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Ravalihasy A. L'évaluateur et l'évaluation d'impact d'une intervention comme levier potentiel de l' empowerment au niveau communautaire : un exercice réflexif à partir de l'intervention MAKASI. Glob Health Promot 2024:17579759241258193. [PMID: 39087362 DOI: 10.1177/17579759241258193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Affiliation(s)
- Andrainolo Ravalihasy
- Ceped (IRD-Université Paris Cité-Inserm ERL 1244), Paris, France
- DeSCID, IAME UMR1137 (Université Paris Cité-Inserm), Paris, France
- Institut Convergences Migrations, Aubervilliers, France
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Palich R, Arias-Rodríguez A, Duracinsky M, Le Talec JY, Rousset Torrente O, Lascoux-Combe C, Lacombe K, Ghosn J, Viard JP, Pialoux G, Ohayon M, Duvivier C, Velter A, Ben Mechlia M, Beniguel L, Grabar S, Melchior M, Assoumou L, Supervie V. High proportion of post-migration HIV acquisition in migrant men who have sex with men receiving HIV care in the Paris region, and associations with social disadvantage and sexual behaviours: results of the ANRS-MIE GANYMEDE study, France, 2021 to 2022. Euro Surveill 2024; 29:2300445. [PMID: 38487889 PMCID: PMC10941311 DOI: 10.2807/1560-7917.es.2024.29.11.2300445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 01/03/2024] [Indexed: 03/17/2024] Open
Abstract
BackgroundSome migrant men who have sex with men (MSM) acquire HIV in France.AimsWe investigated, in migrant MSM receiving HIV care in France, the (i) rate of post-migration-HIV acquisition in France, (ii) delay between arrival and HIV acquisition and (iii) factors affecting HIV acquisition within 1 year after migration.MethodsThis cross-sectional study focused on ≥ 18-year-old MSM born outside France, receiving HIV care in the Paris region. Information on migration history, socioeconomic condition, sexual activity, and health was collected in May 2021-June 2022 through self-administered questionnaires and medical records. Post-migration-HIV-acquisition rate and delay between arrival in France and HIV acquisition were estimated from biographical data and CD4+ T-cell counts. Predictors of HIV acquisition within 1 year after migration were determined using logistic regression.ResultsOverall post-migration HIV-acquisition rate was 61.7% (715/1,159; 95%CI: 61.2-62.2), ranging from 40.5% (95%CI: 39.6-41.6) to 85.4% (95%CI: 83.9-86.0) in participants from Latin America and North Africa. Among post-migration-HIV acquisitions, those within 1 year after migration represented 13.1% overall (95%CI: 11.6-14.6), being highest in participants from sub-Saharan Africa (25%; 95%CI: 21.5-28.3). Participants ≥ 15-years old at migration, with post-migration-acquired HIV, had a 7.5-year median interval from arrival in France to HIV acquisition (interquartile range (IQR): 3.50-14.75). Older age at arrival, region of origin (sub-Saharan Africa and Asia), degree of social disadvantage and numbers of sexual partners were independently associated with acquiring HIV within 1 year in France.ConclusionOur findings may guide HIV prevention policies for most vulnerable migrants to Europe.
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Affiliation(s)
- Romain Palich
- Sorbonne University, Pitié-Salpêtrière hospital, AP-HP, Paris, France
- Sorbonne Université, Pierre Louis Epidemiology and Public Health institute (iPLESP), INSERM 1136, Paris, France
| | - Andrés Arias-Rodríguez
- Sorbonne Université, Pierre Louis Epidemiology and Public Health institute (iPLESP), INSERM 1136, Paris, France
| | - Martin Duracinsky
- Paris Cité University, Patient-Reported Outcomes Unit (PROQOL), INSERM 1123, Paris, France
| | - Jean-Yves Le Talec
- Toulouse Jean Jaurès University, CERTOP, CNRS UMR 5044, Toulouse, France
| | | | | | - Karine Lacombe
- Sorbonne University, Saint Antoine hospital, AP-HP, Paris, France
| | - Jade Ghosn
- Paris Cité University, Bichat hospital, AP-HP, Paris, France
| | - Jean-Paul Viard
- Paris Cité University, Hôtel-Dieu hospital, AP-HP, Paris, France
| | - Gilles Pialoux
- Sorbonne University, Tenon hospital, AP-HP, Paris, France
| | | | - Claudine Duvivier
- Paris Cité University, Necker hospital, AP-HP; INSERM U1016, CNRS UMR8104, Institut Cochin; IHU Imagine; Institut Pasteur Medical Center, Paris, France
| | | | - Mohamed Ben Mechlia
- French National Agency for Research on AIDS, Viral Hepatitis and Emerging Infectious Diseases (ANRS-MIE), Paris, France
| | - Lydie Beniguel
- Sorbonne Université, Pierre Louis Epidemiology and Public Health institute (iPLESP), INSERM 1136, Paris, France
| | - Sophie Grabar
- Sorbonne Université, Pierre Louis Epidemiology and Public Health institute (iPLESP), INSERM 1136, Paris, France
| | - Maria Melchior
- Sorbonne Université, Pierre Louis Epidemiology and Public Health institute (iPLESP), INSERM 1136, Paris, France
| | - Lambert Assoumou
- Sorbonne Université, Pierre Louis Epidemiology and Public Health institute (iPLESP), INSERM 1136, Paris, France
| | - Virginie Supervie
- Sorbonne Université, Pierre Louis Epidemiology and Public Health institute (iPLESP), INSERM 1136, Paris, France
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Cuzin L, Morisot A, Allavena C, Lert F, Pugliese P. Drastic Reduction in Time to Controlled Viral Load in People With Human Immunodeficiency Virus in France, 2009-2019: A Longitudinal Cohort Study. Clin Infect Dis 2024; 78:111-117. [PMID: 37665056 DOI: 10.1093/cid/ciad530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 08/14/2023] [Accepted: 08/29/2023] [Indexed: 09/05/2023] Open
Abstract
BACKGROUND Aspirational targets to end AIDS by 2030 include having 95% of people with human immunodeficiency virus (HIV; PWH) diagnosed, 95% treated, and 95% with controlled viral load (VL). Our objective was to describe, using a large French prospective cohort, the median transition times through the cascade of care between 2009 and 2019. METHODS We analyzed patients whose first HIV diagnosis was made between 1 January 2009 and 31 December 2019. Using the Kaplan-Meier method, we estimated the time to linkage to care (from HIV diagnosis to first biological assessment), to treatment (date of first antiretroviral therapy [ART] prescription), and to controlled VL (first value <200 copies/mL). Analyses were disaggregated by time periods and patients' characteristics. Censoring date was 31 December 2021. RESULTS Among the 16 864 patients linked to care since 2009, the median [Q1; Q3] time from HIV diagnosis to controlled VL decreased from 254 [127-745] to 73 [48-132] days in 2009-2011 and 2018-2019, respectively. Transition times from linkage to care to first ART decreased from 67 [17; 414] in 2009-2011 to 13 [5; 26] days in 2018-2019, and from ART to controlled VL from 83 [35; 130] in 2009-2011 to 38 [28; 90] days in 2018-2019. Differences were observed depending on patients' characteristics. CONCLUSIONS We describe drastic reductions in transition time through the cascade of care, allowing reduction in the transmission period following each new infection. Delayed diagnosis remains the main obstacle to ending AIDS in the next decade.
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Affiliation(s)
- Lise Cuzin
- CERPOP, Toulouse University, INSERM UMR1295, UPS, Toulouse, France
- Infectious and Tropical Diseases, Martinique University Hospital, Fort de France, Martinique (FWI)
| | - Adeline Morisot
- Corevih Paca-Est, Archet Hospital, Côte d'Azur University, Nice, France
| | - Clotilde Allavena
- Infectious and Tropical Diseases Department, Nantes University Hospital, INSERM CIC1413, Nantes, France
| | | | - Pascal Pugliese
- Corevih Paca-Est, Archet Hospital, Côte d'Azur University, Nice, France
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Lutaud R, Cortaredona S, Delorme L, Peretti-Watel P, Mirouse J, Borg M, Cattaneo L, Thery D, Gentile G, Pradier C, Irit T, Brouqui P, Tardieu S, Carles M, Gentile S. COVID-19 patient experiences in prehospital pathways: a processual approach using life-events calendar method and state sequence analysis shows detrimental delays. Fam Med Community Health 2024; 12:e002447. [PMID: 38216208 PMCID: PMC10806557 DOI: 10.1136/fmch-2023-002447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024] Open
Abstract
OBJECTIVES To our best knowledge, no study in France has comprehensively investigated the prehospital history of patients admitted for severe cases of COVID-19. 'Patients' voice is an excellent means to capture data on primary care pathways.We aimed to identify clusters of COVID-19 hospitalised patients with similar prehospital symptom sequences, and to test whether these clusters were associated with a higher risk of poor clinical outcomes. DESIGN Cross-sectional online survey using life-event calendars. SETTING All patients hospitalised for COVID-19 between September 2020 and May 2021 in the Infectious Disease Departments in Nice and in Marseilles in France. PARTICIPANTS 312 patients responded to the survey. MAIN OUTCOME MEASURES From the day of symptom onset to the day of hospitalisation, we defined a symptom sequence as the time-ordered vector of the successive symptom grades (grade 1, grade 2, grade 3). State sequence analysis with optimal matching was used to identify clusters of patients with similar symptom sequences. Multivariate logistic regressions were performed to test whether these clusters were associated with admission to intensive care unit (ICU) and COVID-19 sequelae after hospitalisation. RESULTS Three clusters of symptom sequences were identified among 312 complete prehospital pathways. A specific group of patients (29%) experienced extended symptoms of severe COVID-19, persisting for an average duration of 7.5 days before hospitalisation. This group had a significantly higher probability of being admitted to ICU (adjusted OR 2.01). They were less likely to know a loved one who was a healthcare worker, and more likely to have a lower level of education. Similarly, this group of patients, who were more likely to have previously visited the emergency room without exhibiting severe symptoms at that time, may have been inclined to postpone reassessment when their health worsened.Their relatives played a decisive role in their hospitalisation. CONCLUSION AND RELEVANCE This study highlights the negative impact of delayed hospitalisation on the health outcomes of French patients with severe COVID-19 symptoms during the first wave and underscores the influence of socioeconomic factors, such as lower education levels and limited connections to the medical field, on patients' experiences.
