Multiple discriminations experienced by people living with HIV in France: results from the ANRS-Vespa2 study

Abstract

Since the advent of AIDS, discrimination has remained at the core of the experience of people living with HIV (PLHIV). PLHIV who belong to minority groups are exposed to discrimination not only on the grounds of their HIV infection but also because of rejecting attitudes towards drug users, homosexuals and black people. This article aimed to measure the frequency of discrimination and assess its correlates among PLHIV in France. We used data from a national representative survey, the ANRS-Vespa2 study, conducted in France in 2011 among 3022 male and female HIV-positive patients followed at hospitals. Respondents answered a face-to-face questionnaire documenting their health status and living conditions. Discrimination was documented during the previous two years on the grounds of HIV infection, gender, country of birth, skin colour, sexual orientation, place of residence, and substance abuse in a variety of contexts. For each context, we performed logistic regressions on discrimination, controlling for socio-epidemiological group, age, education level and employment status. Discrimination is frequently experienced by PLHIV in France (26%), particularly when applying for a job (24%), interacting with family (11%) or seeking health services (8%). Women from sub-Saharan Africa reported the highest levels of discrimination, whereas heterosexual non-African men reported the lowest. Men who have sex with men experienced levels of discrimination that fell between those of these two groups. The major perceived reason for discrimination was HIV status (13%). Nationality, skin colour and sexual orientation were cited by 5% each, whereas gender was cited by 1% of respondents. Our analyses show that discrimination is a frequent and cross-cutting experience with differences across the various contexts and among the diverse subpopulations. The intertwining of HIV-related stigma with sexism, racism and homophobia needs to be addressed to understand why discrimination against PLHIV persists when the disease itself has greatly evolved.

Estimation of HIV incidence in two Brazilian municipalities, 2013

“…The already widely recognized benefits of early introduction of antiretroviral therapy 18 seem to be neglected by the stigma and fear of being positive 16 .…”

“…The BED-CEIA test was used to estimate the HIV incidence in several countries and different epidemiologic scenarios 5 , 8 , 16 , including between the reported cases of HIV to estimate the HIV incidence in the United States of America (USA) 10 .…”

Work-related stigma and disclosure: A daily challenge for people living with HIV

“…One study reported that over two-thirds of PLWH reported that they were not allowed to go to a medical appointment during working hours without losing payment, which might be considered as stigma [26]. Another study reported that 24% of their participants indicated facing discrimination when applying for a job [31]. One study made an analysis of the complaints submitted to the Equal Employment Opportunity Commission about discrimination at work because of a chronic disease (including HIV): of all complaints filed by people with disabilities under the employment provisions of the Americans with Disabilities Act in the period 1992-2003, 7.3% concerned discrimination of PLWH.…”

“…stigma Older people, men who have sex with men, drug users, and migrant women experienced significantly more discrimination [31]. A comparative study of PLWH in different geographical regions concluded that work-related stigma and discrimination appeared more often and was more severe in the Caribbean area than in the UK [30].…”

“…Three studies reported the level of perceived stigma at work; this ranged from 6-11% [25,26,31]. One study reported that over two-thirds of PLWH reported that they were not allowed to go to a medical appointment during working hours without losing payment, which might be considered as stigma [26].…”