The changing face of the HIV epidemic in western Europe: what are the implications for public health policies?

Heterogeneous response to HAART across a diverse population of people living with HIV: results from the ANRS-EN12-VESPA Study

“…Our findings have important public health implications since the proportion of heterosexual migrants coming from countries with high HIV prevalence, especially sub-Saharan Africa, and living in precarious socioeconomic conditions has been rising drastically in the last few years [12]. Understanding the reasons underlying a poorer response to treatment in this population appears to be important.…”

“…Based on the characteristics of the HIV epidemic in western Europe [12], participants were divided in seven subgroups corresponding to the most significant groups of persons living with HIV infection in France: homo/bisexual males, IDU heterosexual males, IDU females, French-native heterosexual males without history of IDU, French-native females without history of IDU, migrant heterosexual males without history of IDU, and migrant females without history of IDU. Non French-natives who did not have French nationality at birth were classified as migrants.…”

“…Non French-natives who did not have French nationality at birth were classified as migrants. These seven subgroups constitute homogeneous epidemiological entities regarding HIV transmission [12] and show marked differences in socioeconomic characteristics and living conditions [18].…”

“…Heterosexual migrants without history of IDU account for the great majority of the nonFrench native population living with HIV infection in France (85.4% in our sample) as in other western European countries [12]; they mostly include individuals originating from subSaharan Africa (79.3%) or other non-European countries (14.0%) and are characterized by a recent immigration in France (median: 6 years at the time of the study). Non-heterosexual migrants constitute a marginal part of the HIV-infected population (homo/bisexual migrants account for 2.2% of our sample and IDU migrants for 1.6%); moreover, they differ from heterosexual migrants in that they mainly come from other European countries (respectively, 59.4% and 52.7%) and have been settled in France for a long time (respectively, median of 13 and 24 years at the time of the study).…”

“…In Western countries, the HIV-infected population is made up of diverse subgroups characterized by highly contrasted socioeconomic and cultural backgrounds [12].…”