1 Impact of hardship on sexual risk and HIV infection among sub-Saharan migrants living in FranceAnnabel Desgrées du Loû (IRD, France), J.Pannetier, A. Ravalihasy, A. Gosselin, M. Le Guen,H. Panjo, N. Bajos, N. Lydié, F. Lert, R. Dray-Spira
2 Conflict of Interest full-time employee at IRD, Franceresearch recipient from ANRS and Santé Publique France payed teacher at Paris Descartes university, Paris Ouest university
3 Introduction Sub-Saharan African migrants in France = persons (13% of all immigrants) 42% live below the poverty line, 18% are unemployed A key population for HIV infection and chronic hepatitis B Virological data suggest that 1 in 4 HIV infection cases occured in France (Lucas et al., 2012), but a more precise estimation of HIV acquisition in France is needed.
4 Objectives (1) to estimate the proportion of sub- Saharan migrants who acquired HIV infection after their arrival in France using life-event and clinical data collected in the ANRS-PARCOURS study. (2) to identify social conditions exposing sub-Saharan immigrants to the risk of HIV infection in France .
5 The survey : ANRS-Parcours 2012-2013A retrospective quantitative life-event history survey conducted in 74 health-care facilities in the greater Paris metropolitan area (Ile-de-France). - A face-to-face standardized life-event history questionnaire + data from medical records -3 groups of migrants born in sub-Saharan Africa (randomized sampling) : - receiving HIV care (N=926), - with chronic hepatitis B (N=776), - visiting primary care centres (N=763). .
6 Methods A combined method mixing life-event and CD4 data to assign HIV acquisition in France : Time of HIV diagnosis History of HIV test in France First sex before/after arrival in France. Modelling of CD4 cell count decline Factors related to HIV exposition in France : Outcomes : sexual partnerships each year since arrival in France Casual partnerships (<1 year) Transactional partnerships (to obtain housing, resources...) Paid sex Concurrent partnerships Associated factors tested for each year in France (weighted mixed-effect logistic regressions): Migratory path (age at arrival, reason for migration, time spent in France, …) Living conditions in France each year (housing, residence permit, ressources) Adjustment on study group: HIV acquired after arrival In France / HIV infected before arrival in France /Chronic Hepatitis B / Primary care (REF)
7 Study population, hardship experience and HIV infection in FranceMost of the migrants (>95%) came from Western and Central Africa. The median duration of residence in France was 13 years for women and 12 years for men. Hardships in France after migration were frequent. Around 1 on 2 migrants ever had one year without resident permit Around 1 on 3 migrants ever had one year with no stable housing 35%[31-39](conservative scenario) to 49%[45-53](median scenario) of PLWHIV acquired HIV in France
8 Sexual partnerships exposing to HIV risk
9 Factors related to the probability of occasional partnership each year (ORa)Factors related to the probability of transactional partnership each year (ORa) Women Women
10 Factors related to the probability of occasional partnership each year (ORa)Factors related to the probability of concurrent partnerships each year(ORa) Men Men
11 Conclusion Almost half of sub-Saharan migrants living with HIV acquired HIV while living in France Migrants who acquired HIV in France had more frequently casual, transactional and concurrent sexual partnerships in France These at-risk partnerships were more frequent during years without stable housing and stable residence permit, after adjustment Hardship is a distant factor of HIV infection among African migrants in France Women seem particularly vulnerable when they lack housing, A special attention must be paid to women who escaped their country because they were threatened Desgrees du Lou et al. Eurosurveillance, Desgrees du Lou et al., AIDS,
12 Aknowledgements The PARCOURS survey was funded by the French National Agency for Research on Aids and Viral Hepatitis (ANRS). We thank all patients who agreed to participate in the PARCOURS survey, all medical staff members in the participating hospitals, as well as the community-based organisations RAAC-Sida, COMEDE and SOS hepatites who supported the survey. The PARCOURS Study Group: A. Desgrées du Loû, F.Lert, R Dray-Spira, N. Bajos, N.Lydié (scientific coordinators), J. Pannetier, A. Ravalihasy, A. Gosselin, D. Pourette, with the support of A. Guillaume. Methodological and ground support: Y. Le Strat, J. Gelly, N. Razafindratsima, P. Revault, J. Situ, P. Sogni, G. Vivier Data collection: The ClinSearch firm and the social research institute Ipsos.
13 More results about the Parcours study …
14 Parcours study at the IAS conference, poster exhibitionMonday 24th July 12h30-14h30: Pilecco et al, Induced abortion, migration and HIV: an analysis of migrants from sub-Saharan Africa living in Île-de-France Pannetier et al Prevalence and circumstances of forced sex after migration among sub-Saharan migrant women living in France and post-migration acquisition of HIV Pannetier et al Keeping HIV status secret from steady partners: gender differences among migrants from sub-Saharan Africa living in France Tuesday 25th July Gosselin et al Migration and HIV: a double penalty? Assessing the respective impacts of migration and HIV diagnosis on sub-Saharan immigrants' lives in Paris greater area. Results from the ANRS Parcours survey Maraux et al, Sub-Saharan African (sSA) migrant women living with HIV lack highly effective contraception: migrant effect or HIV consequence? Results from the ANRS-Parcours study Wednesday 26th July Gosselin et al HIV and access to rights for sub-Saharan immigrants in France: results from the ANRS Parcours Survey Vignier et al Refusal to provide healthcare to sub-Saharan African migrants living in the Paris region: a comparison according to their HIV and HBV status