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Affiliation(s)
- Romain Lutaud
- Department of General Practice, Aix-Marseille University, Marseille, France
- ADES, Marseille, France
| | | | - Lea Delorme
- Assistance Publique- Hôpitaux de Marseille (AP-HM), Marseille, France
| | | | - Juliette Mirouse
- Department of General Practice, Aix-Marseille University, Marseille, France
| | - Manon Borg
- Department of General Practice, Aix-Marseille University, Marseille, France
| | - Lucie Cattaneo
- Assistance Publique- Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Didier Thery
- Department of General Practice, Aix-Marseille University, Marseille, France
| | - Gaetan Gentile
- Department of General Practice, Aix-Marseille University, Marseille, France
| | - Christian Pradier
- Department of Public Health, Archet University Hospital, Nice, France
| | - Touitou Irit
- Department of Public Health, Archet University Hospital, Nice, France
| | | | - Sophie Tardieu
- CEReSS - Health Service Research and Quality of life Center, Marseille, France
| | - Michel Carles
- Department of Infectious Diseases, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Stéphanie Gentile
- CEReSS - Health Service Research and Quality of life Center, Marseille, France
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Mosnier E, Artigas F, Richard E, Hoyer M, Michels D, Vandentorren S, Girard G, Nagot N, Regnault H, Mosnier M, Inegbeze G, Roux P, Spire B, Eldin C. Effectiveness of a Community Empowerment Intervention to Improve Access to Pre-exposure Prophylaxis in Migrant Women Sex Workers: Protocol for a Mixed Methods Implementation Study. JMIR Res Protoc 2023; 12:e42844. [PMID: 37540547 PMCID: PMC10439469 DOI: 10.2196/42844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 03/24/2023] [Accepted: 04/03/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND The World Health Organization recommends pre-exposure prophylaxis (PrEP) for all populations at substantial risk of HIV infection. However, at-risk women very rarely use PrEP in France-this represents a critical issue among migrant women sex workers (MWSWs). Previous studies on PrEP use among women sex workers or migrants focused on individual or social determinants of motivation. However, operational studies in real-word settings using a holistic population approach to maximize PrEP adherence among MWSWs are lacking. OBJECTIVE FASSETS (ie, "Favoriser l'Accès à la Santé Sexuelle des Travailleuses du Sexe"; English: "facilitate the access to Sexual Health in women sex workers") is a participative, multilevel, mixed methods study aiming to improve global knowledge of and access to sexual health care and PrEP among MWSWs through targeted empowerment strategies. METHODS This study comprises several phases: (1) phase 1: an initial qualitative study combining semistructured interviews, informal interviews, and participative observations will be performed among MWSWs, local community nongovernmental organizations, and institutions providing sexual reproductive health services to identify the determinants of PrEP access among MWSWs and for respondent-driven sampling (RDS); (2) phase 2: the size of the hidden MWSW population is estimated in Marseille through capture-recapture (the RDS survey will serve as "recapture"); (3) phase 3: a longitudinal cohort will be formed through RDS to represent the MWSW population with a goal of 150 inclusions-this cohort will be followed up for 12 months, and sequential questionnaires exploring medical history; knowledge of sexual health, HIV, and sexually transmitted infections; migration route; and current living conditions will be administered at inclusion (month 0) and months 3, 6, and 12 to measure the following interventional phase's outcomes; and (4) phase 4: an interventional study with community empowerment actions about sexual health and PrEP will be conducted with community health workers; standardized questionnaires and semistructured interviews, observations, and focus groups will highlight MWSWs' experiences with empowerment resources, concerns about sexual health, and especially PrEP use or uptake, and we will evaluate whether and how community-adapted empowerment actions conducted by community health workers are effective in increasing access to sexual health, prevention and screening of sexually transmitted infections, and PrEP knowledge and access among MWSWs. RESULTS Recruitment commenced on March 1, 2022. We estimate the follow-up period to end on September 30, 2023. CONCLUSIONS This multiphase study will provide robust evidence about the magnitude of the MWSW population in Marseille (the second largest town in France) and their current conditions of living, access to and knowledge of sexual health, and PrEP access. Using a mixed methods analysis, we will investigate whether individual and collective community health empowerment approaches can facilitate access to PrEP and its initiation, use, and adherence in this vulnerable population. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/42844.
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Affiliation(s)
- Emilie Mosnier
- Aix Marseille University, Inserm, IRD, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM), Aix Marseille Institute of Public Health ISSPAM, Marseille, France
- University of Health and Science, ANRS | MIE site, Phnom Penh, Cambodia
| | | | - Elodie Richard
- Université de Bordeaux; Laboratoire Bordeaux Population Health (BPH), Inserm U1219, Bordeaux, France
- Fnasat-GV, Paris, France
| | - Maxime Hoyer
- Aix Marseille University, Inserm, IRD, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM), Aix Marseille Institute of Public Health ISSPAM, Marseille, France
| | - David Michels
- Laboratoire de recherche Communautaire, Coalition PLUS, AIDES NGO, Pantin, France
| | - Stephanie Vandentorren
- Université de Bordeaux; Laboratoire Bordeaux Population Health (BPH), Inserm U1219, Bordeaux, France
- Santé publique France, Saint Maurice, France
| | - Gabriel Girard
- Aix Marseille University, Inserm, IRD, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM), Aix Marseille Institute of Public Health ISSPAM, Marseille, France
| | - Nicolas Nagot
- Pathogenesis and Control of Chronic & Emerging Infections, University of Montpellier, Inserm, Etablissement Français du Sang, University of Antilles-Guyane, Montpellier, France
| | - Hippolyte Regnault
- Aix Marseille University, Inserm, IRD, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM), Aix Marseille Institute of Public Health ISSPAM, Marseille, France
| | | | | | - Perrine Roux
- Aix Marseille University, Inserm, IRD, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM), Aix Marseille Institute of Public Health ISSPAM, Marseille, France
| | - Bruno Spire
- Aix Marseille University, Inserm, IRD, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM), Aix Marseille Institute of Public Health ISSPAM, Marseille, France
| | - Carole Eldin
- Unité des Virus Émergents (UVE) Aix-Marseille Univ-IRD 190-Inserm 1207-IHU Méditerranée Infection), Marseille, France
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Zhou Y, Luo Y, Cheng F, Zeng H, Wu L, Gao L, Xu J. Migration experiences and reported commercial and non-commercial sexual behaviors among newly diagnosed HIV infections in China: a cross-sectional study. BMC Infect Dis 2023; 23:370. [PMID: 37264345 DOI: 10.1186/s12879-023-08333-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/16/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Migration is known to influence human health. China has a high migration rate and a significant number of people who are HIV-positive, but little is known about how these factors intersect in sexual risk behaviors. OBJECTIVE This study aimed to explore sexual risk behaviors between migrants and non-migrants among newly diagnosed HIV infections, and assess the changes of sexual risk behaviors with length of stay in the current city of migrants. METHODS A cross-sectional questionnaire was conducted among people newly diagnosed with HIV from July 2018 to December 2020 who lived in Zhejiang Province. In the study, sexual risk behaviors included having multiple sexual partners and unprotected sexual behaviors (in commercial sexual behaviors, non-commercial sexual behaviors, heterosexual behaviors, and homosexual behaviors). Binary logistic regression models were employed to explore the influencing factors of sexual risk behaviors, measured by multiple sexual partners and unprotected sexual partners. RESULTS A total of 836 people newly diagnosed with HIV/AIDS were incorporated in the study and 65.31% (546) were migrants. The percentages of non-commercial sexual behaviors among migrants were statistically higher than those of non-migrants. Commercial heterosexual behavior was higher among non-migrants compared with migrants. The proportion of study participants having unprotected sexual behaviors and multiple sexual partners with commercial/non-commercial partners was both higher among migrants compared with non-migrants. Among migrants, the likelihood of sexual risk behaviors in both commercial and non-commercial sex increased in the first 3 years and reduced after 10 years. Compared with non-migrants, migrants were statistically associated with multiple sexual partners [P = .007, odds ratio (OR) = 1.942]. However, migrants did not exhibit a significant difference in unprotected sexual behaviors compared with non-migrants. In addition, migrants aged between 18 and 45 years who relocated to the current city in the past 2-3 years tended to have multiple sexual partners (P < .05). CONCLUSIONS People newly diagnosed with HIV engaged in different sexual risk behaviors among migrants and non-migrants and more attention should be paid to migrants. For non-migrants, it is urgent to promote the prevention of commercial sexual behaviors. For migrants, prevention of non-commercial sexual behaviors and universal access to health care especially for new arrivals who migrated to the current city for 2-3 years are needed. Moreover, sexual health education and early HIV diagnosis are necessary for the entire population.
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Affiliation(s)
- Yuyin Zhou
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, 866 Yuhangtang Rd, 310058, Hangzhou, China
- Department of Pharmacy, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yan Luo
- Shenzhen Pingshan District Center for Disease Control and Prevention, Shenzhen, China
- Hangzhou Center for Disease Control and Prevention, Hangzhou, China
| | - Feng Cheng
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Institute for Healthy China, Tsinghua University, Beijing, China
| | - Huatang Zeng
- Shenzhen Health Development Research and Data Management Center, Shenzhen, China
| | - Liqun Wu
- Shenzhen Health Development Research and Data Management Center, Shenzhen, China
| | - Liangmin Gao
- Institute for International and Area Studies, Tsinghua University, Beijing, China
| | - Junfang Xu
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, 866 Yuhangtang Rd, 310058, Hangzhou, China.
