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. 2020 May;96(3):227-231.
doi: 10.1136/sextrans-2019-054080. Epub 2019 Jul 26.

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

Anne Gosselin  1   2   3 , Andrainolo Ravalihasy  3   4 , Julie Pannetier  5   3   6 , France Lert  3 , Annabel Desgrées du Loû  5   3   4 ; PARCOURS Study Group
Collaborators, Affiliations

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

Anne Gosselin et al. Sex Transm Infect. 2020 May.

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.

Methods: Within 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.

Results: Overall, 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.

Conclusion: Two 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.

Keywords: france; life-event history survey; prevention; sub-saharan africa.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Flow chart of study population, ANRS PARCOURS survey.
Figure 2
Figure 2
Assignment of HIV acquisition post-settlement (>6 years after migration) among sub-Saharan African immigrants living with HIV in the Paris metropolitan area and who acquired HIV after arrival in France, February 2012–May 2013 (n=277).
Figure 3
Figure 3
Timing of infection among sub-Saharan immigrants living with HIV in the Paris metropolitan area, according to migration history, by sex (N=622).
Figure 4
Figure 4
Determinants of post-migration HIV infection among sub-Saharan migrants living with HIV in the Paris metropolitan area during settlement or post-settlement (N=277).
See this image and copyright information in PMC

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