International migrants left behind in HIV response: Study
International migrants in Australia and beyond are at increased risk of HIV infection due to reduced access to a highly effective prevention measure, a world-first global review led by Monash University has found.
Pre-exposure prophylaxis (PrEP) is up to 99% effective in preventing HIV. The antiretroviral tablet is available by prescription and taken to prevent HIV infection.
Published in The Lancet Public Health, the study identified barriers that migrant populations in Australia and around the world face to access PrEP.
Multiple barriers included lack of awareness, low risk perception for HIV, and service issues such as cost and provider discrimination. They also faced uncertainty in navigating the health system and stigma around HIV, gay and bisexual identities and using PrEP.
Senior author and Melbourne Sexual Health Center physician, Monash University Central Clinical School Associate Professor Jason Ong, said a concerning number of migrants were being left behind in the HIV response compared to those who were Australian-born.
He said the study identified the need for culturally tailored approaches for PrEP access, and to address migration and HIV-related discriminatory policies, including making it much harder for people with HIV to obtain permanent residency.
"Navigating the landscape of HIV prevention is like traversing a maze, with barriers blocking the way at every turn," Associate Professor Ong said. "Culturally tailored approaches act as guiding lights, illuminating the path forward.
"To improve health inequities, we suggest strategies at societal, service and individual levels that address the barriers of using PrEP among those who would benefit from it the most."
Associate Professor Ong said PrEP was "game-changing" in preventing HIV.
"Getting this into the hands of the right people remains a significant barrier in our fight against HIV," he said. "Our study shows that it is possible to improve health inequity in our society if we can direct resources to the right people."
Professor Darryl O'Donnell, the CEO of Health Equity Matters concurred. "We know PrEP is highly effective in preventing HIV. Australia has made PrEP available at low cost to its own citizens. We have a national goal of virtually eliminating HIV transmission," Professor O'Donnell said. "We will only achieve this if PrEP is available to all who can benefit, including people migrating to Australia."
The study involved Alfred Health, Monash University, Australia, UNAIDS, WHO, UNSW Sydney, and the London School of Hygiene & Tropical Medicine.
More information: Warittha Tieosapjaroen et al, Improving access to oral pre-exposure prophylaxis for HIV among international migrant populations, The Lancet Public Health (2023). DOI: 10.1016/S2468-2667(23)00105-6