- Department of Pharmacy, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
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Birth Country Influences the Choice of Antiretroviral Therapy in HIV-Infected Individuals: Experience From a French HIV Centre. J Acquir Immune Defic Syndr 2023; 92:144-152. [PMID: 36257296 DOI: 10.1097/qai.0000000000003114] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 09/28/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To assess whether antiretroviral therapy (ART) prescriptions differ between naive and virally suppressed HIV patients born in France (PBFs) and in Sub-Saharan Africa (PBSSAs). SETTING Observational single-center study. METHODS We included all PBFs and PBSSAs who entered into care at Pitié-Salpêtrière Hospital, Paris, France, from 01/01/2000 to 31/12/2018, with plasma HIV-RNA>200 copies/mL. We first compared the initial ART in naive PBFs and PBSSAs. Second, we compared the last-prescribed ART (including drug-reduced ART: daily 2-drug regimens, daily 1-drug regimens and intermittent 3-drug regimens) in virally suppressed PBFs and PBSSAs, by focusing on patients in care in 2018 with HIV-RNA <50 copies for at least 24 months. A univariable and multivariable logistic regression model was used to assess the impact of geographical origin on ART prescriptions. RESULTS A total of 1944 naive patients were included (915 PBSSAs and 1029 PBFs). PBSSAs were more frequently women, hepatitis B coinfected, with a lower pretherapeutic CD4 T-cell count, and most had tuberculosis at HIV diagnosis. After adjustment for confounders, PBSSAs were more likely to receive a first-line protease inhibitor-based regimen (OR 1.61, 95% CI: 1.31 to 1.98), and less likely to receive an integrase inhibitor-based regimen (OR 0.61, 95% CI: 0.42 to 0.88). Of the 968 virally suppressed patients (431 PBSSAs and 537 PBFs), PBSSAs were less likely to receive drug-reduced ART, including 2-drug regimens and intermittent three-drug regimens (OR 0.48, 95% CI: 0.36 to 0.65). CONCLUSIONS Differences in ART prescriptions between PBSSAs and PBFs were not only explained by different clinical and virologic situations. Personal motivations of doctors in choosing ART according to country of birth need to be explored.
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Le Talec JY, Supervie V, Palich R. Acquisition du virus de l’immunodéficience humaine et parcours de vie d’hommes ayant des rapports sexuels avec d’autres hommes et ayant émigré en France : une enquête exploratoire. SANTE PUBLIQUE (VANDOEUVRE-LES-NANCY, FRANCE) 2023; 34:151-162. [PMID: 37336729 DOI: 10.3917/spub.hs2.0151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
INTRODUCTION The ANRS 14058 Ganymede study aims to determine the proportion post-migration HIV-seroconversion in a sample of HIV-positive men having sex with men (MSM) born outside of France and receiving medical care in Paris region (Île-de-France). The study, based on a self-questionnaire, is also focused on the life course of these MSM before, during and after the migration process. PURPOSE OF RESEARCH The paper refers to a qualitative exploratory study, taking place as a prerequisite for the Ganymede study, in order to refine its questionnaire. The purpose of these interviews was also to explore the migratory motivations and experiences, the sexual biography, and the health history, of a sample of seropositive MSM born outside of France, and to illustrate the diversity of this epidemiological category. RESULTS Forteen respondents participated in the interview study. Nine of them have learned of their HIV-positive status after having emigrated to France. None of the respondents mentioned a major barrier to medical care access and HIV follow-up. The obstacles they reported were related to the coverage of medical expenses, due to their possible precarious legal and social situation. These men were exposed to the effects of power relations, leading to discrimination and violence, whose wider impacts on health were weakly evoked. CONCLUSIONS Although the findings of the exploratory study are not to be generalized, they illustrate the health issues of the interviewees, and the wide diversity of their biographies and life courses, emphasizing the impact of gender and class power relations as a source of social and health inequalities, and precariousness. They invite therefore to describe this epidemiological category of "MSM born outside of France" in a more heterogeneous way.
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Kerani RP, Lugg A, Berzins B, Gaye O, Lipira LE, Bundy C, Kwakwa H, Holmes KK, Golden MR. Post-migration HIV acquisition among african immigrants in the U.S. J Immigr Minor Health 2022; 24:1459-1468. [PMID: 35415766 PMCID: PMC9554041 DOI: 10.1007/s10903-022-01356-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 03/10/2022] [Accepted: 03/14/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND African immigrants in the U.S. are more likely to have a late HIV diagnosis than U.S.-born people, potentially leading to onward transmission. We sought to determine the proportion of African-born people living with HIV (APLWH) who (1) had tested HIV negative prior to diagnosis, and (2) likely acquired HIV in the U.S. METHODS We interviewed APLWH from 2014 to 2017 and estimated the proportion with post-migration HIV acquisition based on clinical data, HIV testing history, immigration date, and behavioral data. RESULTS Of 179 participants, 113 (63%) were women. Less than half (44%) reported a negative HIV test prior to diagnosis. Among 142 (79%) participants with sufficient data to evaluate post-migration HIV acquisition, we estimate that 29% acquired HIV post-migration. Most APLWH acquire HIV prior to immigration. DISCUSSION Approximately one-quarter of APLWH acquire HIV post-migration and HIV testing is infrequent, highlighting the need for prevention efforts for African immigrants in the U.S.
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Affiliation(s)
- Roxanne P Kerani
- Department of Medicine, University of Washington, Seattle, WA, United States.
- HIV/STD Program, Public Health - Seattle and King County, Seattle, WA, United States.
- Department of Epidemiology, University of Washington, Seattle, WA, United States.
- Center for AIDS and STD, Harborview Medical Center, 325 9th Ave, Box 359932, 98104, Seattle, WA, United States.
| | - Amanda Lugg
- African Services Committee, New York, NY, United States
| | - Baiba Berzins
- Division of Infectious Diseases, Northwestern University, Evanston, IL, United States
| | - Oumar Gaye
- Philadelphia Department of Public Health, Philadelphia, PA, United States
| | - Lauren E Lipira
- Department of Health Services, University of Washington, Seattle, WA , United States
- Oregon Health Authority and the Regional Research Institute, Portland State University, Portland, OR, United States
| | - Camille Bundy
- Division of Infectious Diseases, Northwestern University, Evanston, IL, United States
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, United States
| | - Helena Kwakwa
- Philadelphia Department of Public Health, Philadelphia, PA, United States
| | - King K Holmes
- Department of Medicine, University of Washington, Seattle, WA, United States
- Department of Epidemiology, University of Washington, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Matthew R Golden
- Department of Medicine, University of Washington, Seattle, WA, United States
- HIV/STD Program, Public Health - Seattle and King County, Seattle, WA, United States
- Department of Epidemiology, University of Washington, Seattle, WA, United States
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Okeke SR. "It was protected, except, it wasn't [with] a condom": a mixed-methods study of BBVs/STIs protective practices among International University Students in Sydney, Australia. BMC Public Health 2022; 22:2168. [PMID: 36434571 PMCID: PMC9700902 DOI: 10.1186/s12889-022-14512-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 11/01/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND A number of previous sex-related studies among international students in Australia and other Western societies may be limited by conflating students from conservative and non-conservative sexual backgrounds. Such conflation leads to situations where nuances and complexities around sex-related experiences are lost or, at most, tangentially investigated. To address this research problem, this study used a mixed-methods design to examine protective practices against blood-borne viruses and sexually transmissible infections (BBVs/STIs) among Sydney-based East Asian and sub-Saharan African international students. METHODS This mixed-methods study generated quantitative data using anonymous online survey (n = 149), and qualitative data through in-depth interviews (n = 20). The main recruitment strategy involved advertising the study through paper and electronic flyers. Quantitative data were analysed using logistic regression, while interviews data were analysed using reflexive thematic analysis. RESULTS Self-reported BBVs/STIs protective practices in the last 12 months include abstinence (28.7%), consistent condom use (19.9%), occasional condom use (18.7%), single partner fidelity (25.1%), other strategies (1.8%), and nothing (5.8%). Further, findings from the bivariate analysis showed higher BBVs/STIs prevention knowledge, lower acculturation into Australian sexual culture, greater access to sexual health information, less conservative sexual norms, greater emotional social support and older age were significantly associated with increased protective practices. Variables significant at bivariate level were entered into a logistic regression. The model was statistically significant, (X2(6) = 31.33, p < 0.01) and explained 33.1% of the variance in BBVs/STIs protective practices. However, only acculturation to sexual norms in Australia (OR = 0.883, 95% CI = 0.820-0.952) was found to be independent predictor of BBVs/STIs protective practices. The results of the study based on the quantitative data, indicated condom use (consistent and occasional) was the most reported BBVs/STIs protective behaviour among sexually active participants. Therefore, interviews data was used to explore condom-use motives and practices. The interviews results showed participants primary concern as regards condom use was around pregnancy and not BBVs/STIs. Thus, some participants described safe sex largely as contraception, with BBVs/STIs constituting a secondary concern or no concern at all. CONCLUSIONS Based on the results of this study, tailored sexual health interventions for international students; which incorporate strategies for modifying perceived sexual norms in Australia, are advocated. In addition, this study recommends sexual health interventions that promote dual protection of condoms for both contraception and BBVs/STIs.
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Affiliation(s)
- Sylvester Reuben Okeke
- grid.1005.40000 0004 4902 0432Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
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Vignier N, Moussaoui S, Marsaudon A, Wittwer J, Jusot F, Dourgnon P. Burden of infectious diseases among undocumented migrants in France: Results of the Premiers Pas survey. Front Public Health 2022; 10:934050. [PMID: 35991026 PMCID: PMC9386354 DOI: 10.3389/fpubh.2022.934050] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 07/11/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction An increase in migration rates to the European Union has been observed over the last few years. Part of these migrants is undocumented. This work aimed to describe the reported frequency of infectious diseases and their associated factors among unselected samples of undocumented migrants in France. Methodology The Premier Pas survey is a cross-sectional epidemiological survey of a random sample (two-stage sample design) conducted among undocumented migrants recruited in Paris and the Bordeaux region, in places and facilities likely to be frequented by undocumented migrants. The percentages were weighted. The analysis was performed using Stata 15.1 software. Results A total of 1,223 undocumented migrants were recruited from 63 places and facilities, with a participation rate of 50%. Most of them were between 30 and 40 years of age (36%), 69% were men, aged mainly 30–40 (36%) years old, from sub-Saharan Africa (60%) or North Africa (25%), and 60% had arrived <3 years earlier. Among the participants, 24.8% declared a poor perceived health status and 33.5% a chronic health condition. Dental infections concerned 43.2% of the participants. Apart from dental issues, 12.9% reported suffering from at least one infectious disease: HIV infection (3.5%), chronic hepatitis B virus infection (3.1%), upper respiratory tract infection (1.7%), skin mycosis (1.2%), skin and soft tissue infection (0.8%), chronic hepatitis C infection (0.8%), urinary tract infection (0.7%), lower respiratory tract infection (0.7%), scabies (0.3%), tuberculosis disease (0.2%), vaginal mycosis (0.6%), and herpes (0.1%). Regarding HIV, HBV, and HCV infections, 56, 71, and 89%, respectively, were diagnosed after their arrival. Chronic viral infections were more often reported by undocumented migrants from sub-Saharan Africa and Latin America. In multivariate analysis, a higher risk of reporting chronic viral infection was observed among people food insecure. Conclusion This original study on a large random sample confirms the frequency of infectious diseases among undocumented migrants in France and the importance of integrating their screening during a health Rendezvous and their management into early access to care and inclusive medico-psycho-social management.
