Surveillance Open Access
Like 0



The assumption that migrants acquire human immunodeficiency virus (HIV) before migration, particularly those from high prevalence areas, is common.


We assessed the place of HIV acquisition of migrants diagnosed in four European countries using surveillance data.


Using CD4+ T-cell count trajectories modelled to account for seroconversion bias, we estimated infection year of newly HIV-diagnosed migrants residing in the United Kingdom (UK), Belgium, Sweden and Italy with a known arrival year and CD4+ T-cell count at diagnosis. Multivariate analyses identified predictors for post-migration acquisition.


Between 2007 and 2016, migrants constituted 56% of people newly diagnosed with HIV in the UK, 62% in Belgium, 72% in Sweden and 29% in Italy. Of 23,595 migrants included, 60% were born in Africa and 70% acquired HIV heterosexually. An estimated 9,400 migrants (40%; interquartile range (IQR): 34–59) probably acquired HIV post-migration. This proportion was similar by risk group, sex and region of birth. Time since migration was a strong predictor of post-migration HIV acquisition: 91% (IQR: 87–95) among those arriving 10 or more years prior to diagnosis; 30% (IQR: 21–37) among those 1–5 years prior. Younger age at arrival was a predictor: 15–18 years (81%; IQR: 74–86), 19–25 years (53%; IQR: 45–63), 26–35 years (37%; IQR: 30–46) and 36 years and older (25%; IQR: 21–33).


Migrants, regardless of origin, sex and exposure to HIV are at risk of acquiring HIV post-migration to Europe. Alongside accessible HIV testing, prevention activities must target migrant communities.


Article metrics loading...

Loading full text...

Full text loading...



