U = U

Undetectable = Untransmittable

This is not a mathematical equation. It is science.

Having an undetectable HIV status means that the amount of HIV in a person’s blood is so low that it cannot be detected by standard HIV tests (see here for more information). Untransmittable means that, when taking antiretroviral drugs as prescribed by your doctor, you cannot pass HIV on to sexual partners. This status is only possible by staying on regular treatment with the use of antiretroviral drugs (ART) – treatment available, for example, in the UK for free to all migrant communities regardless of their immigration status.

Migrant communities in Europe are more likely to be diagnosed with HIV later than non-migrants[1], an inequity reflecting lower rates of testing and the many barriers to accessing ART faced by migrants. Without access to ART and other healthcare services, it is difficult for many migrants to maintain an undetectable viral load.

Migrant HIV Undetectable Status: Challenges and Solutions U=U
A person holds HIV medication.
Source: Building Healthy Online Communities.

So, what could be possibly behind this issue?

Several factors are pointed to, such as:

  1. Lack of access to healthcare services due to immigration status. Not all countries in Europe offer free (sexual) health services. Not only that, but many migrants that may not have legal status yet in the country they are living in are hesitant to access medical care for fear of being deported, because of past experiences of discrimination by healthcare providers and/or due to stigma.
  2. Linguistic and cultural barriers. Translators may be unavailable or worse yet, not even provided by the healthcare system at all. Additionally, migrants may not speak the language of the country they are living in, may have a hard time understanding or navigating the healthcare system, and/or the available information about HIV treatment and care may not be appropriate for or relevant to them. Additionally, some may come from a cultural background of heavy HIV stigma, making it challenging to seek testing and treatment.

How can this situation be improved?

To address these challenges, there are several steps that can be taken to improve HIV care for migrant groups in Europe:

  1. Providing language assistance and cultural competency training for healthcare providers to better serve migrant patients – this may include hiring interpreters or providing targeted co-produced and translated materials about HIV care. It may also involve addressing the biased attitudes of some healthcare providers so that an equitable standard of care is applied to migrant and non-migrant patients alike.
  2. Tailored and targeted outreach and education to migrant communities about HIV testing and treatment. This may happen through community-based organizations that migrants trust or through partnerships with migrant-led organizations. Providing reassurance about the confidentiality of HIV testing and treatment (and about any limitations of that confidentiality, as required by law) is also important as it can help reduce the stigma associated with HIV and encourage more people to feel comfortable enough get tested.
  3. Addressing the legal barriers to healthcare access for migrants is crucial in improving HIV care for this population. As many European countries determine eligibility for healthcare services based on immigration status, regularizing migrants’ status is a form of HIV prevention. Additionally, providing legal assistance to migrants who are wrongly denied healthcare and implementing policies that protect the confidentiality of HIV-positive individuals may also prevent discrimination.

Migrant populations everywhere face unique challenges in accessing HIV care and in maintaining an undetectable HIV status. By addressing their challenges, it would be possible to improve HIV care for diverse migrant communities and ultimately reduce the burden of HIV everywhere.

Watch this space for updates on our شراكة Mi-Health HIV. Would your organization be interested in partnering with us?

We would love to hear from you. Feel free to reach out at mihealth@africadvocacy.org.

[1] European Centre for Disease Prevention and Control. HIV and migrants. Monitoring implementation of the Dublin Declaration on Partnership to Fight HIV/AIDS in Europe and Central Asia: 2017 progress report Stockholm: ECDC; 2017.

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