Elevated prevalence of HIV and STIs among migrant gay men in Europe

Migrant gay and other men who have sex with men (MSM) have a higher prevalence of HIV and sexually transmitted infections (STIs) than non-migrant gay men, results of a large European internet-based survey show. Migrant gay men were more likely to report difficulty accessing HIV and STI testing facilities and also to report some behaviour associated with an increased risk of HIV.

Approximately 180,000 participants from 38 European countries completed the European Men-Who-Have-Sex-with-Men Internet Survey (EMIS) in 2010. This is the largest international study of men who have sex with men ever conducted.

Men who were not living in their country of birth were defined as migrants. Just under 12% of men met this definition. Such a broad definition of migrant is not without problems. “It is important to consider that the profile of someone seeking asylum, for example, is not the same as someone who migrates for economic reasons or to experience another culture,” write the authors. “Different migrants could have different sexual health needs.”

Countries with the highest percentage of migrants were Luxembourg (50%), Cyprus (34%), the UK (28%), Switzerland (27%), the Netherlands (23%), Belgium (23%) and Spain (22%). Countries with the fewest migrants were Romania and Lithuania (3% each).

The majority of migrants (60%) were born in another European country, most often a country neighbouring that of their current residence. However, there were exceptions. In Spain and Portugal, 44% of migrants originated from Latin America or the Caribbean. Almost half (48%) of migrant gay men in Baltic countries were originally from former Soviet countries.

The vast majority (94%) of participants completed the survey in the official language(s) of their current country of residence. To the authors, this suggested “integration into the host society/culture, at least from a linguistic point of view”. Almost two-thirds of migrants had been living in their host country for five or more years. 

A number of social and demographic characteristics were associated with being a migrant.

Compared with non-migrants, migrants were significantly more likely to live in a large city (61 vs 43%), be over 25 years of age (82 vs 76%), to have higher levels of educational attainment (66 vs 47%), be employed (73 vs 71%) and to identify as gay/homosexual rather than as bisexual or heterosexual (79 vs 76%).

Overall, migrants were significantly more likely (p < 0.05) than non-migrants to report six or more casual sex partners in the previous twelve months. Unprotected anal sex with a steady partner in the previous twelve months was reported by 14% of migrant men, and 15% reported unprotected anal sex with a casual partner in the previous year. After controlling for factors such as country of residence, age, education and HIV status, there was no association between migration status and prevalence of unprotected sex with steady or non-steady sex partners in the previous twelve months.

The survey results showed that migrant men had a number of characteristics potentially associated with an increased risk of HIV or STIs.

Migrant men were more likely than non-migrants to report the use of drugs associated with sex and parties (AOR = 1.18; 95% CI, 1.13-1.23), heroin or crack (AOR = 1.46; 95% CI, 1.27-1.68), poppers (AOR = 1.06; 95% CI, 1.02-1.10) and drugs such as Viagra (AOR = 1.13; 95% CI, 1.07-1.19).

Moreover, migrants were 17% more likely than indigenous men to say they were HIV positive, and were also 21% more likely to state that they had been diagnosed with a STI in the previous twelve months.

Migrants were also more likely to report being lonely than indigenous study participants (AOR = 1.10; 95% CI, 1.05-1.16).

Despite having higher care needs, migrant men were 26% more likely than non-migrant men to report difficulty accessing HIV testing, and were also 32% more likely than indigenous men to state they had encountered problems obtaining STI services.

“The higher prevalence of HIV and STIs among migrant men, and their paucity of access to free or affordable HIV and testing services, indicate that specific prevention interventions should be tailored and targeted at this group,” conclude the authors. “Efforts are needed to increase access to HIV/STI testing among migrant MSM.”