  1. Eurostat. Migration and migrant population statistics. Brussels: European Commission. [Accessed: 11 Aug 2021]. Available from: https://ec.europa.eu/eurostat/statistics-explained/index.php/Migration_and_migrant_population_statistics
  2. European Centre for Disease Prevention and Control (ECDC). Assessing the burden of key infectious diseases affecting migrant populations in the EU/EEA. Stockholm: ECDC; 2014. Available from: https://www.ecdc.europa.eu/en/publications-data/assessing-burden-key-infectious-diseases-affecting-migrant-populations-eueea#no-link
  3. Amo JD, Perez-Cachafeiro S, Hernando V, González C, Jarrin I, Bolumar F. Migrant health series: Epidemiology of HIV and AIDS in migrant communities and ethnic minorities in EU/EEA countries. Stockholm: European Centre for Disease Prevention and Control. [Accessed: 11 Aug 2021]. Available from: https://www.ecdc.europa.eu/en/publications-data/migrant-health-series-epidemiology-hiv-and-aids-migrant-communities-and-ethnic
  4. European Centre for Disease Prevention and Control, WHO Regional Office for Europe. HIV/AIDS surveillance in Europe 2019–2018 data. Copenhagen: WHO Regional Office for Europe; 2019. Available from: https://www.ecdc.europa.eu/en/publications-data/hivaids-surveillance-europe-2019-2018-data
  5. Burns FM, Arthur G, Johnson AM, Nazroo J, Fenton KA, SONHIA collaboration group. United Kingdom acquisition of HIV infection in African residents in London: more than previously thought. AIDS. 2009;23(2):262-6.  https://doi.org/10.1097/QAD.0b013e32831c546b  PMID: 19098498 
  6. Fakoya I, Álvarez-del Arco D, Woode-Owusu M, Monge S, Rivero-Montesdeoca Y, Delpech V, et al. A systematic review of post-migration acquisition of HIV among migrants from countries with generalised HIV epidemics living in Europe: mplications for effectively managing HIV prevention programmes and policy. BMC Public Health. 2015;15(1):561.  https://doi.org/10.1186/s12889-015-1852-9  PMID: 26085030 
  7. Weine SM, Kashuba AB. Labor migration and HIV risk: a systematic review of the literature. AIDS Behav. 2012;16(6):1605-21.  https://doi.org/10.1007/s10461-012-0183-4  PMID: 22481273 
  8. Sinka K, Mortimer J, Evans B, Morgan D. Impact of the HIV epidemic in sub-Saharan Africa on the pattern of HIV in the UK. AIDS. 2003;17(11):1683-90.  https://doi.org/10.1097/00002030-200307250-00013  PMID: 12853751 
  9. Rice BD, Elford J, Yin Z, Delpech VC. A new method to assign country of HIV infection among heterosexuals born abroad and diagnosed with HIV. AIDS. 2012;26(15):1961-6.  https://doi.org/10.1097/QAD.0b013e3283578b80  PMID: 22781226 
  10. Desgrées-du-Loû A, Pannetier J, Ravalihasy A, Gosselin A, Supervie V, Panjo H, et al. Sub-Saharan African migrants living with HIV acquired after migration, France, ANRS PARCOURS study, 2012 to 2013. Euro Surveill. 2015;20(46):30065.  https://doi.org/10.2807/1560-7917.ES.2015.20.46.30065  PMID: 26607135 
  11. Alvarez-Del Arco D, Fakoya I, Thomadakis C, Pantazis N, Touloumi G, Gennotte AF, et al. High levels of postmigration HIV acquisition within nine European countries. AIDS. 2017;31(14):1979-88.  https://doi.org/10.1097/QAD.0000000000001571  PMID: 28857779 
  12. Zetola NM, Pilcher CD. Diagnosis and management of acute HIV infection. Infect Dis Clin North Am. 2007;21(1):19-48, vii.  https://doi.org/10.1016/j.idc.2007.01.008  PMID: 17502228 
  13. Brown AE, Kall MM, Smith RD, Yin Z, Hunter A, Hunter A, et al. Auditing national HIV guidelines and policies: The United Kingdom CD4 surveillance scheme. Open AIDS J. 2012;6(1):149-55.  https://doi.org/10.2174/1874613601206010149  PMID: 23049663 
  14. Neogi U, Häggblom A, Santacatterina M, Bratt G, Gisslén M, Albert J, et al. Temporal trends in the Swedish HIV-1 epidemic: increase in non-B subtypes and recombinant forms over three decades. PLoS One. 2014;9(6):e99390.  https://doi.org/10.1371/journal.pone.0099390  PMID: 24922326 
  15. Public Health England (PHE). HIV & AIDS new diagnoses database (HANDD): metadata files. London: PHE. [Accessed: 11 Aug 2021]. Available from: https://www.gov.uk/guidance/hiv-surveillance-systems
