Increasing numbers of people from Eastern Europe accessing sexual health services in London

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There has been an increase in the proportion of patients from central or eastern Europe accessing sexual health services in central London in recent years, investigators report in a study published in the online edition of Sexually Transmitted Infections. The investigators found that patients from these regions were, overall, no more likely to be diagnosed with a sexually transmitted infection than individuals from other regions. However, compared to patients from other countries, central and eastern European men were more likely to be diagnosed with syphilis. Furthermore, women from central and eastern Europe were more likely to have family planning related reasons for their use of sexual health services than women from other countries.

In May 2004 eight countries in central and eastern Europe (the Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Slovakia and Slovenia) joined the European Union (EU). This led to a rapid increase in the number of young economic migrants from these countries in the UK.

Investigators wished to assess the impact of the migration of individuals from these eight countries on demand for sexual health services in central London. They looked at the country of origin of individuals attending two clinics in central London between mid-2001 and mid-2007 to see if the accession of these countries to the EU was reflected in increased attendances. They also recorded information on diagnoses of acute sexually transmitted infections to see if patients from the accession countries were more or less likely to be presenting with certain infections or health issues.

Glossary

acute infection

The very first few weeks of infection, until the body has created antibodies against the infection. During acute HIV infection, HIV is highly infectious because the virus is multiplying at a very rapid rate. The symptoms of acute HIV infection can include fever, rash, chills, headache, fatigue, nausea, diarrhoea, sore throat, night sweats, appetite loss, mouth ulcers, swollen lymph nodes, muscle and joint aches – all of them symptoms of an acute inflammation (immune reaction).

syphilis

A sexually transmitted infection caused by the bacterium Treponema pallidum. Transmission can occur by direct contact with a syphilis sore during vaginal, anal, or oral sex. Sores may be found around the penis, vagina, or anus, or in the rectum, on the lips, or in the mouth, but syphilis is often asymptomatic. It can spread from an infected mother to her unborn baby.

on demand

In relation to pre-exposure prophylaxis (PrEP), on-demand dosing is an alternative term for event-based dosing. See ‘event based’.

During the period of the study, 150,000 visits were made to the clinics by people with a known country of origin. A little over 5800 (4%) of these visits involved individuals born in the eight central and eastern European countries that joined the EU in 2004.

Over the six years of the study, the proportion of patients from these countries increased significantly for both men (1% to 2.5%, p < 0.0001) and women (3% to 8%, p < 0.0001).

Attendances by women from these countries at sessions specifically run for female sex workers also increased significantly (13% of all attendances in 2001, increasing to 40% of all attendances in 2007).

Rather than finding a sudden influx of individuals from the eight central and eastern European countries after their accession to the EU, the investigators found that the proportion of attendances increased gradually year on year from 2000.

The investigators found that patients from central and eastern Europe were younger than patients from other countries (median age men, 27 vs 29 years, p < 0.001; median age women, 25 vs 26 years, p = 0.0005).

Overall, central and eastern European men were more likely to be diagnosed with an acute sexually transmitted infection than women from these regions (27% vs 16%).

However, men from these regions were no more likely to be diagnosed with an infection then men from other countries (29% vs 27%). Similarly, the proportion of women from the eight accession countries diagnosed with an acute sexually transmitted infection was no different to that recorded in women from other regions (14% vs 16%).

Next the investigators looked at rates of specific sexually transmitted infections. Men from central and eastern Europe were no more likely to be diagnosed with any infection with the exception of syphilis (1% vs 0.4% men from other regions, p = 0.037).

The proportion of infections recorded as being acquired as a result of sex between men did not differ by region of origin. But the researchers did notice that men from the eight central and eastern European countries were more likely to be recorded as gay or bisexual than men from other countries (38% vs 32%, p = 0.003).

Women from the accession countries had comparable rates of sexually transmitted infections to women from other countries, but were more likely to be accessing family planning related services than women from other regions (24% vs 12%, p < 0.0001).

“This study shows that central and eastern European migrants are already having a substantial impact on GUM services in London and probably the UK”, comment the investigators.

They note that control of sexually transmitted infections, particularly syphilis, deteriorated markedly in many central and eastern European countries after the collapse of communism, which also saw an explosion in injecting drug use in many countries and that over 1% of the adult population in Estonia is estimated to be HIV-positive.

The investigators therefore write: “the demographic profile of the central and eastern European migrant population indicates that they are likely to be sexually active and to have reproductive ambitions; there is a high background prevalence of sexually transmitted infections and HIV in their countries of origin.”

They believe this could have implications for demand for sexual health services in London and elsewhere in the UK.

References

Burns FM et al. Increased attendances by people of Eastern European origin at sexual health services in London. Sex Transm Infect (online edition), 2009.