Assessment of voluntary HIV screening for asylum seekers in two Swiss cantons
To evaluate the feasibility of HIV screening, offered to newly arrived asylum seekers in the Swiss cantons of Valais (VS) and Vaud (VD) in order to meet the national and international standards for early detection and effective treatment of HIV infections.
HIV screening was offered free of charge to every asylum seeker who arrived from June 2015 to November 2016 in VS, and from June to October 2016 in VD. Pregnant women and children <16 were excluded. Written consent was required in VS through multi-language forms, whereas VD required oral consent obtained with the help of interpreters.
807 asylum seekers were offered HIV testing (VS 451, VD 356). Their mean age was 27.6 years, 61.2% were male, 67.4% were single, 60.8% arrived from sub-Saharan Africa. The overall proportion that accepted HIV screening was 72.2% (VS 63.2%, VD 83.7%). Prevalence of HIV infection was 0.87% (two newly and five previously diagnosed persons). Multivariable analysis found that a higher proportion accepted HIV testing among asylum seekers originating from sub-Saharan Africa, men, and those arriving in VD.
The acceptance of HIV screening among asylum seekers was high and appeared to respond to a real demand among this vulnerable population, particularly among those coming from high endemic regions. It may help guaranteeing an equitable access to the local health care system. Ways to reach a high testing rate should still be explored, taking available and necessary resources into account.
- UNAIDS. Global update 2018. Miles to go: closing gaps, breaking barriers, righting injustice. Available from: http://www.unaids.org/sites/default/files/media_asset/miles-to-go_en.pdf (accessed November 15, 2018)
- European Centre for Disease Prevention and Control. HIV testing: increasing uptake and effectiveness in the European Union. Stockholm: ECDC; 2010. Available from: http://ecdc.europa.eu/en/publications/Publications/101129_GUI_HIV_testing.pdf (accessed November 15, 2018)
- Office fédéral de la santé publique (OFSP). Section Migration et santé. Programme national Migration et santé. Bilan 2008–2013 et axes prioritaires 2014–2017. OFSP 2013. Available from: https://www.bag.admin.ch/bag/fr/home/strategie-und-politik/nationale-gesundheitsstrategien/gesundheitliche-chancengleichheit/programm-migration-und-gesundheit-2002-2017.html (accessed November 15, 2018)
- Programme commun des Nations Unies sur le VIH/sida (ONUSIDA). Accélérer la riposte: mettre fin à l'épidémie de Sida d'ici à 2030. Genève 2014. Available from: http://www.unaids.org/fr/resources/documents/2014/JC2686_WAD2014report (accessed November 15, 2018)
- Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al.; HPTN 052 Study Team. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365(6):493–505. doi:.https://doi.org/10.1056/NEJMoa1105243
- World Health Organization. Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV. September 2015. Available from: http://apps.who.int/iris/bitstream/handle/10665/186275/9789241509565_eng.pdf (accessed November 15, 2018)
- Kohler P, Schmidt AJ, Cavassini M, Furrer H, Calmy A, Battegay M, et al.; Swiss HIV Cohort Study. The HIV care cascade in Switzerland: reaching the UNAIDS/WHO targets for patients diagnosed with HIV. AIDS. 2015;29(18):2509–15. doi:.https://doi.org/10.1097/QAD.0000000000000878
- Office fédéral de la santé publique. Dépistage du VIH effectué sur l’initiative des médecins. Bull OFSP. 2015;21:375–9.
- Seedat F, Hargreaves S, Nellums LB, Ouyang J, Brown M, Friedland JS. How effective are approaches to migrant screening for infectious diseases in Europe? A systematic review. Lancet Infect Dis. 2018;18(9):e259–71. doi:.https://doi.org/10.1016/S1473-3099(18)30117-8
- Martin SF, Tirman J, eds. Women, migration, and conflict: breaking a deadly cycle. Dordrecht; New York: Springer; 2009.
- Alvarez-del Arco D, Monge S, Azcoaga A, Rio I, Hernando V, Gonzalez C, et al. HIV testing and counselling for migrant populations living in high-income countries: a systematic review. Eur J Public Health. 2013;23(6):1039–45. doi:.https://doi.org/10.1093/eurpub/cks130
- Durieux-Paillard S, Tardin A, Wetzel D. HIV voluntary counselling and testing (VCT) among migrants in Geneva (Switzerland): implementation of a new prevention programme. Wonca 2007 Paris, abstract 637. Available from: http://www.woncaeurope.org/content/637-hiv-voluntary-counselling-and-testing-vct-among-migrants-geneva-switzerland (accessed November 15, 2018)
- Chernet A, Neumayr A, Hatz C, Kling K, Sydow V, Rentsch K, Utzinger J, et al. Spectrum of infectious diseases among newly arrived Eritrean refugees in Switzerland: a cross-sectional study. Int J Public Health. 2018;63(2):233–9. doi:.https://doi.org/10.1007/s00038-017-1034-x
- Fakoya I, Álvarez-Del Arco D, Monge S, Copas AJ, Gennotte AF, Volny-Anne A, et al.; aMASE Study Team. HIV testing history and access to treatment among migrants living with HIV in Europe. J Int AIDS Soc. 2018;21(Suppl 4):e25123. doi:.https://doi.org/10.1002/jia2.25123
- Marks G, Crepaz N, Senterfitt JW, Janssen RS. Meta-analysis of high-risk sexual behavior in persons aware and unaware they are infected with HIV in the United States: implications for HIV prevention programs. J Acquir Immune Defic Syndr. 2005;39(4):446–53. doi:.https://doi.org/10.1097/01.qai.0000151079.33935.79
- Pottie K, Lotfi T, Kilzar L, Howeiss P, Rizk N, Akl EA, et al. The effectiveness and cost-effectiveness of screening for HIV in migrants in the EU/EEA: a systematic review. Int J Environ Res Public Health. 2018;15(8):1700. doi:.https://doi.org/10.3390/ijerph15081700
- Manirankunda L, Loos J, Alou TA, Colebunders R, Nöstlinger C. “It’s better not to know”: perceived barriers to HIV voluntary counseling and testing among sub-Saharan African migrants in Belgium. AIDS Educ Prev. 2009;21(6):582–93. doi:.https://doi.org/10.1521/aeap.2009.21.6.582