Sub-Saharan African migrants living with HIV acquired after migration, France, ANRS PARCOURS study, 2012 to 2013

Abstract

We estimated the proportion of migrants from sub-Saharan Africa who acquired human immunodeficiency virus (HIV) while living in France. Life-event and clinical information was collected in 2012 and 2013 from a random sample of HIV-infected outpatients born in sub-Saharan Africa and living in the Paris region. We assumed HIV infection in France if at least one of the following was fulfilled: (i) HIV diagnosis at least 11 years after arrival in France, (ii) at least one negative HIV test in France, (iii) sexual debut after arrival in France. Otherwise, time of HIV infection was based on statistical modelling of first CD4(+) T-cell count; infection in France was assumed if more than 50% (median scenario) or more than 95% (conservative scenario) of modelled infection times occurred after migration. We estimated that 49% of 898 HIV-infected adults born in sub-Saharan Africa (95% confidence interval (CI): 45-53) in the median and 35% (95% CI: 31-39) in the conservative scenario acquired HIV while living in France. This proportion was higher in men than women (44% (95% CI: 37-51) vs 30% (95% CI: 25-35); conservative scenario) and increased with length of stay in France. These high proportions highlight the need for improved HIV policies targeting migrants.

High levels of postmigration HIV acquisition within nine European countries

“…Overall differences between countries were highly significant, but after adjustment for differences in the distribution of transmission category and length of stay, differences became clearly non-significant. HIV reports from surveillance data from UK [15] and in a random sample of migrants from SSA in France [12].…”

“…how to best determine timing of HIV infection and different methodologies have adopted [12][13][14][15]. Further, all published studies to date have been confined to one city or one country and most have addressed heterosexually transmitted HIV among people from SSA [12,15,17].…”

“…Further, all published studies to date have been confined to one city or one country and most have addressed heterosexually transmitted HIV among people from SSA [12,15,17].…”

Health and mortality patterns among migrants in France

“…However, the study on HIV infection demonstrates their vulnerability to contracting those diseases after arrival (Desgrées-du-Loû et al, 2015). It is worth noting also that the most recent waves of migrants originate from countries well advanced in the health transition process, and in which chronic diseases are on the rise.…”

Similar, but different: drivers of the disproportionate HIV and sexually transmitted infection burden of key populations

“…The definition of who belongs to a KP has varied among normative bodies, but common features include engagement in specific practices that augment risk (e.g. Others have considered migrants to also be a KP [8][9][10][11], given their disproportionate HIV/STI burden and lack of social protection. The UNAIDS programme includes men who have sex with men (MSM), transgender people, sex workers, people who inject drugs (PWID) as KP [2] and incarcerated persons [3][4][5][6][7].…”