1. 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

2. 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.

3. 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

4. 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

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

6. 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

7. 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

8. 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

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

10. 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

11. 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

12. 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 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

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

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

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

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

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

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

19. 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

20. Diagnoses of gonorrhoea by gender, January 2015 to August 2016

21. 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

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

23. 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

24. Go raibh maith agaibh!
Thank you!