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Affiliation(s)
- Nicolas Vignier
- Institut de recherche et documentation en économie de la santé, IRDES, Paris, France
- Centre d'Investigation Clinique Antilles Guyane, CIC INSERM 1424, Centre hospitalier de Cayenne, Cayenne, French Guiana
- Sorbonne Université, INSERM UMR 1136, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, Department of Social Epidemiology, Paris, France
- French Collaborative Institute on Migration, Institut Convergences Migrations, ICM, Aubervilliers, France
- Université Sorbonne Paris Nord, UFR SMBH, IAME, INSERM UMR 1137, Hôpital Avicenne, Hôpitaux Universitaires Paris Seine-Saint-Denis, AP-HP, Department of Infectious and Tropical diseases, Bobigny, France
- *Correspondence: Nicolas Vignier
| | - Sohela Moussaoui
- Institut de recherche et documentation en économie de la santé, IRDES, Paris, France
- Sorbonne Université, INSERM UMR 1136, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, Department of Social Epidemiology, Paris, France
- Bordeaux University, Bordeaux Population Health, INSERM U1219, Economic and Management of Healthcare Organizations Team, Emos Team, Bordeaux, France
| | - Antoine Marsaudon
- Institut de recherche et documentation en économie de la santé, IRDES, Paris, France
| | - Jérome Wittwer
- Bordeaux University, Bordeaux Population Health, INSERM U1219, Economic and Management of Healthcare Organizations Team, Emos Team, Bordeaux, France
| | - Florence Jusot
- Institut de recherche et documentation en économie de la santé, IRDES, Paris, France
- Université Paris-Dauphine, PSL-Research University, Leda-Legos, Paris, France
| | - Paul Dourgnon
- Institut de recherche et documentation en économie de la santé, IRDES, Paris, France
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Differential patterns of postmigration HIV-1 infection acquisition among Portuguese immigrants of different geographical origins. AIDS 2022; 36:997-1005. [PMID: 35220350 DOI: 10.1097/qad.0000000000003203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the dynamics of phylogenetic transmission clusters involving immigrants of Portuguese Speaking Countries living in Portugal. DESIGN/METHODS We included genomic sequences, sociodemographic and clinical data from 772 HIV migrants followed in Portugal between 2001 and 2017. To reconstruct HIV-1 transmission clusters, we applied phylogenetic inference from 16 454 patients: 772 migrants, 2973 Portuguese and 12 709 global controls linked to demographic and clinical data. Transmission clusters were defined using: clusters with SH greater than 90% (phylogenetic support), genetic distance less than 3.5% and clusters that included greater than 66% of patients from one specific geographic origin compared with the total of sequences within the cluster. Logistic regression was performed to assess factors associated with clustering. RESULTS Three hundred and six (39.6%) of migrants were included in transmission clusters. This proportion differed substantially by region of origin [Brazil 54% vs. Portuguese Speaking African Countries (PALOPs) 36%, P < 0.0001] and HIV-1 infecting subtype (B 52%, 43% subtype G and 32% CRF02_AG, P < 0.001). Belonging to a transmission cluster was independently associated with treatment-naive patients, CD4+ greater than 500, with recent calendar years of sampling, origin from PALOPs and with seroconversion. Among Brazilian migrants - mainly infected with subtype B - 40.6% were infected by Portuguese. Among migrants from PALOPs - mainly infected with subtypes G and CFR02_AG - the transmission occurred predominantly within the migrants' community (53 and 80%, respectively). CONCLUSION The acquisition of infection among immigrants living in Portugal differs according to the country of origin. These results can contribute to monitor the HIV epidemic and prevent new HIV infections among migrants.
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Gil H, Delgado E, Benito S, Georgalis L, Montero V, Sánchez M, Cañada-García JE, García-Bodas E, Díaz A, Thomson MM. Transmission Clusters, Predominantly Associated With Men Who Have Sex With Men, Play a Main Role in the Propagation of HIV-1 in Northern Spain (2013–2018). Front Microbiol 2022; 13:782609. [PMID: 35432279 PMCID: PMC9009226 DOI: 10.3389/fmicb.2022.782609] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
Viruses of HIV-1-infected individuals whose transmission is related group phylogenetically in transmission clusters (TCs). The study of the phylogenetic relations of these viruses and the factors associated with these individuals is essential to analyze the HIV-1 epidemic. In this study, we examine the role of TCs in the epidemiology of HIV-1 infection in Galicia and the Basque County, two regions of northern Spain. A total of 1,158 HIV-1-infected patients from both regions with new diagnoses (NDs) in 2013–2018 were included in the study. Partial HIV-1 pol sequences were analyzed phylogenetically by approximately maximum-likelihood with FastTree 2. In this analysis, 10,687 additional sequences from samples from HIV-1-infected individuals collected in Spain in 1999–2019 were also included to assign TC membership and to determine TCs’ sizes. TCs were defined as those which included viruses from ≥4 individuals, at least 50% of them Spaniards, and with ≥0.95 Shimodaira-Hasegawa-like node support in the phylogenetic tree. Factors associated to TCs were evaluated using odds ratios (OR) and their 95% CI. Fifty-one percent of NDs grouped in 162 TCs. Male patients (OR: 2.6; 95% CI: 1.5–4.7) and men having sex with men (MSM; OR: 2.1; 95% CI: 1.4–3.2) had higher odds of belonging to a TC compared to female and heterosexual patients, respectively. Individuals from Latin America (OR: 0.3; 95% CI: 0.2–0.4), North Africa (OR: 0.4; 95% CI: 0.2–1.0), and especially Sub-Saharan Africa (OR: 0.02; 95% CI: 0.003–0.2) were inversely associated to belonging to TCs compared to native Spaniards. Our results show that TCs are important components of the HIV-1 epidemics in the two Spanish regions studied, where transmission between MSM is predominant. The majority of migrants were infected with viruses not belonging to TCs that expand in Spain. Molecular epidemiology is essential to identify local peculiarities of HIV-1 propagation. The early detection of TCs and prevention of their expansion, implementing effective control measures, could reduce HIV-1 infections.
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Affiliation(s)
- Horacio Gil
- HIV Biology and Variability Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
- *Correspondence: Michael M. Thomson, ; Horacio Gil,
| | - Elena Delgado
- HIV Biology and Variability Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Sonia Benito
- HIV Biology and Variability Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Leonidas Georgalis
- HIV Biology and Variability Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Vanessa Montero
- HIV Biology and Variability Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Mónica Sánchez
- HIV Biology and Variability Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Javier E. Cañada-García
- HIV Biology and Variability Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Elena García-Bodas
- HIV Biology and Variability Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Asunción Díaz
- HIV Surveillance and Behavioral Monitoring Unit, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Michael M. Thomson
- HIV Biology and Variability Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
- *Correspondence: Michael M. Thomson, ; Horacio Gil,
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Cortier M, de La Porte C, Papot E, Goudjo A, Guenneau L, Riou F, Cervantes-Gonzalez M, Prioux M, Yazdanpanah Y, Galy A. Health status and healthcare trajectory of vulnerable asylum seekers hosted in a French Reception Center. Travel Med Infect Dis 2021; 46:102180. [PMID: 34699955 DOI: 10.1016/j.tmaid.2021.102180] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 08/19/2021] [Accepted: 10/18/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Europe lacks studies related to asylum-seekers' health. METHODS We described the health status, healthcare and follow-up of men seeking asylum, accommodated in a primary reception center in Paris (CPA). This observational study included volunteer patients presenting for care at the CPA primary care unit (PCU) from January to March 2018. They could be referred to on-site GPs and psychiatrists or to surrounding healthcare facilities. After their asylum application, patients were transferred to other French accommodation centers. PCU healthcare professionals could make referrals for close medical reassessments after transfer. RESULTS The 728 included men came mostly from Central Asia or Middle East (65%) and Africa (34%). Seventy percent reported violence during migration. Seventy-five percent (547/728) were referred to on-site GPs, 20% to psychiatrists. During patients' stay at CPA, 67% (144/214) of referrals to surrounding healthcare facilities led to performed consultations. Seven percent of all the included patients (49/728) were referred for frequent communicable infectious diseases screening. Final diagnoses (n = 1108) included 31% infectious diseases and 7% psychiatric disorders. When post-transfer accommodation centers could be reached, 69% (33/48) of the medical referrals had led to a scheduled appointment. CONCLUSIONS The healthcare trajectory at CPA could benefit from optimization of infectious and psychiatric screenings, and improved coordination of care and follow-up.
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Affiliation(s)
- Marie Cortier
- Assistance Publique - Hôpitaux de Paris, Nord - Université de Paris, Bichat - Claude-Bernard University Hospital, Department of Infectious and Tropical Diseases, 46 rue Henri Huchard, 75018, Paris, France
| | - Clémentine de La Porte
- Assistance Publique - Hôpitaux de Paris, Nord - Université de Paris, Bichat - Claude-Bernard University Hospital, Department of Infectious and Tropical Diseases, 46 rue Henri Huchard, 75018, Paris, France.
