What is driving the HIV epidemic in French Guiana?

Abstract

Thirty years after the first HIV case in French Guiana, the drivers of the epidemic are not clearly known, but the epidemic is usually conceptualized as generalized. Cross-linking results from a study in the general population and a study in the HIV-infected population in Cayenne suggests that in the general population of HIV-positive men, 45% of HIV cases are attributable to having sex with someone they paid. Similarly, for HIV-positive women exchanging sex for presents or money, 10.7% of HIV cases are attributable to transactional sex. A surprising finding was that 16.8% of HIV patients had tried crack cocaine before. On the Maroni river, the female-biased sex ratio suggests the drivers in that remote area may be related to cultural polygyny. These observations have important consequences on communication and prevention strategies.

Predictive Factors of HTLV1-HIV Coinfections in French Guiana

“…Overall, 30% of the population is foreign. 2 Because a large number of HTLV1 serology results were missing in the patient file, a preliminary stage was to collect the missing data from the main laboratories in French Guiana performing this serology. The missing data was then entered into eNADIS to complete the database.…”

“…With 1.3% of infected pregnant women, 1 the epidemic is generalized according to UNAIDS criteria. However, 64% of new patients are migrants and sex work and crack use are suspected drivers of the epidemic 2 ; the predominant mode of infection is heterosexual sex. 3 French Guiana is also an area where the human T lymphotropic virus 1 (HTLV1) is endemic, concentrated in descendants of African slaves (notably Maroons).…”

HIV-testing among female sex workers on the border between Brazil and French Guiana: the need for targeted interventions

“…The epidemic both in Brazil and in French Guiana is described as a concentrated or mixed epidemic 7,8 . Epidemics are concentrated if transmission occurs largely in defined vulnerable groups 9 , and mixed when the epidemic is defined by a prevalence in pregnant women that is consistently over 1%, transitioning into the general population and raising concerns about the possibility of a generalized epidemic 9 .…”

“…cidades.ibge.gov.br/xtras/temas.php?lang=&cod mun=160010&idtema=125&search=amapa, accessed on 10/Dec/2014). Sex workers are considered as an important driver of the HIV epidemic in the region and prevalence seems higher in this population 6,8,13 . In order to maximize the impact of prevention, the World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) recommended in the second generation surveillance program to monitor high risk groups, among whom sex workers figure 14 .…”

How Many Have Died from Undiagnosed Human Immunodeficiency Virus–Associated Histoplasmosis, A Treatable Disease? Time to Act

“…There have been some decreases in incidence in some states in this region, but recent increases in incidence in northern states of Brazil have been reported. [1][2][3] The population of the Amazon basin is estimated to be approximately 10 million persons, 4 which would imply that approximately 100,000 persons are HIV positive in the Amazon Basin.…”