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HIV in migrant & mobile populations in industrialised countries

HIV in migrant & mobile populations in industrialised countries. Chris Lemoh Monash Infectious Diseases Refugee Health Service. Global AIDS epidemic. Origins of AIDS epidemic. Key affected populations. Priority based on: Incidence Prevalence Vulnerability. MIGRANTS?. UNAIDS 2010.

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HIV in migrant & mobile populations in industrialised countries

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  1. HIV in migrant & mobile populations in industrialised countries Chris Lemoh Monash Infectious Diseases Refugee Health Service

  2. Global AIDS epidemic

  3. Origins of AIDS epidemic

  4. Key affected populations • Priority based on: • Incidence • Prevalence • Vulnerability MIGRANTS?

  5. UNAIDS 2010

  6. UN Political Declaration on HIV/AIDS: targets for 2015 • Reduce sexual HIV transmission by 50% • Reduce HIV transmission in PWID by 50% • Eliminate new infections in children & substantially reduce maternal AIDS-related deaths • 15 million PLHIV on treatment • Reduce TB-associated deaths in PLHIV by 50% • Close resource gap: US$ 22–24 billion in low/middle-income countries • Eliminate gender inequalities/violence: increase capacity of women & girls to protect themselves against HIV • Eliminate HIV-related stigma & discrimination • Eliminate HIV-related restrictions on entry/stay/residence • Integrate AIDS response into global health & development UN General Assembly 2011

  7. UNAIDS 2011–2015 strategy:Getting to zero • Zero new HIV infections • Zero AIDS-related deaths • Zero discrimination

  8. HIV in Australia 1984 – 2012 Kirby Institute (2013)

  9. PLHIV born abroad Diagnosis rate, by region of birth (cases/100 000/year) Australia 4.0 – 4.5 Asia 4.3 – 7.0 Sub-Saharan Africa 27.3 – 37.1 Kirby Institute 2013

  10. “I keep six honest serving men (They taught me all I knew); Their names are What and Why and When And How and Where and Who...” - Rudyard Kipling

  11. Migrants in OECD • Migrants in 2013: • 3.2% of total world population (231.5 million people) • 11% of population in high-income countries • Refugees 7% of all international migrants OECD –UNDESA Oct 2013

  12. Migrants amongst EU HIV cases 2006 • Migrants • 58% of all HIV cases • 18% of MSM PLHIV • Wide variation between countries Del Amo Eur J Public Health 2010

  13. Migrant PLHIV in Israel Male Jewish and non-Jewish migrants with HIV 1981–2009 Migrants from high-burden countries Ethiopian Jews Female Mor et al. BMJ Open 2013

  14. Migrants in US HIV cases - 1 Foreign-born: 23% of HIV cases 36% of population

  15. Migrants in US HIV cases - 2 • Over-representation of African-born and ethnic minorities

  16. HIV & the African diaspora OECD proportion of recent African immigrants amongst new HIV cases 2009 Number of recent African immigrants

  17. Clinical issues for migrant PLHIV • Late diagnosis • TB • Africa, Asia, Eastern Europe • Mother-to-child transmission • HIV-related stigma • Poverty • Similar disease progression • Adherence • HIV-1 subtypes • Similar response to cART Del Amo, Eur J Pub Health (2010) Easterbrook, JAIDS (2010) Caro-Murillo, EnfermInfecMicrobiolClin (2009) Dodds, J Commun Applied SocPsychol(2006)

  18. Responding to challenges • UK • Ethnic surveillance data • Community mobilisation • EU • Enhanced surveillance • Migrant HIV projects • US • HIV entry ban rescinded • Black AIDS activism • Canada • ABDGN • Special report on Black African/Caribbean • Israel • HIV prevention and support for Jewish African PLHIV • ?response to non-Jewish African PLHIV • NZ • HIV Futures 3: CALD refugee PLHIV • Ethnic surveillance data • Australia • Medicare-ineligible ART project • CALD PLHIV support services and health promotion • AFAO African Australian HIV project • Research: epidemiology

  19. HIV and mobility: UNAIDS http://data.unaids.org/publications/irc-pub02/jc513-popmob-tu_en.pdf

  20. International Organisation for Migration

  21. Future challenges

  22. Acknowledgements African Australian Welfare Council Family and Reproductive Rights Program Sudanese Community Association of Victoria Horn of Africa Senior Women’s Group Dinka Jieng Community Council of Victoria United Somali Women Oromo Community Association in Victoria Melbourne Health Burnet Institute Melbourne Sexual Health Centre Alfred Health Royal Women’s Hospital Southern Health (Monash Medical Centre) St Vincent’s Hospital (Melbourne) Centre for Youth Multicultural Issues Inner South Community Health Service Scarlet Alliance New Hope Foundation Positive Women Straight Arrows Islamic Women’s Welfare Council of Victoria HealthWorks Kirby Institute for Infection and Immunity in Society Special thanks to all study participants Supported by a Project Grant from the Department of Human Services and a scholarship from the Centre for Clinical Research Excellence in Infectious Diseases

  23. Acknowledgements

  24. “No man is an island entire of itself” John Donne (1572-1631)

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