Impact of immigration and international travel on HIV in UK

Worldwide travel has increased in the past decade due, in part, to its increasing accessibility and affordability. Affluent, widely-travelled gay men were among the first to be affected by HIV back in the early 1980s. After the establishment of the HIV epidemic in the UK, most transmission occurred within gay male communities in the UK. But in recent years the epidemiology of HIV in the UK has changed completely, as we saw above.

The number of migrants to the UK including refugees and asylum seekers increased from the mid-1990s.

The 2005 BBC ‘Born Abroad’ survey found that 7.5% of people living in Britain were born abroad (4.3 million out of 57.1 million), and that between 1991 and 2001, half of Britain’s population and peaked in 2002. London had by far the biggest number of non-nationals and has also experienced the biggest rise in immigrants, with a 45% increase in Londoners born abroad between 1991 and 2001. However areas that had previously had very few immigrants like the north-east also had big increases.

Immigrants come for a wide variety of reasons and have a number of different legal statuses ranging from full naturalisation through work permits and student visas to refugees and asylum seekers – both documented and undocumented. An illustration of this variety is the fact that some of London’s richest (Hyde Park, Chelsea) and poorest (East Ham, Tottenham) districts are among those with the highest immigrant populations. So is the list of countries with the biggest migrant populations in the UK. Excluding the Republic of Ireland, the top five are India, Pakistan, Germany, the Caribbean nations and the USA, with two countries with high HIV prevalence – South Africa and Kenya – coming in at numbers seven and eight.

The countries that have contributed the biggest net increases of migrants during the 1990s are also a varied list, showing how immigration is equally a phenomenon of skilled workers travelling to the UK for jobs and people fleeing the world’s trouble spots. The nationalities with the biggest net population increase during the 1990s were Afghanistan, Albania, China, former Yugoslavia, Finland, Greece, Sierra Leone, South Africa, Sweden and Zimbabwe.

In terms of people ‘pushed’ by persecution rather than ‘pulled’ by economic advantage, applications for asylum peaked in 2002 at 84,130 but have since fallen dramatically and in 2004 stood at 33,930. In terms of applicants per head of population, the UK is about midway down the list of EU countries, with Austria getting 3.9 times as many applicants per capita and Italy getting a fifth as many.

The country of origin of asylum seekers varies rapidly according to the war and human rights conditions in different parts of the world. The ‘top five’ countries for applicants over the last five years are as follows:

Obviously some countries, like China, are on the list because of their high populations. In terms of asylum seekers per head of population, last year’s ‘top five’ looks like this:

Asylum seekers per 10,000 population in originating country:

• Somalia 3.1
• Zimbabwe 1.6
• Iraq 0.7
• Iran 0.5
• China 0.018

Other small African countries like Eritrea (2.5 asylum seekers per 10,000) are also over-represented.

Equally, asylum seekers come from countries with widely varying HIV prevalence. Zimbabwe has nearly the highest HIV prevalence in the world at 24.6% of the adult population, according to UNAIDS, and in 2002 there were more Zimbabweans diagnosed with HIV in the UK than British citizens. The number of Zimbabwean entrants has since declined to less than a third of the 2002 since the introduction of via requirements for Zimbabweans in 2003.

Somalia’s HIV prevalence is unknown, as the country’s civil disorder has prevented adequate surveillance, but appeared to be about 1% in surveys done in 2003-4; Iran, China and Iraq all have prevalences under 0.1%, though the first two are experiences rapid HIV increases in vulnerable populations.

Equally many migrants come from other countries that have high prevalence but are not in a state of war or problems with human rights violations, like South Africa.

These migrants are predominantly young people aged less than 35 years and are likely to be a sexually-active population. However the majority of migrants from South Africa are white, and HIV prevalence has been found to be low on this portion of the South African population.

Additionally, worldwide travel has increased in recent years, including both UK residents travelling abroad and nationals from other countries visiting the UK.

Recent studies have shown evidence of population-wide changes in sexual behaviour in the past decade, including the acquisition of new partners abroad. Taken together, these factors contribute to the increased probability of encountering STIs and HIV.

Between 2000 and 2001, following the introduction of new HIV diagnosis reporting by clinicians, country of infection was recorded for 84% of newly diagnosed HIV infections. The UK was the likely country of infection for 28% (1042 of 3727) of those diagnosed, while for 47% (1755) it was an African country, 3% (105) Europe, and 3% (112) Asia. Stark differences can be observed by exposure category; 85% (758 of 892) of HIV infections attributed to sex between men acquired in the UK, compared to 13% (284 of 2,243) of heterosexual infections.

Between 2000 and 2001, 83% of heterosexuals diagnosed with HIV in the UK were born abroad. Of the heterosexuals born in the UK (358) 10% (37) were probably infected in Thailand, while 47% were infected in the UK. For male heterosexuals born in the UK, where country of infection was known, 18% (35 of 196) were probably infected in Thailand compared to 30% in the UK.