Is Hardship During Migration a Determinant of HIV infection? Results from The ANRS PARCOURS Study of Sub-Saharan African Migrants in France

OBJECTIVES:

In Europe, sub-Saharan African migrants are a key population for HIV infection. We analyse how social hardships during settlement in France shape sexual partnerships and HIV risk.

DESIGN:

PARCOURS is a life-event survey conducted from February 2012 to May 2013 in 74 health-care facilities in the Paris region, among three groups of sub-Saharan migrants: 926 receiving HIV care (296 acquired HIV in France), 779 with chronic hepatitis B, and 763 with neither HIV nor hepatitis B (reference group).

METHODS:

Hardships (lack of residence permit, economic resources and housing) and sexual partnerships were documented for each year since arrival in France. For each sex, reported sexual partnerships were compared by group and their associations with hardships each year analysed with mixed-effects logistic regression models.

RESULTS:

Hardships were frequent: more than 40% had lived a year or longer without a residence permit, and more than 20% without stable housing. Most of the migrants had non-stable and concurrent partnerships, more frequent among those who acquired HIV in France compared to reference group, as were casual partnerships among men (76.7% vs 54.2%; p = 0.004) and women (52.4% vs 30.5%; p = 0.02), concurrent partnerships among men (69.9% vs 45.8%; p = 0.02), and transactional partnerships among women (8.6% vs 2.3%; p = 0.006). Hardship increased risky behaviours: in women, lacking a residence permit increased casual and transactional partnerships (resp. OR = 2.01[1.48-2.72] and OR = 6.27[2.25-17.44]). Same trends were observed for lacking stable housing (OR = 3.71[2.75-5.00] and OR = 10.58[4.68-23.93]).

CONCLUSION:

Hardships faced by migrants increase sexual and HIV risks. Women, especially during the period without stable housing, appear especially vulnerable.

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By:  Lou AD1, Pannetier J, Ravalihasy A, Le Guen M, Gosselin A, Panjo H, Bajos N, Lydie N, Lert F, Dray-Spira R; Parcours Study Group..

• 1aIRD, CEPED, Paris, France bSorbonne Universités, UPMC Univ Paris 06, Inserm, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), F75013, Paris, France cUniversité Paris Descartes, CEPED, Paris, France dINSERM, CESP-U 1018, Villejuif, France eINPES, Saint-Denis, France. 

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