are required to improve HIV prevention among such populations [66]. In a phylodynamic study in South Africa using a large sequence dataset, the date of origin of 18 clades fell between 1979 and 1992 and a strong growth was found to have occurred in the 1990s.…”

Factors Associated with Lack of HIV Testing among Latino Immigrant and Black Patients at 4 Geographically and Demographically Diverse Emergency Departments

“…In the United States (US), HIV/AIDS disproportionately affects Black/African American and Hispanic/Latino individuals, 1 notably Latino immigrants. 2 - 4 Of the more than 1.1 million Americans living with HIV/AIDS, 14% are unaware of their infection. 5 , 6 Undiagnosed HIV infections are an important public health concern, since those unknowingly infected serve as a reservoir for the ongoing transmission of HIV.…”

Women from afar: an observational study of demographic characteristics and mortality among foreign‐born women living with HIV in the Women’s Interagency HIV Study (WIHS) in the United States 1994‐2016

“…Most originate from countries in South and East Asia, Latin America, sub‐Saharan Africa and the Caribbean and may therefore be considerably different in terms of socio‐cultural characteristics and health status compared with persons born in the US [2]. Studies in the US and Western Europe have suggested that the rate of HIV diagnosis may be higher among foreign‐born persons when compared with native‐born populations [3‐7]. For instance, adult HIV incidence rate in the Caribbean is second only to that in sub‐Saharan Africa [8].…”

“…For instance, adult HIV incidence rate in the Caribbean is second only to that in sub‐Saharan Africa [8]. These studies have also highlighted that foreign‐born persons both those who acquired HIV before and after migration have distinct epidemiologic profiles, including higher rates of diagnosis among women, lower rates of injection drug use transmission, higher rates of heterosexual transmission, higher CD4+ T cell counts at diagnosis and lower mortality rates [3,4].…”

“…Studies suggest that foreign‐born women are more susceptible to the less desirable outcomes of HIV due to low socioeconomic and educational status, language barriers, poor access to health providers, lack of transportation, and lack of documented legal status, among others, and may be negatively impacted in accessing or utilizing services because of similar factors [17,18]. Thus, interventions to meet their needs require an understanding of these multifaceted factors that impact access to care [3,18].…”