| | - Emmanuelle Papot
- Assistance Publique - Hôpitaux de Paris, Nord - Université de Paris, Bichat - Claude-Bernard University Hospital, Department of Infectious and Tropical Diseases, 46 rue Henri Huchard, 75018, Paris, France; Université de Paris, IAME, INSERM, UMR 1137, 16 rue Henri Huchard, 75018, Paris, France
| | - Abdon Goudjo
- Samusocial de Paris, 35 avenue Courteline, 75012, Paris, France
| | - Laure Guenneau
- Samusocial de Paris, 35 avenue Courteline, 75012, Paris, France
| | - Françoise Riou
- Samusocial de Paris, 35 avenue Courteline, 75012, Paris, France
| | - Minerva Cervantes-Gonzalez
- Assistance Publique - Hôpitaux de Paris, Nord - Université de Paris, Bichat - Claude-Bernard University Hospital, Department of Infectious and Tropical Diseases, 46 rue Henri Huchard, 75018, Paris, France; Université de Paris, IAME, INSERM, UMR 1137, 16 rue Henri Huchard, 75018, Paris, France
| | - Maëlle Prioux
- Samusocial de Paris, 35 avenue Courteline, 75012, Paris, France
| | - Yazdan Yazdanpanah
- Assistance Publique - Hôpitaux de Paris, Nord - Université de Paris, Bichat - Claude-Bernard University Hospital, Department of Infectious and Tropical Diseases, 46 rue Henri Huchard, 75018, Paris, France; Université de Paris, IAME, INSERM, UMR 1137, 16 rue Henri Huchard, 75018, Paris, France
| | - Adrien Galy
- Assistance Publique - Hôpitaux de Paris, Nord - Université de Paris, Bichat - Claude-Bernard University Hospital, Department of Infectious and Tropical Diseases, 46 rue Henri Huchard, 75018, Paris, France
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15
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Pantazis N, Rosinska M, van Sighem A, Quinten C, Noori T, Burns F, Cortes Martins H, Kirwan PD, O'Donnell K, Paraskevis D, Sommen C, Zenner D, Pharris A. Discriminating Between Premigration and Postmigration HIV Acquisition Using Surveillance Data. J Acquir Immune Defic Syndr 2021; 88:117-124. [PMID: 34138772 DOI: 10.1097/qai.0000000000002745] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/02/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Migrant populations are overrepresented among persons diagnosed with HIV in the European Union and the European Economic Area. Understanding the timing of HIV acquisition (premigration or postmigration) is crucial for developing public health interventions and for producing reliable estimates of HIV incidence and the number of people living with undiagnosed HIV infection. We summarize a recently proposed method for determining the timing of HIV acquisition and apply it to both real and simulated data. METHODS The considered method combines estimates from a mixed model, applied to data from a large seroconverters' cohort, with biomarker measurements and individual characteristics to derive probabilities of premigration HIV acquisition within a Bayesian framework. The method is applied to a subset of data from the European Surveillance System (TESSy) and simulated data. FINDINGS Simulation study results showed good performance with the probabilities of correctly classifying a premigration case or a postmigration case being 87.4% and 80.4%, respectively. Applying the method to TESSy data, we estimated the proportions of migrants who acquired HIV in the destination country were 31.9%, 37.1%, 45.3%, and 45.2% for those originating from Africa, Europe, Asia, and other regions, respectively. CONCLUSIONS Although the considered method was initially developed for cases with multiple biomarkers' measurements, its performance, when applied to data where only one CD4 count per individual is available, remains satisfactory. Application of the method to TESSy data, estimated that a substantial proportion of HIV acquisition among migrants occurs in destination countries, having important implications for public health policy and programs.
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Affiliation(s)
- Nikos Pantazis
- Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Magdalena Rosinska
- Department of Epidemiology of Infectious Diseases and Surveillance, National Institute of Public Health-National Institute of Hygiene, Warsaw, Poland
| | | | - Chantal Quinten
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Teymur Noori
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Fiona Burns
- Institute for Global Health, University College London, London, United Kingdom
| | | | - Peter D Kirwan
- Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge, United Kingdom
- Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Division, Public Health England, London, United Kingdom
| | - Kate O'Donnell
- HSE-Health Protection Surveillance Centre, Dublin, Ireland
| | - Dimitrios Paraskevis
- Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | | | - Dominik Zenner
- Centre for Global Public Health, Institute for Population Health Sciences, Queen Mary University London, London, United Kingdom
| | - Anastasia Pharris
- European Centre for Disease Prevention and Control, Stockholm, Sweden
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Yin Z, Brown AE, Rice BD, Marrone G, Sönnerborg A, Suligoi B, Sasse A, Van Beckhoven D, Noori T, Regine V, Delpech VC. Post-migration acquisition of HIV: Estimates from four European countries, 2007 to 2016. ACTA ACUST UNITED AC 2021; 26. [PMID: 34414881 PMCID: PMC8380976 DOI: 10.2807/1560-7917.es.2021.26.33.2000161] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BackgroundThe assumption that migrants acquire human immunodeficiency virus (HIV) before migration, particularly those from high prevalence areas, is common.AimWe assessed the place of HIV acquisition of migrants diagnosed in four European countries using surveillance data.MethodsUsing CD4+ T-cell count trajectories modelled to account for seroconversion bias, we estimated infection year of newly HIV-diagnosed migrants residing in the United Kingdom (UK), Belgium, Sweden and Italy with a known arrival year and CD4+ T-cell count at diagnosis. Multivariate analyses identified predictors for post-migration acquisition.ResultsBetween 2007 and 2016, migrants constituted 56% of people newly diagnosed with HIV in the UK, 62% in Belgium, 72% in Sweden and 29% in Italy. Of 23,595 migrants included, 60% were born in Africa and 70% acquired HIV heterosexually. An estimated 9,400 migrants (40%; interquartile range (IQR): 34-59) probably acquired HIV post-migration. This proportion was similar by risk group, sex and region of birth. Time since migration was a strong predictor of post-migration HIV acquisition: 91% (IQR: 87-95) among those arriving 10 or more years prior to diagnosis; 30% (IQR: 21-37) among those 1-5 years prior. Younger age at arrival was a predictor: 15-18 years (81%; IQR: 74-86), 19-25 years (53%; IQR: 45-63), 26-35 years (37%; IQR: 30-46) and 36 years and older (25%; IQR: 21-33).ConclusionsMigrants, regardless of origin, sex and exposure to HIV are at risk of acquiring HIV post-migration to Europe. Alongside accessible HIV testing, prevention activities must target migrant communities.
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Affiliation(s)
- Zheng Yin
- HIV and STI Department, CIDSC, Public Health England, Colindale, London, United Kingdom
| | - Alison E Brown
- HIV and STI Department, CIDSC, Public Health England, Colindale, London, United Kingdom
| | - Brian D Rice
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Gaetano Marrone
- Department of Infectious Diseases, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Anders Sönnerborg
- Department of Infectious Diseases, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Barbara Suligoi
- National AIDS Unit, Department of Infectious Diseases, National Institute of Health, Rome, Italy
| | - Andre Sasse
- Scientific Institute of Public Health, Brussels, Belgium
| | | | - Teymur Noori
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Vincenza Regine
- National AIDS Unit, Department of Infectious Diseases, National Institute of Health, Rome, Italy
| | - Valerie C Delpech
- HIV and STI Department, CIDSC, Public Health England, Colindale, London, United Kingdom
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Who falls between the cracks? Identifying eligible PrEP users among people with Sub-Saharan African migration background living in Antwerp, Belgium. PLoS One 2021; 16:e0256269. [PMID: 34407146 PMCID: PMC8372948 DOI: 10.1371/journal.pone.0256269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 08/03/2021] [Indexed: 12/25/2022] Open
Abstract
Introduction This study produces an estimate of the proportion of eligible PrEP users among people of Sub-Saharan African background based on the Belgian PrEP eligibility criteria and examines associations with socio-economic and demographic characteristics. Methods We performed logistic regression analysis on data of a representative community-based survey conducted among Sub-Saharan African communities (n = 685) living in Antwerp. Results Almost a third (30.3%) of the respondents were eligible to use PrEP. Those who were male, single, lower educated, undocumented, and had experienced forced sex were more likely to be eligible for PrEP use. The findings highlight the importance of taking intra-, interpersonal and structural HIV risk factors into account. Conclusions The study shows high unmet PrEP needs in this population, especially among those with high vulnerability for HIV acquisition. A better understanding of barriers to PrEP use in this population group is needed to allow for equitable access.
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Poncet L, Panjo H, Ringa V, Andro A. Do vulnerable groups access prevention services? Cervical cancer screening and HIV testing among homeless migrant women in the Paris metropolitan area. PLoS One 2021; 16:e0255900. [PMID: 34388200 PMCID: PMC8363022 DOI: 10.1371/journal.pone.0255900] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 07/26/2021] [Indexed: 11/19/2022] Open
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.
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Affiliation(s)
- Lorraine Poncet
- UVSQ, Univ. Paris-Sud, Inserm, Primary Care and Prevention Team, CESP, Université Paris-Saclay, Villejuif, France
- French Collaborative Institute on Migration, Paris, France
| | - Henri Panjo
- UVSQ, Univ. Paris-Sud, Inserm, Primary Care and Prevention Team, CESP, Université Paris-Saclay, Villejuif, France
| | - Virginie Ringa
- UVSQ, Univ. Paris-Sud, Inserm, Primary Care and Prevention Team, CESP, Université Paris-Saclay, Villejuif, France
| | - Armelle Andro
- French Collaborative Institute on Migration, Paris, France
- Institute of Demography, Université Paris I Pantheon-Sorbonne, Paris, France
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Cuzin L, Allavena C, Cotte L, Delpierre C, Huleux T, Palich R, Delobel P, Raffi F, Cabié A. No barrier to care, yet disparities in the HIV care continuum in France: a nationwide population study. J Antimicrob Chemother 2021; 76:1573-1579. [PMID: 33704444 DOI: 10.1093/jac/dkab061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 02/10/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Even in an 'optimal' health system, patients' characteristics may have an impact on their care. We investigated whether age, gender and place of birth have an impact in the HIV care continuum in France, a country with a universal free healthcare system. METHODS We estimated differences in the 5 year restricted mean percentage of person-time spent (i) in care, (ii) receiving ART and (iii) on ART and virally suppressed among 2432 (30.2%) women, 3925 MSM (48.7%) and 1709 men who have sex with women (MSW; 21.2%) entering care in the Dat'AIDS French prospective cohort between 1 January 2013 and 31 December 2017. Trial registration: Clinicaltrials.gov reference NCT02898987. RESULTS Men and women spent 85.6% and 82.8% of person-time on ART and 69.9% and 65% suppressed, respectively. MSM, MSW and women spent 86.9%, 82.6% and 82.8% of person-time on ART and 72.5%, 63.7% and 65% suppressed, respectively. Patients born in France (47%) and patients born abroad spent 87.9% and 81.9% of person-time on ART and 74.6% and 62.9% suppressed, respectively. Young men born abroad were found to spend the smallest person-time with non-detectable viral load (53% for MSW and 58.1% for MSM). CONCLUSIONS Despite free access to care and universal ART in France, disparities remain in the HIV continuum care across age, country of birth and way of HIV acquisition. Clinical and public health interventions targeting specific patients' conditions are needed.
