Increases in HIV and syphilis among migrant men who have sex with men in Ireland International Union against Sexually Transmitted Infections Europe Congress - 16 September, 2016 Eve Robinson

Background Men who have sex with men (MSM) disproportionately affected by HIV and STIs across Europe1 Migrant MSM are at particular risk of HIV acquisition and transmission after migrating to the EU/EEA2 Aim To determine the contribution of migrant MSM to recent increases in HIV and syphilis among MSM in Ireland 1. European Centre for Disease Prevention and Control (ECDC) (2015). HIV and STI prevention among men who have sex with men. ECDC, Stockholm. 2. European Centre for Disease Prevention and Control (ECDC) (2013). Migrant health: Sexual transmission of HIV within migrant groups in the EU/EEA and implications for effective interventions. ECDC, Stockholm.

Methods HIV and STIs notified through the national Computerised Infectious Disease Reporting (CIDR) system Laboratory and clinical notifications Enhanced surveillance information on HIV and syphilis Mode of transmission, country of birth, clinical and laboratory variables HIV Mandatory reporting since 2012 All new diagnoses in Ireland Change in notification criteria Only one confirmatory East region May 2015 Nationally January 2016 Syphilis Early infectious syphilis based on clinical confirmation of stage Change in laboratory notification criteria January 2014 July 2016

Methods Migrant Population data Region of birth male population 2011: Born outside of Ireland Population data National census: 2006 & 2011 2016 data not available yet Region of birth male population 2011: Region of birth n % Ireland 1,862,656 83 Migrant 380, 769 17 Europe 286,942 13 Asia 40,447 2 Africa 27,345 1 Latin America 6,528 0.003

HIV diagnoses by mode of transmission, 2012-2015 * Change in laboratory notification criteria May 2015 for one region

HIV diagnoses in MSM by migrant status, 2006-2015 2015 first year when number of migrant MSM diagnosed with HIV in Ireland exceeded the number of irish born. * Change in laboratory notification criteria May 2015 for one region

HIV diagnoses in MSM by migrant status, 2006-2015 When region of birth known - 64% of cases in 2015 were born abroad 2015 first year when number of migrant MSM diagnosed with HIV in Ireland exceeded the number of irish born. * Change in laboratory notification criteria May 2015 for one region

HIV diagnoses in MSM by migrant status, rate per 100,000 male population, 2006-2015 Take into consideration the population, MSM born abroad have always had a higher burden Change in laboratory notification criteria May 2015 for one region Census 2011 data applied from 2009

HIV diagnoses among MSM by region of birth, 2012-2015

HIV diagnoses in MSM in Ireland by region of origin, rate per 100,000 male population, 2006-2015 Change in laboratory notification criteria May 2015 for one region Census 2011 data applied from 2009

Diagnoses of HIV amongst MSM previously tested HIV positive abroad, 2012-2015 The proportion of notifications of HIV amongst MSM where it is reported that they were previously diagnosed abroad has increased * Change in laboratory notification criteria May 2015 for one region

Diagnoses of HIV amongst MSM reported to be infected in Ireland by region of origin, 2012-2015 If we look at where people report they were infected - overall, the number of MSM who reported that they acquired infection in Ireland has remained stable between 2014 and 2015 (104 and 102). However, we can see the number of Latin American MSM who reported acquiring infection in Ireland doubled between 2014 and 2015. Reported country of infection does need to be interpreted with caution though. We don’t know if it is always based on a direct question to the patient, or the assumption of the person filling out the form. * Change in laboratory notification criteria May 2015 for one region

Early infectious syphilis by mode of transmission, 2012 - 2015 * Change in laboratory notification criteria January 2014

Early infectious syphilis by mode of transmission, 2012 - 2015 MSM ↑ 56% * Change in laboratory notification criteria January 2014

Early infectious syphilis among MSM in Ireland by migrant status, 2012 - 2015 * Change in laboratory notification criteria January 2014

Early infectious syphilis among MSM in Ireland by migrant status, 2012 - 2015 Change in laboratory notification criteria January 2014 Census 2011 data applied

Early infectious syphilis among MSM by region of birth, 2012 - 2015 * Change in laboratory notification criteria January 2014

Early infectious syphilis among MSM in Ireland by region of origin, 2012 - 2015 Change in laboratory notification criteria January 2014 Census 2011 data applied

2016 HIV diagnoses in males and MSM by month (moving average), 2015 – July, 2016 Number of early infectious syphilis notifications by month and proportion of cases with stage recorded, 2014 – week 32, 2016 Change in lab notification criteria

Diagnoses of gonorrhoea by gender, January 2015 to August 2016

Discussion Migrant MSM disproportionately affected by HIV and syphilis in Ireland Particularly Latin American MSM Limitations Population data not up to date Why the increase in Latin Americans? Impact of migration on surveillance Transient population High proportion previously diagnosed

Discussion National response group established Interventions based on ECDC framework Focused response: LA men Communications Peer led intervention

Acknowledgements Epidemiology subgroup of national response group: Department of Public Health, HSE East: Fionnuala Cooney, Orla Ennis, Philomena Downes Department of Public Health, HSE South: Aileen Kitching Department of Public Health, HSE Midwest: Margaret Morris Downes Department of Public Health, HSE Southeast: Sarah Doyle Health Protection Surveillance Centre: Gillian Cullen, Sarah Henessy, Derval Igoe, Kate O’Donnell, Eve Robinson National Virus Reference Laboratory: Cillian De Gascun, Paul Holder, Joanne Moran St James’s Hospital: Linda Dalby, Dominic Rowley National response group All those who provide, collect, and input data to CIDR

Go raibh maith agaibh! Thank you!