Prevention and Initial Management of HIV Infection

TO THE EDITOR: Feinberg and Keeshin (1) explored the importance of HIV preexposure prophylaxis in the prevention and initial management of HIV. We strongly agree with their statement about specific indications for preexposure prophylaxis. However, we believe that their indications are substantially less valuable to a national health department or for global epidemic prevention because they overlook the important issue of how to address HIV prevention and management in the setting of migration. Migration as an important factor associated with HIV transmission increases the likelihood of risky behaviors that contribute to HIV exposure (2). Transmission of HIV caused by migration is a global issue, and how to manage it effectively cannot be ignored. In recent years, migration rates within Europe have increased. Infections were detected in 3.7% of these migrant populations, and Europe faced a disproportionate burden of tuberculosis, HIV, and hepatitis B and C infections (3). European countries used various methods to screen migrants for infection; however, most of these countries screen for a single disease—mainly active or latent tuberculosis infection. Furthermore, 24.6% of the migrant population was not screened. Screening for and prevention of HIV were not sufficient, resulting in an increase in potential infection rates and a delay in prevention and treatment (4). A study analyzing the relationship between migration and the HIV epidemic in South Africa found that migration was statistically significantly associated with an increased risk for HIV infection and that HIV infection and risky sexual behavior were more common among men and women in the setting of migration than in their nonmigrant counterparts (5). The same problem exists in China, a country with a large population. The migrant labor force in China can reach up to 300 million persons, and migration-related HIV has become an urgent problem here because of the lack of both sex education and awareness of self-protection (3). HIV and other infectious diseases caused by migration are a global problem. The increased risk for infection caused by migration is related to not only individuals but also the formulation of effective decision making at the national health level. Effective combined HIV prevention strategies targeting migrant populations are urgently needed. Great emphasis must be placed on developing innovative and sustainable strategies to facilitate screening, complete treatment, and improve health outcomes for migrants as well as the local population.