  16. Sasse A, Liesnard C, van der Groen G, Burtonboy G, Plum J, Sondag-Thull D, et al. Recent increase in diagnoses of HIV infections based on surveillance system data in Belgium. AIDS. 2000;14(17):2798-800.  https://doi.org/10.1097/00002030-200012010-00026  PMID: 11125905 
  17. Van Beckhoven D, Buvé A, Ruelle J, Seyler L, Sasse A, Belgian HIV Cohort Study Group. A national cohort of HIV-infected patients in Belgium: design and main characteristics. Acta Clin Belg. 2012;67(5):333-7. PMID: 23189540 
  18. Camoni L, Boros S, Regine V, Santaquilani M, Ferri M, Pugliese L, et al. Aggiornamento delle nuove diagnosi di infezione da HIV e dei casi di AIDS in Italia al 31 dicembre 2014. [Update of the new diagnoses of HIV infection and of AIDS cases in Italy as of 31 December 2019]. Not Ist Super Sanità. 2015;28(9):3-47. Italian.
  19. Audigé A, Taffé P, Rickenbach M, Battegay M, Vernazza P, Nadal D, et al. Low postseroconversion CD4 count and rapid decrease of CD4 density identify HIV+ fast progressors. AIDS Res Hum Retroviruses. 2010;26(9):997-1005.  https://doi.org/10.1089/aid.2009.0263  PMID: 20715931 
  20. CASCADE Collaboration. Differences in CD4 cell counts at seroconversion and decline among 5739 HIV-1-infected individuals with well-estimated dates of seroconversion. J Acquir Immune Defic Syndr. 2003;34(1):76-83.  https://doi.org/10.1097/00126334-200309010-00012  PMID: 14501798 
  21. Klein MB, Young J, Dunn D, Ledergerber B, Sabin C, Cozzi-Lepri A, et al. The effects of HIV-1 subtype and ethnicity on the rate of CD4 cell count decline in patients naive to antiretroviral therapy: a Canadian-European collaborative retrospective cohort study. CMAJ Open. 2014;2(4):E318-29.  https://doi.org/10.9778/cmajo.20140017  PMID: 25485259 
  22. Lodi S, Phillips A, Touloumi G, Geskus R, Meyer L, Thiébaut R, et al. Time from human immunodeficiency virus seroconversion to reaching CD4+ cell count thresholds <200, <350, and <500 Cells/mm3: assessment of need following changes in treatment guidelines. Clin Infect Dis. 2011;53(8):817-25.  https://doi.org/10.1093/cid/cir494  PMID: 21921225 
  23. Wolbers M, Babiker A, Sabin C, Young J, Dorrucci M, Chêne G, et al. Pretreatment CD4 cell slope and progression to AIDS or death in HIV-infected patients initiating antiretroviral therapy--the CASCADE collaboration: a collaboration of 23 cohort studies. PLoS Med. 2010;7(2):e1000239.  https://doi.org/10.1371/journal.pmed.1000239  PMID: 20186270 
  24. The EMIS Network. EMIS 2010: The European men-who-have-sex with-men Internet survey. Findings from 38 countries. 2013. Available from: https://www.ecdc.europa.eu/en/publications-data/emis-2010-european-men-who-have-sex-men-internet-survey
  25. Loos J, Nöstlinger C, Vuylsteke B, Deblonde J, Ndungu M, Kint I, et al. First HIV prevalence estimates of a representative sample of adult sub-Saharan African migrants in a European city. Results of a community-based, cross-sectional study in Antwerp, Belgium. PLoS One. 2017;12(4):e0174677.  https://doi.org/10.1371/journal.pone.0174677  PMID: 28380051 
  26. de Waure C, Bruno S, Furia G, Di Sciullo L, Carovillano S, Specchia ML, et al. Health inequalities: an analysis of hospitalizations with respect to migrant status, gender and geographical area. BMC Int Health Hum Rights. 2015;15(1):2.  https://doi.org/10.1186/s12914-014-0032-9  PMID: 25881154 
  27. Nkulu Kalengayi FK, Hurtig AK, Ahlm C, Krantz I. Fear of deportation may limit legal immigrants’ access to HIV/AIDS-related care: a survey of Swedish language school students in Northern Sweden. J Immigr Minor Health. 2012;14(1):39-47.  https://doi.org/10.1007/s10903-011-9509-y  PMID: 21814777 
  28. Brännström J, Svedhem Johansson V, Marrone G, Wendahl S, Yilmaz A, Blaxhult A, et al. Determinants of late diagnosis of HIV in Sweden. 20th International AIDS Conference in Melbourne, Australia 20-25 July, 2014.