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Affiliation(s)
- Lise Cuzin
- Infectious and Tropical Diseases Unit, Martinique University Hospital, Fort-de-France, France.,INSERM UMR1027, Toulouse III University, Toulouse, France
| | - Clotilde Allavena
- Infectious and Tropical Diseases, Nantes University Hospital, Nantes, France.,CIC 1413, INSERM, Nantes, France
| | - Laurent Cotte
- Infectious Diseases University Department, Hospices Civils de Lyon, Lyon, France
| | | | - Thomas Huleux
- Infectious Diseases University Department, Tourcoing Hospital, Tourcoing, France
| | - Romain Palich
- Sorbonne University, Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health institute (iPLESP), INSERM 1136, Paris, France
| | - Pierre Delobel
- Infectious and Tropical Diseases Department, Toulouse University Hospital, Toulouse, France.,INSERM UMR1043, Toulouse III University, Toulouse, France
| | - François Raffi
- Infectious and Tropical Diseases, Nantes University Hospital, Nantes, France.,CIC 1413, INSERM, Nantes, France
| | - André Cabié
- Infectious and Tropical Diseases Unit, Martinique University Hospital, Fort-de-France, France.,CIC1424, INSERM, Fort-de-France, France
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20
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Dramatic decline in new HIV diagnoses in persons born in France in a large nationwide HIV cohort. Public Health 2021; 196:129-134. [PMID: 34192605 DOI: 10.1016/j.puhe.2021.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/28/2021] [Accepted: 05/23/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVES As trends in new HIV diagnoses represent a measure of the HIV epidemic, we conducted a 6-year longitudinal study to evaluate the change in rates of new HIV diagnosis, stratified by birthplace, HIV risk groups and CD4 cell count at diagnosis in a large French multicentre cohort. STUDY DESIGN We performed a retrospective cohort study using data from the mainland French Dat'AIDS cohort. METHODS Data were obtained for subjects with a new HIV diagnosis date between 2013 and 2018. HIV diagnosis date was defined as the date of the first known positive HIV serology. RESULTS Between 2013 and 2018, a total of 68,376 people living with HIV (PLHIV) were followed in the Dat'AIDS cohort; 9543 persons were newly diagnosed with HIV. The annual number of new HIV diagnoses decreased from 1856 in 2013, to 1149 in 2018 (-38.1%), P = 0.01; it was more pronounced among subjects born in France, from 858 to 484 (-43.6%), P < 0.01, than in those born abroad (-23.8%, from 821 to 626, P = 0.13). Among subjects born in France, the decrease over the period was -46.7% among men who have sex with men (MSM), -43.5% for heterosexual women and -33.3% for heterosexual men. CONCLUSION Our findings show changes in HIV epidemiology in PLHIV born in France, with a decline around 40% in new HIV diagnoses, and a more pronounced decrease among MSM and heterosexual women. Our results support the long-term effectiveness of the antiretroviral therapy as a prevention strategy among the various tools for HIV prevention.
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21
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Maritim C, McClarty L, Leung S, Bruce S, Restall G, Migliardi P, Becker M. HIV treatment outcomes among newcomers living with HIV in Manitoba, Canada. JOURNAL OF THE ASSOCIATION OF MEDICAL MICROBIOLOGY AND INFECTIOUS DISEASE CANADA = JOURNAL OFFICIEL DE L'ASSOCIATION POUR LA MICROBIOLOGIE MEDICALE ET L'INFECTIOLOGIE CANADA 2021; 6:119-128. [PMID: 36341034 PMCID: PMC9608691 DOI: 10.3138/jammi-2020-0042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 12/04/2020] [Indexed: 06/16/2023]
Abstract
BACKGROUND Despite the overrepresentation of immigrants and refugees (newcomers) in the HIV epidemic in Canada, research on their HIV treatment outcomes is limited. This study addressed this knowledge gap by describing treatment outcomes of newcomers in comparison with Canadian-born persons living with HIV in Manitoba. METHODS Clinical data from 1986 to 2017 were obtained from a cohort of people living with HIV and receiving care from the Manitoba HIV Program. Retrospective cohort analysis of secondary data was completed using univariate and multivariate statistics to compare differences in socio-demographic and clinical characteristics and treatment outcomes among newcomers, Canadian-born Indigenous persons, and Canadian-born non-Indigenous persons on entry into HIV care. RESULTS By end of 2017, 86 newcomers, 259 Canadian-born Indigenous persons, and 356 Canadian-born non-Indigenous persons were enrolled in the cohort. Newcomers were more likely than Canadian-born Indigenous and non- Indigenous cohort participants to be younger and female and have self-reported HIV risk exposure as heterosexual contact. Average CD4 counts at entry into care did not differ significantly between groups. A higher proportion of newcomers was also diagnosed with tuberculosis within 6 months of entry into care (21%), compared with 6% and 0.6% of Canadian-born Indigenous non-Indigenous persons, respectively. Newcomers and Canadian-born non-Indigenous persons had achieved viral load suppression (< 200 copies/mL) at a similar proportion (93%), compared with 82% of Canadian-born Indigenous participants (p < 0.05). CONCLUSIONS The distinct demographic and clinical characteristics of newcomers living with HIV requires a focused approach to facilitate earlier diagnosis, engagement, and support in care.
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Affiliation(s)
- Charity Maritim
- Institute for Global Public Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Leigh McClarty
- Institute for Global Public Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Stella Leung
- Institute for Global Public Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sharon Bruce
- Institute for Global Public Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Gayle Restall
- Department of Occupational Therapy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Paula Migliardi
- Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada
| | - Marissa Becker
- Institute for Global Public Health, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada
- Manitoba HIV Program, Winnipeg, Manitoba, Canada
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Bromberg DJ, Tate MM, Alaei K, Karimov S, Saidi D, Alaei A. Association between time spent in the Russian Federation and late presentation for HIV among Tajikistani migrants. BMC Public Health 2020; 20:1379. [PMID: 32912203 PMCID: PMC7488340 DOI: 10.1186/s12889-020-09434-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 08/24/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Between 700 thousand and 1.2 million citizens of Tajikistan currently live in the Russian Federation, one of the only countries where the HIV epidemic continues to worsen. Given the previously reported barriers to healthcare access for migrants to the Russian Federation, and the rapidly expanding HIV epidemic in Eastern Europe and Central Asia, this present study set out to determine whether these barriers impact late presentation with HIV among Tajikistani migrants upon their return to Tajikistan. METHOD This study uses data from the Tajikistan Ministry of Health surveillance system (2006 - 2019). At time of diagnosis, patients are interviewed by staff of AIDS centers, and doctors complete routine intake forms and complete medical exams. Descriptive characteristics of migrants with HIV who had lived in the Russian Federation (n=503) were calculated and compared with those of non-migrants with HIV (n=9519). Missing data were imputed using multiple imputation (predictive means matching, logistic regression imputation, and polytomous regression imputation). Two logistic models were created to model the probability of late presentation for HIV. The first model shows unadjusted associations between predictor variables and late presentation for HIV. The second model shows multivariable associations between significant study variables identified in the univariate model, and late presentation. RESULTS Compared to non-migrants, migrants with HIV are more likely to be from Gorno-Badakhshan region, are less likely to use illicit drugs, and are more likely to have purchased the services of sex workers. The unadjusted logistic model found that for every year spent in the Russian Federation, the risk of late presentation for a Tajikistani migrant with HIV increases by 4.0% (95% CI: 0.3-7.7). The multivariate model showed that when age, sex, and region of origin are held constant, the risk of late presentation for a Tajikistani migrant with HIV increases by 4.0% (95% CI: 0.1-7.8) for each year spent in the Russian Federation. CONCLUSION The results of this paper suggest that if the Russian Federation were to loosen its restrictions on HIV care for foreign nationals, it might improve the treatment outcomes of migrant laborers. As this analysis is only correlational in nature, further research is needed to explicate the causal pathways of the associations found in the present analysis.
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Affiliation(s)
- Daniel J Bromberg
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, CT, USA
- Center for Interdisciplinary Research on AIDS (CIRA), Yale University, New Haven, CT, USA
| | - Mary M Tate
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Kamiar Alaei
- Institute for International Health and Education, Albany, NY, USA
- Department of Health Sciences, California State University, Long Beach, USA
| | - Saifuddin Karimov
- Republican AIDS Center, Tajikistan Ministry of Health, Dushanbe, Tajikistan
| | - Dilshod Saidi
- Republican AIDS Center, Tajikistan Ministry of Health, Dushanbe, Tajikistan
| | - Arash Alaei
- Institute for International Health and Education, Albany, NY, USA.
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Dias S, Gama A, Abrantes P, Gomes I, Fonseca M, Reigado V, Simões D, Carreiras E, Mora C, Pinto Ferreira A, Akpogheneta O, Martins MO. Patterns of Sexual Risk Behavior, HIV Infection, and Use of Health Services Among Sub-Saharan African Migrants in Portugal. JOURNAL OF SEX RESEARCH 2020; 57:906-913. [PMID: 31002270 DOI: 10.1080/00224499.2019.1601154] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This study identified patterns of sexual risk behavior among a sub-Saharan African migrant (SAM) population in Portugal and examined its associations with human immunodeficiency virus (HIV) prevalence, sociodemographics, use of sexual health services, and HIV testing. A cross-sectional biobehavioral survey was conducted with a venue-based sample of 790 SAMs. Data were collected using questionnaires and rapid HIV tests. Cluster analysis identified five subgroups with differing levels of HIV infection (2.5% to 11.3%). In Cluster 1, most participants reported sexual abstinence over the past year and the remaining used condoms consistently; this cluster had the highest HIV prevalence (11.3%). In Cluster 2, most reported one sexual partner and all reported unprotected sex; all HIV-positive participants in this cluster were unaware of their HIV-positive status. In Clusters 3 and 4, most had four or more partners, yet all used condoms. In Cluster 3, 56.5% reported both regular and occasional partners. In Cluster 4, 74% had only occasional partners; all engaged in commercial sex. In Cluster 5, all reported four or more partners and condomless sex. In all subgroups we found low rates of HIV testing and high unawareness of HIV serostatus. Targeted prevention interventions are needed to reduce unprotected sexual relations and undiagnosed infection, as well as improve linkage to sexual health services.
