Busting the health tourism myth: Migrants face fresh HIV risk in Europe

This article is part of Telescope: The New AIDS Epidemic, a deep-dive investigation into the modern face of a disease that transformed the world.

A year before Britons voted to leave the EU and end free movement of people, a top Brexiteer warned of migrants toting the worlds most feared, incurable disease to the U.K.

“You can come into Britain from anywhere in the world and get diagnosed with HIV and get the [anti-]retroviral drugs, that cost up to £25,000 a year per patient,” then-UKIP leader Nigel Farage argued in a 2015 debate. “It seems rather clear to me theyre coming here with the suspicion they may have it, knowing that we as a country will treat them,” he said in a follow-up interview.

In fact, people from all over the world are contracting HIV in Britain — and other Western European countries — rather than their home countries, according to a growing body of evidence. And health workers are struggling to get them connected to treatment and prevention — even in systems that offer free services.

“Historically, it was thought that HIV-positive migrants had been infected in their home countries prior to coming to Europe,” said Teymur Noori, an HIV expert at the European Centre for Disease Prevention and Control.

“Our task as countries that are receiving people, we have to prevent these new HIV transmissions” — Débora Álvarez, researcher

But that assumption has changed over the past six or seven years, Noori said. Studies suggest some are at risk of the disease for “many years” after arrival, he added, so countries cant assume theyre taking care of people by simply screening them at points of entry.

Rates of new HIV infections are declining around Western Europe. But after men who have sex with men, migrants are the second biggest demographic driving new diagnoses, around four in 10. A landmark 2017 study suggested that a high proportion — 63 percent — of non-natives living in eight EU countries and Switzerland who were diagnosed with HIV in the last five years were infected after their arrival. That share was even higher for the subgroup of men who have sex with men, at 72 percent.

Geography is also a factor: 71 percent of people originally from Latin America or the Caribbean diagnosed with HIV likely acquired the virus in Europe, compared to 45 percent of those from sub-Saharan Africa.

The 2017 study drew data from HIV clinics across Europe using peoples T-cell counts (which show how well the immune system is working) and questionnaires to estimate how long ago they acquired HIV compared to when they arrived. The study has some limitations in terms of how representative it is of the broader HIV population. However, theres still a surprising degree of “congruency across Europe,” according to lead co-author Fiona Burns.

Nigel Farage spoke bluntly about migrants with HIV coming to the UK | Lindsey Parnaby/AFP via Getty Images

Burns had worked as a clinician, and the belief — even within the health sector — that most migrants arrived already infected with HIV did “not reflect my clinical experience,” she said.

“You have to be relatively strong and fit to migrate,” she noted.

The reasons migrants are vulnerable after arrival are as varied as the cultures and countries they come from. For gay men coming from homophobic cultures, the chance to live out their sexuality freely comes with risks. Others may think the threat isnt as serious if theyre moving from a high prevalence country to a low one. And people dealing with moving to another country, finding a place to live, adjusting to a new culture, putting food on the table and worrying about their immigration status are just not thinking as much about their health, researchers say.

“Its no longer something that has nothing to do with us,” said Débora Álvarez, another researcher involved in the nine-country study. “Our task as countries that are receiving people, we have to prevent these new HIV transmissions.”

Not in my backyard

About 52 percent of British respondents to a YouGov poll agreed with Farage, saying that foreign-born people with serious conditions like HIV are “costing the health service a large amount of money.”

A more accurate claim, say health workers, is that many dont get tested or pursue treatment.

Men from sub-Saharan Africa, in particular, are “coming from backgrounds where there is high HIV stigma,” said Takudzwa Mukiwa, head of social media marketing for the U.K. HIV charity Terrence Higgins Trust. “So it makes it really unlikely for them to proactively seek help for HIV.”

The government in Belgium, another country riven by the politics of migration, is also trying to draw more migrants into the system.

Activists and public health workers trying to prevent HIV in migrant communities, especially Africans, are trapped between two sets of prejudice.

In the heavily African Brussels neighborhood of Matongé, social worker Seydou Niang of the health ministry-funded NGO Plate-Forme Prévention Sida spends many Wednesday afternoons in an office waiting to give people free, instant HIV tests. Often, no one comes.

Last year, he only had three tests deliver an HIV-positive result. One really sticks with him: A man from a South American country living in Luxembourg traveled to Brussels for his test, out of fear that his small community would find out if he got tested in the Duchy. When he learned he was HIV-positive, he wanted to buy the drugs out-of-pocket in Belgium rather than risk exposure by signing up for coverage in Luxembourg. Niang eventually talked him out of it.

One person did come in for a test on a recent Wednesday in January: Ruth, a 25-year-old woman from Cameroon. She said shes pretty conscientious about her health and gets regular checkups — so she was none-too-pleased when she realized the hospital simply forgot to do an HIV test during a recent screening. “Its a bit of a lesson for next time,” she told a reporter after Niang gave her relief-inducing news, resolving to remind her doctors in the future.

But Ruths frustration is also emblematic of another problem: Most sub-Saharan migrants in the EU, 57 percent, who were diagnosed in 2018 learned their status several years after they were infected — what doctors consider late, according to the ECDC. Thats compared to 49 percent of the general population.

Opposing prejudices

Activists and public health workers trying to prevent HIV in migrant communities, especially Africans, are trapped between two sets of prejudice.

On the one hand, they dont want to provide fodder to politicians like Farage, or even promote more mainstream stereotyping.

“You dont want whatever campaign youre doing now to come out as saying Dont shag the black Africans,” as Mukiwa put it.

At the same time, they need to get the word out to communities most at risk, and universal messages dont always work as well. In an experiment by the Terrence Higgins Trust, for example, social media messages on HIV featuring pictures of black people got more clicks than those of whites.

There is some resistance to dealing with HIV in African communities | Jekesai Njikizana/AFP via Getty Images

Influencers have potential to draw in migrant audiences without making them feel scapegoated or stereotyped. Kelechi Anyikude, whose fandom of the Arsenal football club has made him a YouTube celebrity among his fellow Nigerian immigrants, tweeted to his 42,000 followers about National HIV Testing Week last November.

Rebecca Mbewe, who trains others on HIV awareness and relationships, is bracing herself to see her own face in a London tube station after she agreed to be featured in the “It starts with you” awareness campaign. Her poster will have the message “It stops with you,” stressing that people on treatment cant transmit the virus to others.

Now 52, Mbewe came to the U.K. from Zambia in the 1990s to join her husband who had been hospitalized, likely due to complications from AIDS. An HIV test showed she waRead More – Source