Do vulnerable groups access prevention services? Cervical cancer screening and HIV testing among homeless migrant women in the Paris metropolitan area

Abstract

Introduction Homeless migrant women, facing adverse living conditions and barriers to legal status, are at risk of cervical cancer, HIV infection and may encounter barriers to screening services. We investigate factors associated with each screening in a population of migrant women in France and aim to determine the mean time since last HIV testing according to duration of residence in France. Methods We use data from the DSAFHIR study (Rights and Health of Migrant Women in Emergency Housing) investigating health and migration experience of homeless migrant women housed in emergency housing hotels in the Paris Metropolitan area in 2017. We computed multivariate logistic regression models to investigate no lifetime cervical cancer screening (CCS) and no lifetime HIV test. We used linear regression models to analyze time since last HIV test. Results We included 469 women. 46% of respondents had no lifetime CCS, 31% had no lifetime HIV test. Both screenings were associated with educational attainment and French proficiency. Compared with duration of residence < 1 year, duration ≥ 7 years was associated with a lower likelihood of no lifetime CCS (adjusted Odd Ratio = 0.17; 95% CI = 0.07–0.39). Compared to women born in North Africa, women born in West (aOR = 0.15; 95% CI = 0.07–0.33) and East Africa (aOR = 0.06; 95% CI = 0.02–0.20) were less likely to have no lifetime HIV test. Time since last HIV test increased for each additional year spent in France (coef = 0.21; 95% CI = 0.09, 0.33). Conclusion While access to CCS remains poor for recent migrants, HIV testing is more likely to occur shortly after migration.

Proof of concept of a sexual health outreach program led by community health workers in homeless hostels in the greater Paris region

“…(3) social support; (4) experience with organizing collective workshops; (5) and program strengths and weaknesses. Observations focused on: (1) the health education information provided by the CHWs during workshops, including the nature of the information and topics covered, CHWs' knowledge and perspectives, vocabulary used, accessibility of the information provided, and adaptation to the participants' literacy level; (2) the CHWs' intervention approach, including their posture, communication style, tools used, emphasis on participant involvement and discussion; and (3) the residents' level of knowledge and health literacy, including their experiences and practices.…”

“…Women experiencing homelessness in France are predominantly foreign-born migrants, are at particularly high risk for sexually transmitted infections (STIs) such as HIV (2) and face risk factors such as sexual violence (3) and difficulties negotiating safer sex practices (4). Although homeless women are specifically targeted for STI screening, 31% report never having received an HIV test, with poorer access to screening among women with lower levels of education and French proficiency, as well as women in relationships (5). About a quarter of homeless women report unmet healthcare needs, but an even larger proportion report no healthcare needs whatsoever, even if their current health status is poor or they have specific risk factors (6,7).…”