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Affiliation(s)
- Sónia Dias
- Escola Nacional de Saúde Pública, Centro de Investigação em Saúde Pública , Universidade NOVA de Lisboa
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL
| | - Ana Gama
- Escola Nacional de Saúde Pública, Centro de Investigação em Saúde Pública , Universidade NOVA de Lisboa
| | - Patrícia Abrantes
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL
| | - Isabel Gomes
- Center for Mathematics and Applications, Faculty of Sciences and Technology, Nova University of Lisbon
| | - Miguel Fonseca
- Center for Mathematics and Applications, Faculty of Sciences and Technology, Nova University of Lisbon
| | - Vera Reigado
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL
| | | | - Emília Carreiras
- AJPAS - Associação de Intervenção Comunitária, Desenvolvimento Social e de Saúde
| | - Cristina Mora
- AJPAS - Associação de Intervenção Comunitária, Desenvolvimento Social e de Saúde
| | | | - Onome Akpogheneta
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL
| | - Maria O Martins
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL
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Kerani RP, Satcher Johnson A, Buskin SE, Rao D, Golden MR, Hu X, Hall HI. The Epidemiology of HIV Among People Born Outside the United States, 2010-2017. Public Health Rep 2020; 135:611-620. [PMID: 32805191 DOI: 10.1177/0033354920942623] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Although some studies have reported a higher incidence of HIV infection among non-US-born people than among US-born people, national data on this topic are scarce. We compared the epidemiology of HIV infection between US-born and non-US-born residents of the United States and examined the characteristics of non-US-born people with diagnosed HIV infection by region of birth (ROB). METHODS We used a cross-sectional study design to produce national, population-based data describing HIV infection among US-born and non-US-born people. We analyzed National HIV Surveillance System data for people with HIV infection diagnosed during 2010-2017 and reported to the Centers for Disease Control and Prevention (CDC). We compared data on demographic characteristics, transmission risk category, and stage 3 infection (AIDS) classification within 3 months of HIV diagnosis, by nativity and ROB. RESULTS During 2010-2017, 328 317 children and adult US residents were diagnosed with HIV infection and were reported to CDC: 214 973 (65.5%) were US-born, 50 301 (15.3%) were non-US-born, and 63 043 (19.2%) were missing data on country of birth. After adjusting for missing country of birth, 266 147 (81.1%) people were US-born and 62 170 (18.9%) were non-US-born. This group accounted for 15 928 of 65 645 (24.2%) HIV diagnoses among girls and women and 46 242 of 262 672 (17.6%) HIV diagnoses among boys and men. A larger percentage of non-US-born people than US-born people had stage 3 infection (AIDS) at HIV diagnosis (31.2% vs 23.9%). Among non-US-born people with HIV diagnoses, 19 876 (39.5%) resided in the South. CONCLUSIONS Characterizing non-US-born people with HIV infection is essential for developing effective HIV interventions, particularly in areas with large immigrant populations.
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Affiliation(s)
- Roxanne P Kerani
- 7284 Division of Allergy and Infectious Disease, Department of Medicine, University of Washington, Seattle, WA, USA.,7285 HIV/STD Program, Public Health-Seattle and King County, Seattle, WA, USA.,7284 Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Anna Satcher Johnson
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Susan E Buskin
- 7285 HIV/STD Program, Public Health-Seattle and King County, Seattle, WA, USA.,7284 Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Deepa Rao
- 7284 Department of Global Health, University of Washington, Seattle, WA, USA
| | - Matthew R Golden
- 7284 Division of Allergy and Infectious Disease, Department of Medicine, University of Washington, Seattle, WA, USA.,7285 HIV/STD Program, Public Health-Seattle and King County, Seattle, WA, USA.,7284 Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Xiaohong Hu
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - H Irene Hall
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Gosselin A, Coulibaly K, Ravalihasy A, Carillon S, Ridde V, Derche N, Mbiribindi R, Desgrées du Loû A. Finding the missing link: when community-based outreach in public space is key to engage migrants in health prevention programmes in Paris, France. J Epidemiol Community Health 2020; 74:668-675. [PMID: 32350125 DOI: 10.1136/jech-2019-213394] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 03/18/2020] [Accepted: 03/31/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND One of the classic challenges for prevention programmes is reaching the populations they serve. In France, a substantial number of African migrants living with HIV acquired their infection after migrating. The aim of this paper is to better understand the characteristics of the population reached by a community-based outreach approach. METHODS We compared sociodemographic characteristics across three different groups in the Paris greater area: (1) the general African migrant population (Population census), (2) the African migrant population using either the regular healthcare system or the system for vulnerable populations (PARCOURS Survey) and (3) the African migrant population reached through a community-based mobile unit (Afrique Avenir). Comparisons were conducted according to sex, age, region of origin, duration of residence and occupational and legal statuses using χ2 tests. RESULTS The migrants reached by the mobile unit were mostly men (69%), 52% of whom were younger than 35 years old. They more often lived in precarious situations than did the general sub-Saharan population (49% vs 35% were unemployed, respectively, p<0.001) and the ones accessing the regular healthcare system. Fewer of them lived in precarious situations than did migrants seeking healthcare consultations for vulnerable populations (42% in the mobile unit vs 54% in healthcare consultations were undocumented, p<0.028). CONCLUSION Our study shows that the outreach approach can constitute a missing link in the prevention chain among sub-Saharan African migrants, reaching a group that differs from the general migrant population and from the migrant population in healthcare services-not only the newly arrived migrants who live in more precarious situations but also those who have been in France for several years and are still affected by social hardship.
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Affiliation(s)
- Anne Gosselin
- French Collaborative Institute on Migrations, CNRS, Aubervilliers, France .,ERES, Social Epidemiology Unit, IPLESP, INSERM S1136, Faculté de Médecine de Saint Antoine, Paris, France.,Centre Population et Développement (Université Paris Descartes, IRD, ERL Inserm SAGESUD), Paris, France
| | - Karna Coulibaly
- Centre Population et Développement (Université Paris Descartes, IRD, ERL Inserm SAGESUD), Paris, France.,Institut de Recherche Pour le Développement, Marseille, France
| | - Andrainolo Ravalihasy
- Centre Population et Développement (Université Paris Descartes, IRD, ERL Inserm SAGESUD), Paris, France.,Institut de Recherche Pour le Développement, Marseille, France
| | - Séverine Carillon
- Centre Population et Développement (Université Paris Descartes, IRD, ERL Inserm SAGESUD), Paris, France
| | - Valéry Ridde
- French Collaborative Institute on Migrations, CNRS, Aubervilliers, France.,Centre Population et Développement (Université Paris Descartes, IRD, ERL Inserm SAGESUD), Paris, France.,Institut de Recherche Pour le Développement, Marseille, France
| | | | | | - Annabel Desgrées du Loû
- French Collaborative Institute on Migrations, CNRS, Aubervilliers, France.,Centre Population et Développement (Université Paris Descartes, IRD, ERL Inserm SAGESUD), Paris, France.,Institut de Recherche Pour le Développement, Marseille, France
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Dias S, Gama A, Loos J, Roxo L, Simões D, Nöstlinger C. The role of mobility in sexual risk behaviour and HIV acquisition among sub-Saharan African migrants residing in two European cities. PLoS One 2020; 15:e0228584. [PMID: 32023309 PMCID: PMC7001961 DOI: 10.1371/journal.pone.0228584] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 01/18/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Migrants from high endemic countries accounted for 18% of newly diagnosed HIV infections in Europe in 2017. Knowledge on the link between HIV risk and post-migration travels and their impact on HIV acquisition is scarce, but critical to inform prevention. This study aims to explore risky sexual behaviour and HIV-acquisition among sub-Saharan African migrants, and to assess post-migration mobility as a determinant of sexual risk behaviour. METHODS Data from two cross-sectional bio-behavioural surveys to assess HIV-prevalence conducted in Lisbon and Antwerp were analysed to explore migration-related characteristics, travel patterns, and sexual risk taking in the host country and abroad. Bi- and multivariate associations were estimated through adjusted odds ratios and 95% confidence intervals; multivariable logistic regression determined factors associated with condomless sexual intercourse. RESULTS Among N = 1508 participants above 18 years (58% males), 68% travelled post-migration (49.2% reported intercourse abroad). The overall proportion of condomless sex at last sexual intercourse was high (68.1%). The odds of condomless sex in the host country was five times higher when the last sexual intercourse abroad was also condomless [OR:5.32; 95%CI:2.98-9.25]. About half of the travellers reported concurrency, i.e. a regular partner in the host country while having other sexual partners abroad. Almost three percent of the participants reported being HIV+, but 5% had a reactive HIV test-result, with similar proportions among travellers and non-travellers. Also, among the n = 75 participants with reactive HIV test-results, condomless sex occurred (n = 40) and was associated with mobility. CONCLUSIONS Sub-Saharan African migrants are mobile and engage in sexual risk behaviours in the countries of residence and while travelling, increasing risk of post-migration HIV-acquisition. A transnational perspective on HIV prevention and sexual health promotion is needed for effectively reducing migrants' HIV risk related to their mobility.
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Affiliation(s)
- Sónia Dias
- NOVA National School of Public Health, Public Health Research Centre & Global Health and Tropical Medicine, Universidade NOVA de Lisboa, Lisboa, Portugal
- Comprehensive Health Research Centre (CHRC), Lisboa, Portugal
- * E-mail:
| | - Ana Gama
- NOVA National School of Public Health, Public Health Research Centre & Global Health and Tropical Medicine, Universidade NOVA de Lisboa, Lisboa, Portugal
- Comprehensive Health Research Centre (CHRC), Lisboa, Portugal
| | - Jasna Loos
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Luis Roxo
- NOVA National School of Public Health, Public Health Research Centre & Global Health and Tropical Medicine, Universidade NOVA de Lisboa, Lisboa, Portugal
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Blood-borne chronic viral infections in a large cohort of immigrants in southern Italy: A seven-centre, prospective, screening study. Travel Med Infect Dis 2020; 35:101551. [PMID: 31945499 DOI: 10.1016/j.tmaid.2020.101551] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 12/31/2019] [Accepted: 01/02/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Aim of this study was to evaluate the prevalence of blood-borne chronic viral infections in immigrants living in southern Italy and identify factors associated to viral infections. METHODS A prospective screening program was performed in seven clinical centers operating in Campania, Apulia and Calabria regions in southern Italy, in order to identify immigrants with HBV, HCV or HIV infections. RESULTS Of 4,125 immigrants observed in the study period, 3,839 (93.0%) agreed to be screened: 381 (9.9%) resulted HBsAg-positive, 136 (3.5%) anti-HCV, 62 (1.6%) anti-HIV and 1,448 (37.7%) HBsAg-negative and anti-HBc-positive. Ongoing or previous HBV infection was observed more frequently in males (p = 0.02 and p < 0.001, respectively), whereas HIV infection in females (p = 0.01). Immigrants from western Africa showed a higher rate of HBsAg positivity (p < 0.0001), HBsAg negativity/anti-HBc positivity (p < 0.0001) and anti-HIV positivity (p = 0.004) compared with those from other geographical areas. At multivariate analysis, ongoing HBV infection was associated with male sex (OR 1.49, 95% CI: 1.04-2.14) and origin from western Africa (OR 4.67, 95% CI: 1.70-12.80) and eastern Europe (OR 3.44, 95% CI: 1.17-10.08). HCV infection showed the tendency to be more frequent among males (OR 1.84, 95% CI: 0.99-3.42). HIV infection was associated with an older age (OR 1.04, 95% CI: 1.01-1.06), origin from western Africa (OR 4.09, 95% CI: 1.26-13.29) and female sex (OR 2.38, 95% CI: 1.29-4,39; p = 0.006). CONCLUSIONS The high prevalence of HBV, HCV and HIV infections in our large cohort of immigrants should definitively prompt Italian Healthcare Authorities to develop adequate cost-effective screening policies.
