HIV Incidence, Migration and Diagnosis Dynamics, France, 2012-2023: A Surveillance and Modeling Data Analysis.

BACKGROUND

In France, new HIV diagnoses have declined since 2012 among native-born men who have sex with men (MSM) but not among MSM or heterosexuals born abroad. We aimed to disentangle and describe trends in HIV incidence in France, migration of undiagnosed people living with HIV (PLHIV), and diagnosis delays among people born abroad.

SETTING

France.

METHODS

We applied a mathematical model that estimates individual-level diagnosis delay distributions and identifies likely premigration infections to surveillance data of new HIV diagnoses from France. We then applied a second model to estimate HIV incidence in France and the number of arriving migrants with premigration infections each year from 2012 to 2023. Denominators were estimated from official population statistics.

RESULTS

The number of undiagnosed PLHIV arriving in France fell sharply during the COVID-19 pandemic before resuming previous trends; HIV incidence showed no such effect. Excluding this period, overall HIV incidence and migrations of undiagnosed PLHIV have been stable among people from sub-Saharan Africa despite increasing immigration. However, they have increased among MSM born in sub-Saharan Africa and other foreign countries. People with premigration infections are diagnosed at a later clinical stage of infection than those born in France but generally within 1 year of arrival; people with postmigration infections have diagnosis delays similar to those born in France. Only 15% of undiagnosed PLHIV were infected premigration.

CONCLUSION

Progress in HIV prevention among people born abroad has been mixed. Preventing and diagnosing postmigration infections are key to preventing onward transmission.