  29. Pezzoli MC, Hamad IE, Scarcella C, Vassallo F, Speziani F, Cristini G, et al. HIV infection among illegal migrants, Italy, 2004-2007. Emerg Infect Dis. 2009;15(11):1802-4.  https://doi.org/10.3201/eid1511.090908  PMID: 19891869 
  30. Brown AE, Mohammed H, Ogaz D, Kirwan PD, Yung M, Nash SG, et al. Fall in new HIV diagnoses among men who have sex with men (MSM) at selected London sexual health clinics since early 2015: testing or treatment or pre-exposure prophylaxis (PrEP)? Euro Surveill. 2017;22(25):30553.  https://doi.org/10.2807/1560-7917.ES.2017.22.25.30553  PMID: 28662762 
  31. European Centre for Disease Control (ECDC). HIV/AIDS surveillance in Europe. Stockholm: ECDC; 2016. Available from: https://ecdc.europa.eu/en/publications-data/hivaids-surveillance-europe-2017-2016-data
  32. Brown AE, Kirwan PD, Chau C, Khawam J, Gill ON, Delpech VC. Towards elimination of HIV transmission, AIDS and HIV-related deaths in the UK – 2017 report. London: Public Health England; 2017. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/675809/Towards_elimination_of_HIV_transmission_AIDS_and_HIV_related_deaths_in_the_UK.pdf
  33. Lodi S, Phillips A, Touloumi G, Pantazis N, Bucher HC, Babiker A, et al. CD4 decline in seroconverter and seroprevalent individuals in the precombination of antiretroviral therapy era. AIDS. 2010;24(17):2697-704.  https://doi.org/10.1097/QAD.0b013e32833ef6c4  PMID: 20885283 
  34. Seay JS, McIntosh R, Fekete EM, Fletcher MA, Kumar M, Schneiderman N, et al. Self-reported sleep disturbance is associated with lower CD4 count and 24-h urinary dopamine levels in ethnic minority women living with HIV. Psychoneuroendocrinology. 2013;38(11):2647-53.  https://doi.org/10.1016/j.psyneuen.2013.06.022  PMID: 23850225 
  35. Maduagwu Sm, Kaidal A, Gashau W, Balami A, Ojiakor Ac, Denue Ba, et al. Effect of aerobic exercise on CD4 cell count and lipid profile of HIV infected persons in North Eastern Nigeria. J AIDS Clin Res. 2015;6(10):508.  https://doi.org/10.4172/2155-6113.1000508  PMID: 30918743 
  36. Rawat R, McCoy SI, Kadiyala S. Poor diet quality is associated with low CD4 count and anemia and predicts mortality among antiretroviral therapy-naive HIV-positive adults in Uganda. J Acquir Immune Defic Syndr. 2013;62(2):246-53.  https://doi.org/10.1097/QAI.0b013e3182797363  PMID: 23117502 
  37. Sajadi MM, Pulijala R, Redfield RR, Talwani R. Chronic immune activation and decreased CD4 cell counts associated with hepatitis C infection in HIV-1 natural viral suppressors. AIDS. 2012;26(15):1879-84.  https://doi.org/10.1097/QAD.0b013e328357f5d1  PMID: 22824629 
  38. Holmes CB, Wood R, Badri M, Zilber S, Wang B, Maartens G, et al. CD4 decline and incidence of opportunistic infections in Cape Town, South Africa: implications for prophylaxis and treatment. J Acquir Immune Defic Syndr. 2006;42(4):464-9.  https://doi.org/10.1097/01.qai.0000225729.79610.b7  PMID: 16810113 
  39. Touloumi G, Pantazis N, Pillay D, Paraskevis D, Chaix ML, Bucher HC, et al. Impact of HIV-1 subtype on CD4 count at HIV seroconversion, rate of decline, and viral load set point in European seroconverter cohorts. Clin Infect Dis. 2013;56(6):888-97.  https://doi.org/10.1093/cid/cis1000  PMID: 23223594 
  40. May M, Wood R, Myer L, Taffé P, Rauch A, Battegay M, et al. CD4(+) T cell count decreases by ethnicity among untreated patients with HIV infection in South Africa and Switzerland. J Infect Dis. 2009;200(11):1729-35.  https://doi.org/10.1086/648096  PMID: 19848608 
  41. Ramalingam S, Kannangai R, Zachariah A, Mathai D, Abraham C. CD4 counts of normal and HIV-infected south Indian adults: do we need a new staging system? Natl Med J India. 2001;14(6):335-9. PMID: 11804363 
  42. Yin Z, Kirwan P, Aghaizu A, Skingsley A, Croxford S, Delpech V. Proposal for an enhanced case-definition of late HIV diagnosis - implication on MSM in the UK. Presented at the International AIDS Conference, Durban, 2016.

Data & Media loading...

Supplementary data

Submit comment
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error