When and why? Timing of post-migration HIV acquisition among sub-Saharan migrants in France

Abstract

ObjectiveRecent studies highlighted that many HIV-positive migrants in Europe acquired their infections post-migration. However, the timing of these infections is not always known. This study aims to estimate the timing of post-migration HIV acquisition among sub-Saharan migrants in France and to understand the correlates of post-migration infection.MethodsWithin the PARCOURS retrospective survey conducted in 2012–2013 in 74 healthcare facilities in the Paris region, life-event data were collected among a random sample of 926 patients living with HIV in HIV services and 763 patients undiagnosed with HIV in primary care centres born in sub-Saharan Africa (reference group). Based on previous analysis, we considered the first 6 years in France after migration as a settlement period. Among the persons who acquired HIV after migration, we estimated the proportion of persons infected during settlement (0–6 years after migration) and after settlement (>6 years after migration) by using an algorithm that combines life-event data and a modelisation of CD4+ T-cell count decline. We then assessed the determinants of HIV acquisition during settlement and after settlement using bivariate logistic regression models.ResultsOverall, 58% of sub-Saharan migrants who acquired HIV after migration were infected during the first 6 years in France. HIV acquisition during settlement was found to be linked to short/transactional partnerships and lack of a resident permit. 42% of migrants had contracted HIV after settlement. After settlement, HIV acquisition was associated with short/transactional but also with concurrent partnerships and not with social hardship.ConclusionTwo profiles of HIV post-migration acquisition emerged. The majority of HIV post-migration acquisition occurs during the settlement period: comprehensive combination prevention programmes among recently arrived migrants are needed. However, long-term migrants are also at risk for HIV through multiple partnerships. Prevention programmes should address the different profiles of migrants at risk for post-migration HIV acquisition.

Finding the missing link: when community-based outreach in public space is key to engage migrants in health prevention programmes in Paris, France

“…As previous research among the sub-Saharan African migrant population has shown, not only are newly arrived migrants at risk for HIV infection acquisition but migrants, especially men, who have been in France for several years are also at risk. 15…”

“…In France, African migrants are disproportionally affected by the HIV epidemic, and a previous study showed that post-migration HIV acquisition was frequent among people living in precarious situations but also among people already settled. 14 15 It is therefore necessary to increase primary prevention among sub-Saharan migrants, particularly among those absent from the healthcare system, who may not be reached by prevention programmes. We engaged in a community-based, street outreach prevention programme named Makasi conducted in Paris and its surroundings from 2018 onwards in order to reach these hard-to-reach African migrants.…”

Who Falls Between the Cracks? Identifying Eligible PrEP Users Among People With Sub-saharan African Migration Background Living in Antwerp, Belgium

“…As not all Belgian PrEP eligibility criteria could be measured directly, proxies were used approaching the original criteria as much as possible. These were developed based on existing scienti c evidence and expert advice (1,16,17). Box 2 shows the eligibility guidelines and their operationalization based on the available information of the TOGETHER survey.…”

“…To operationalize eligibility criterion 7 'People in general who are exposed to condomless sex with a high risk of HIV infection' we rely on recent publications focusing on important risk factors among SSA migrants (1,16,17). Three SSA migrant-speci c factors (not yet covered by one of the other national criteria) were selected and they are counted as separate criteria.…”

Good acceptability of HIV, HBV, and HCV screening during immigration medical check-up amongst migrants in France in the STRADA study

“…In France, all legal migrants undergo a mandatory health check-up at the migration office (Office Français de l'Immigration et de l'Intégration-OFII) upon arrival in France or when they obtain a residency permit [7]. This free-of-charge check-up includes a chest X-ray screening for active pulmonary tuberculosis, a review of vaccinations, a vision test, a measure of body mass index, and a glycemic test.…”