title: The five-year impact of an evolving global epidemic, changing migration patterns, and policy changes in a regional Canadian HIV population.
abstract: OBJECTIVE
  To evaluate the impact of policy changes to Canada's Immigration Act and changing migration patterns on a regional HIV population.
  
  
  METHODS
  All HIV-positive individuals enrolled in care at the Southern Alberta Cohort between 2001 and 2007 were included and subdivided by self-reported country of birth. Demographic, clinical, and health utilization data were collected at each visit. We compare data and outcomes for each group and analyze changes since policy implementation.
  
  
  RESULTS
  The proportion of immigrants/refugees increased significantly over the past five years. They present with lower CD4 counts, different HIV-subtypes, and previously rare co-morbidities. Management of disease progression necessitates more clinical visits and laboratory testing. Immigrants/refugees require greater social support to engage in, and to continue to access health care. Outcomes in HIV care were, however, equivalent to the Canadian-born population.
  
  
  CONCLUSIONS
  The impact of changes to immigration policies is evident five years after implementation. Immigrant medical screening identifies increasing numbers of immigrants diagnosed with HIV. Immigrants require engagement in health care to achieve the full benefits of HIV management. Developed countries with increasing immigrant populations should be aware of how policy changes affect HIV prevalence rates, modes diagnosis and presentation, future clinical demands, and health care utilization.
authors.affiliation: Southern Alberta Clinic, Calgary, Alberta, Canada.
authors.forename: Hartmut
authors.initials: H
authors.lastname: Krentz
authors.forename: Michael John
authors.initials: MJ
authors.lastname: Gill
mesh_terms: D002170:Canada / Q000453:epidemiology; D015897:Comorbidity; D004196:Disease Outbreaks; D004641:Emigration and Immigration / Q000639:trends*; D015658:HIV Infections / Q000453:epidemiology*; D006291:Health Policy; D006801:Humans; D012036:Refugees / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors