Migrants from Sub-Saharan Africa in the Swiss HIV Cohort Study: A Single Center Study of Epidemiologic Migration-Specific and Clinical Features

Abstract

According to official Swiss data an increasing number of HIV-positive migrants reside in Switzerland. The present study examined epidemiologic, clinical, and migration-specific characteristics of HIV-infected migrants at the HIV clinic of the University Hospital of Berne, which is one of the centers of the national, prospective Swiss HIV cohort study. Data were collected by chart review. Among the 1331 patients the proportion of northwestern European patients decreased from 88% before 1989 to 67% in the late 1990s while the number of patients from sub-Saharan Africa and Southeast Asia increased from 3 (1.6%) to 47 (14%) and from 2 (1%) to 17 (5%), respectively. Sub-Saharan Africans and Southeast Asians were more likely to be younger, female, and infected heterosexually. At first clinical visit the various patient groups did not differ in CD4 counts or HIV RNA levels. Sub-Saharan African patients were more likely to be anemic. A majority of HIV-positive migrants were most likely infected prior to arrival in Switzerland. Sub-Saharan Africans and Southeast Asians were often diagnosed to be HIV-positive after showing suggestive symptoms of infection, while European patients were more often diagnosed in a screening setting. Thirteen patients with indication for antiretroviral therapy were forced to leave Switzerland because they were denied asylum. In response to the increasing migrant population attending the HIV clinic, further qualitative and quantitative research is required to improve understanding of this vulnerable population group and to promote their knowledge of the disease and its prevention.

Participation, characteristics and retention rates of HIV‐positive immigrants in the Swiss HIV Cohort Study*

“…The increase in the proportion of female enrollees in the SHCS was striking: the proportion of individuals from sub-Saharan Africa among women entering the SHCS rose from 19% (1996-1999) to 42% (2004)(2005)(2006)(2007)(2008), thus more than doubling. The large proportion of individuals from sub-Saharan Africa among immigrants is not a reflection of a large sub-Saharan African population in Switzerlandthey account for only 0.9% of 7.6 million inhabitants of the country [5] -but rather shows the high prevalence of HIV/ AIDS in their countries of origin. An increasing proportion of individuals from sub-Saharan Africa in those acquiring HIV infection via heterosexual transmission has also been reported in other European countries: in the UK, more than two-thirds of newly detected HIV infections were among sub-Saharan Africans [16].…”

“…Currently, 22% of people living in Switzerland are foreignborn, with the percentage varying regionally and reaching up to 38% in the French-speaking urban areas of the country [3]. The majority of HIV-positive migrants from high-prevalence countries were infected in their home regions [4,5].…”

Socioeconomic Differences in the Impact of HIV Infection on Workforce Participation in France in the Era of Highly Active Antiretroviral Therapy

“…In Western countries, since 1996 and the wide-scale diffusion of highly active antiretroviral therapies (HAART), HIV infection has become a chronic disease; moreover, the epidemic has shifted towards more socially vulnerable populations, especially migrants [16][17][18][19]. In this context, social aspects of HIV infection have emerged as key factors for the management and progress of the disease.…”

New times for migrants' health in Europe

“…Migrant MSM may be at particular risk of HIV acquisition and transmission post-migration, especially due to assortative sexual mixing 18,24 . Infection acquired post-migration ranged from as low as 2% among Sub-Saharan Africans in Switzerland 25 , to 62% among black Caribbean MSM in the UK 26 , also a large proportion of HIV-positive Latin American MSM have been infected in Spain 27 . Table 2 shows examples of intervention and good practices in HIV related with migrants across the EU.…”