Immigration influences HIV diagnosis demographics

By Lynda Williams, Senior MedWire Reporter

HIV-positive individuals born outside the USA are a heterogenous population but have significant demographic differences to infected patients born within in the USA, research reveals.

HIV-positive individuals who emigrated to the USA are significantly more likely to be Asian or Hispanic than White or Black (42.2, 64.3, 3.3, and 10.0%, respectively), report Adria Prosser (National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA) and colleagues.

Persons born outside the USA were also significantly more likely to contract HIV through heterosexual contact (39.4%) than those born within the USA (27.2%), and women born outside the USA were significantly less likely to contract HIV through intravenous drug use than USA-born women (5.8 vs 17.5%).

Refugees, undocumented immigrants, and pregnant women born outside the USA are at particularly high risk for rape and sexual assault, the researchers note.

In an accompanying editorial, Mitchell Katz (Los Angeles County Department of Health Services, California, USA) notes that HIV-positive persons born outside of the USA "are in need of appropriate education and outreach, testing and treatment, and mental health services including specialized services for those who experience traumatic events in their home countries or during the immigration process, substance treatment for those addicted to drugs, as well as HIV care for those who are infected."

He emphasizes: "Although these lessons may apply regardless of country of origin for HIV-infected persons, the effectiveness of these messages and interventions will require culturally relevant delivery to each specific population of immigrants."

Overall, individuals born outside of the USA made up 16.2% of the 191,697 patients diagnosed with HIV between 2007 and 2010 in 46 US states and five territories. California, Florida, New York, and Texas had the highest rates for both overall HIV diagnosis and diagnosis of HIV infection in persons born overseas.

Of note, 14.5% of diagnosed individuals born outside of the USA were from Africa, 41.0% were from Central American including Mexico, and 21.5% were from the Caribbean, with individuals originating from Mexico, Haiti, Cuba, and El Salvador having the highest rates of HIV diagnosis.

As date of first entry into the USA is not recorded, patients may have acquired HIV before or after immigration, in their home country or the USA, Prosser et al note.

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