title: Restricted access to antiretroviral treatment for undocumented migrants: a bottle neck to control the HIV epidemic in the EU/EEA.
abstract: BACKGROUND
  In the European Union/European Economic Area (EU/EEA), migrants from high-endemic countries are disproportionately affected by HIV. Between 2007 and 2012, migrants represented 39 % of reported HIV cases. There is growing evidence that a significant proportion of HIV acquisition among migrant populations occurs after their arrival in Europe.
  
  
  CONCLUSIONS
  Migrants are confronted with multiple risk factors that shape patterns of population HIV susceptibility and vulnerability, which simultaneously affect HIV transmission. Undocumented migrants incur additional risks for contracting HIV due to limited access to adequate health care services, protection and justice, alongside insecure housing and employment conditions. All EU/EEA countries have ratified a number of international and regional human rights instruments that enshrine access to health care as a human right that should be available to everyone without discrimination. From a clinical and public health perspective, early HIV care and treatment is associated with viral suppression, improved health outcomes and reductions in transmission risks. A current challenge of the HIV epidemic is to reach the highest proportion of overall viral suppression among people living with HIV in order to impact on HIV transmission. Although the majority of EU/EEA countries regard migrants as an important sub-population for their national responses to HIV, and despite the overwhelming evidence of the individual and public health benefits associated with HIV care and treatment, a significant number of EU/EEA countries do not provide antiretroviral treatment to undocumented migrants. HIV transmission dynamics in migrant populations depend on the respective weight of all risk and vulnerability factors to which they are exposed, which act together in a synergistic way. People who are not linked to HIV care will continue to unwillingly contribute to the on-going transmission of HIV. Following the recommendations of the European Union Agency for Fundamental Rights, ensuring access to HIV-care for all sub-populations, including undocumented migrants, would fulfil the human rights of those populations and also strengthen the control of HIV incidence among those not currently able to access HIV care.
authors.affiliation: Scientific Institute of Public Health, Epidemiology of Infectious Diseases, Juliette Wytsmanstraat 14, 1050, Brussels, Belgium. Jessika.deblonde@wiv-isp.be.
authors.forename: Jessika
authors.initials: J
authors.lastname: Deblonde
authors.affiliation: Scientific Institute of Public Health, Epidemiology of Infectious Diseases, Juliette Wytsmanstraat 14, 1050, Brussels, Belgium. andre.sasse@wiv-isp.be.
authors.forename: André
authors.initials: A
authors.lastname: Sasse
authors.affiliation: Institute of Health Carlos III, National Center for Epidemiology, C/Sinesio Delgado 6, 28029, Madrid, Spain. jdamo@isciii.es.
authors.forename: Julia
authors.initials: J
authors.lastname: Del Amo
authors.affiliation: University College London, Research Department of Infection & Population Health, London, WC1E 6JB, UK. f.burns@ucl.ac.uk.|Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK. f.burns@ucl.ac.uk.
authors.forename: Fiona
authors.initials: F
authors.lastname: Burns
authors.affiliation: Public Health England, PHIV & STI Department, 61 Colindale Avenue, London, NW9 5EQ, UK. Valerie.Delpech@phe.gov.uk.
authors.forename: Valerie
authors.initials: V
authors.lastname: Delpech
authors.affiliation: Statens Serum Institut, Department of Infectious Medicine Epidemiology, Artillerivej 5, 2300, Copenhagen S, Denmark. SCO@ssi.dk.
authors.forename: Susan
authors.initials: S
authors.lastname: Cowan
authors.affiliation: PICUM- Platform for International Cooperation on Undocumented Migrants, Rue du Congrès 37-41 / 5, Brussels, 1000, Belgium. michele.levoy@picum.org.
authors.forename: Michele
authors.initials: M
authors.lastname: Levoy
authors.affiliation: PICUM- Platform for International Cooperation on Undocumented Migrants, Rue du Congrès 37-41 / 5, Brussels, 1000, Belgium. lilana.keith@picum.org.
authors.forename: Lilana
authors.initials: L
authors.lastname: Keith
authors.affiliation: European Centre for Disease Prevention and Control, Surveillance and Response Support Unit, Tomtebodavagen 11A, 171 83, Stockholm, Sweden. Anastasia.pharris@ecdc.europa.eu.
authors.forename: Anastasia
authors.initials: A
authors.lastname: Pharris
authors.affiliation: European Centre for Disease Prevention and Control, Office of the Chief Scientist, Tomtebodavagen 11A, 171 83, Stockholm, Sweden. Andrew.amato@ecdc.europa.eu.
authors.forename: Andrew
authors.initials: A
authors.lastname: Amato-Gauci
authors.affiliation: European Centre for Disease Prevention and Control, Surveillance and Response Support Unit, Tomtebodavagen 11A, 171 83, Stockholm, Sweden. Teymur.noori@ecdc.europa.eu.
authors.forename: Teymur
authors.initials: T
authors.lastname: Noori
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use*; D003140:Communicable Disease Control; D054242:Emigrants and Immigrants; D058872:Epidemics; D005006:Ethnicity; D005060:Europe / Q000453:epidemiology; D005062:European Union; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000635:transmission; D006297:Health Services Accessibility; D006806:Human Rights; D006801:Humans; D015994:Incidence; D008297:Male; D011634:Public Health; D012307:Risk Factors; D012935:Social Justice; D014171:Transients and Migrants
chemical_list: D019380:Anti-HIV Agents