HIV Risk: Poverty & Immigration Linked in Netherlands Study

New HIV diagnoses in the Netherlands, while having stabilized after a consistent decline throughout the 2010s, reveal a concerning social gradient. Individuals experiencing poverty or who are first-generation immigrants are significantly more likely to receive an HIV diagnosis, according to research published in The Lancet Regional Health – Europe.

The study, led by Dr. Vita Jongen of Stichting HIV Monitoring, highlights how intersecting vulnerabilities – the combination of poverty and immigration status – further elevate risk. This finding underscores the complex interplay between socioeconomic factors and public health, even within a country that has made substantial progress toward achieving UNAIDS’ 95-95-95 targets.

The UNAIDS goals aim for 95% of all people living with HIV to be diagnosed, 95% of those diagnosed to be on treatment, and 95% of those on treatment to achieve viral suppression. The Netherlands is nearing these benchmarks, and access to pre-exposure prophylaxis (PrEP) has effectively reduced HIV transmission, particularly among younger populations. However, the stabilization of new diagnoses around 500 per year since 2020 indicates that certain populations continue to be disproportionately affected.

Currently, the majority of new HIV diagnoses – approximately 60% – occur among gay, bisexual, and other men who have sex with men. Other men account for around 20% of diagnoses, women for 16%, and transgender individuals for 4%. The research emphasizes that gaps in prevention and treatment coverage persist, particularly for women and cisgender straight men.

The challenges faced by migrants in accessing HIV services are a key component of this disparity. Researchers note that newcomers to the Netherlands may lack the necessary knowledge to navigate the healthcare system and may encounter language barriers that hinder their ability to obtain testing, treatment, and preventative care. These obstacles are compounded by socioeconomic disadvantages.

A related nationwide analysis, utilizing data from the ATHENA cohort and Statistics Netherlands, further investigated these intersecting vulnerabilities. This research, published in November 2025, sought to identify the socio-demographic, socioeconomic, and mental health factors associated with new HIV diagnoses. While the study did not identify papers specifically describing inequalities among those newly diagnosed with HIV in the Netherlands, it added value by providing a comprehensive analysis of these interconnected factors.

Beyond the challenges of access, broader socioeconomic determinants of health play a significant role. Data suggests a correlation between older age at HIV diagnosis and living in poverty. Research combining data from the ATHENA cohort with national registry data reveals that living in poverty is associated with both having detectable viral loads and disengagement from HIV care across all subgroups of men who have sex with men, cisgender heterosexual men, and women. Younger age was also linked to detectable viral loads.

Specifically within the male population who have sex with men, having only a primary education, a second-generation migration background, and living in unstable household situations (single-parent, institutionalized, or other) were also associated with having a detectable viral load. This suggests that educational attainment, migration history, and housing stability are critical factors influencing HIV care outcomes.

The findings underscore that the HIV care continuum in the Netherlands is heavily influenced by socioeconomic factors, rather than solely health-related ones. This has important implications for public health interventions. Efforts to optimize HIV care should prioritize addressing the economic vulnerabilities of individuals at risk, rather than focusing exclusively on medical interventions.

The use of registry data, as demonstrated by the ATHENA cohort study, proves valuable in identifying gaps in care and understanding the broader context of HIV transmission, and treatment. This approach allows researchers to model the complex interplay of factors influencing HIV outcomes and to target interventions more effectively.

While the Netherlands has made significant strides in combating HIV, these findings serve as a crucial reminder that achieving zero new infections requires a holistic approach that addresses the social determinants of health. Continued monitoring and targeted interventions are essential to ensure that all populations have equitable access to HIV prevention, testing, and treatment services.