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Gosselin A, Carillon S, Coulibaly K, Ridde V, Taéron C, Kohou V, Zouménou I, Mbiribindi R, Derche N, Desgrées du Loû A. Participatory development and pilot testing of the Makasi intervention: a community-based outreach intervention to improve sub-Saharan and Caribbean immigrants' empowerment in sexual health. BMC Public Health 2019; 19:1646. [PMID: 31805909 PMCID: PMC6896752 DOI: 10.1186/s12889-019-7943-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 11/12/2019] [Indexed: 11/10/2022] Open
Abstract
Background Sub-Saharan and Caribbean immigrants are particularly affected by HIV in Europe, and recent evidence shows that a large portion of them acquired HIV after arrival. There is a need for efficient interventions that can reduce immigrants’ exposure to HIV. We describe the pilot phase of a community-based empowerment outreach intervention among sub-Saharan and Caribbean immigrants in the greater Paris area aimed at 1) constructing the intervention, 2) assessing its feasibility, and 3) assessing the feasibility of its evaluation based on a stepped-wedge approach. Methods 1) To develop the intervention, a literature review was conducted on existing interventions and participatory approaches developed, including the constitution of peer groups. 2) To assess the intervention’s feasibility, a pilot was conducted between April 2018 and December 2018. A daily register was used to collect data on sociodemographic characteristics of all persons who visited the mobile team to assess eligibility and acceptability. 3) To assess the feasibility of performing a stepped-wedge trial to evaluate the intervention, we compared eligibility, enrolment and retention at 3 months in two arms (immediate vs deferred). Chi-squared tests were used to compare reach and retention between the two arms. Results Intervention development. The Makasi intervention was designed as an outreach intervention that starts with the persons’ capacities and helps them appropriate existing resources and information and obtain knowledge about sexual health, based upon motivational interviewing techniques. Intervention Feasibility. Between April 2018 and December 2018, a total of 485 persons were identified as eligible. Participation in the intervention was proposed to 79% of eligible persons. When proposed, the persons enrolled in the intervention with a response rate of 69%. Some were lost to follow-up, and 188 persons were finally included. Evaluation Feasibility. The proportions of eligible (45 and 42%) individuals and of enrolled individuals (65 and 74%) were similar and not significantly different in the immediate and deferred arms, respectively. Conclusions A community-based outreach intervention aimed at improving sub-Saharan and Caribbean immigrants’ empowerment in sexual health is feasible. The pilot phase was key to identifying challenges, designing a relevant intervention and validating the stepped-wedge protocol for evaluation.
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Affiliation(s)
- Anne Gosselin
- French Collaborative Institute on Migrations, Paris, France. .,Department of Social Epidemiology (ERES), Pierre Louis Institute for Epidemiology and Public Health (IPLESP/ INSERM UMR_S 1136), Paris, France. .,CEPED, Centre for Population and Development (Paris Descartes University, IRD, Inserm), Paris, France.
| | - Séverine Carillon
- CEPED, Centre for Population and Development (Paris Descartes University, IRD, Inserm), Paris, France.,Solthis, Paris, France
| | - Karna Coulibaly
- CEPED, Centre for Population and Development (Paris Descartes University, IRD, Inserm), Paris, France
| | - Valéry Ridde
- French Collaborative Institute on Migrations, Paris, France.,CEPED, Centre for Population and Development (Paris Descartes University, IRD, Inserm), Paris, France.,IRD, French Institute for Sustainable Development, Paris, France
| | | | | | | | | | | | - Annabel Desgrées du Loû
- French Collaborative Institute on Migrations, Paris, France.,CEPED, Centre for Population and Development (Paris Descartes University, IRD, Inserm), Paris, France.,IRD, French Institute for Sustainable Development, Paris, France
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Immune profile at HIV infection diagnosis: Evolution in the French Alps area over the last 20 years. Med Mal Infect 2019; 50:428-432. [PMID: 31757516 DOI: 10.1016/j.medmal.2019.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 04/04/2019] [Accepted: 10/23/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Health of HIV-infected people relies on early antiretroviral therapy, i.e. early diagnosis. We aimed to determine whether the characteristics at HIV diagnosis in two French medical centres changed over the last 20 years. PATIENTS AND METHODS All individuals diagnosed with HIV infection in Grenoble University Hospital (N=814) and Annecy Hospital (N=246) between 1997 and 2015 were included. We collected age, country of birth, mode of transmission, CD4T cell count, CD4/CD8 ratio, and HIV viral load. RESULTS Among the 1060 patients (mean age 37.4±11 years, 70.2% of men), 42.5% were men having sex with men (MSM); 65.2% were born in France, and 24.4% were born in Africa. Mean CD4T cell count at diagnosis was 396±288/mm3 and was stable over the study period when considering all patients; when considering the MSM group, a significant increase over time was observed, with a mean increase of 7.3 CD4/mm3 per year (P<0.001). A higher CD4 count at diagnosis was observed after 2005 (400±289 vs 468±271/mm3, P=0.005). The proportion of MSM patients with a CD4 count<200/mm3 at diagnosis was lower after 2005 (14.7% after 2005 and 25.6% before, P=0.028) This was not observed in heterosexual patients (born in Africa or not). CONCLUSION In the MSM population, CD4 count at diagnosis is higher after 2005, suggesting that screening campaigns have become more efficient. This was not observed in other populations, who should be better targeted in future strategies.
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Mayer KH, Allan‐Blitz L. Similar, but different: drivers of the disproportionate HIV and sexually transmitted infection burden of key populations. J Int AIDS Soc 2019; 22 Suppl 6:e25344. [PMID: 31468653 PMCID: PMC6716057 DOI: 10.1002/jia2.25344] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 06/18/2019] [Indexed: 12/30/2022] Open
Affiliation(s)
- Kenneth H Mayer
- Beth Israel Deaconess Medical CenterHarvard Medical SchoolThe Fenway InstituteBostonMA
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Are Opportunities Being Missed? Burden of HIV, STI and TB, and Unawareness of HIV among African Migrants. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16152710. [PMID: 31366010 PMCID: PMC6696163 DOI: 10.3390/ijerph16152710] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 07/26/2019] [Accepted: 07/28/2019] [Indexed: 01/09/2023]
Abstract
Sub-Saharan African migrants (SSAMs) have been disproportionately affected by infectious disease burden. We aimed to identify correlates of HIV, past sexually transmitted infection (STI) and past Tuberculosis infection (TB), as well as examine HIV seropositivity unawareness and testing history among SSAMs. A venue-based sample of 790 SSAMs completed a cross-sectional biobehavioral survey on sexual practices, HIV testing and self-reported infectious diseases; an HIV rapid test was offered. Overall, 5.4% of participants were HIV-positive and 16.7% reported a past STI. Odds of being HIV positive or having a past STI were higher among participants with low socioeconomic status and who experienced violence from a partner. Increased odds of having a past STI were also found among long-term migrants and those who reported sexual risk behaviors. In total, 4.1% of participants had TB in the past; these were more likely male and HIV positive. Unawareness of HIV-positive status was notably high (35%). Half of the participants had never been tested for HIV before, including over a third of those who had STI or TB in the past. Efforts are needed to reduce missed opportunities for HIV/STIs prevention and uptake of HIV testing among SSAMs through more integrated care, while addressing social determinants of infectious diseases.
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Gosselin A, Ravalihasy A, Pannetier J, Lert F, Desgrées du Loû A. When and why? Timing of post-migration HIV acquisition among sub-Saharan migrants in France. Sex Transm Infect 2019; 96:227-231. [PMID: 31350379 PMCID: PMC7231462 DOI: 10.1136/sextrans-2019-054080] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 06/24/2019] [Accepted: 07/08/2019] [Indexed: 11/25/2022] Open
Abstract
Recent 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.
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Affiliation(s)
- Anne Gosselin
- French Collaborative Institute on Migrations, CNRS, Paris, Ile-de-France, France .,Social Epidemiology Department, iPLESP, Inserm S1136, Paris, Ile-de-France, France.,CEPED, Paris Descartes University, IRD, ERL Inserm SAGESUD, Paris, Ile-de-France, France
| | - Andrainolo Ravalihasy
- CEPED, Paris Descartes University, IRD, ERL Inserm SAGESUD, Paris, Ile-de-France, France.,IRD, French National Institute for Sustainable Development, Bondy, Ile-de-France, France
| | - Julie Pannetier
- French Collaborative Institute on Migrations, CNRS, Paris, Ile-de-France, France.,CEPED, Paris Descartes University, IRD, ERL Inserm SAGESUD, Paris, Ile-de-France, France.,Cresppa-GTM, Paris-Nanterre University, Paris 8 University, CNRS, Nanterre, Île-de-France, France
| | - France Lert
- CEPED, Paris Descartes University, IRD, ERL Inserm SAGESUD, Paris, Ile-de-France, France
| | - Annabel Desgrées du Loû
- French Collaborative Institute on Migrations, CNRS, Paris, Ile-de-France, France.,CEPED, Paris Descartes University, IRD, ERL Inserm SAGESUD, Paris, Ile-de-France, France.,IRD, French National Institute for Sustainable Development, Bondy, Ile-de-France, France
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HIV outcomes among migrants from low-income and middle-income countries living in high-income countries: a review of recent evidence. Curr Opin Infect Dis 2019; 31:25-32. [PMID: 29095720 DOI: 10.1097/qco.0000000000000415] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Migrants living in high-income countries are disproportionately affected by HIV infection and frequently have characteristics associated with poor HIV clinical outcomes. HIV epidemiology among migrants is influenced by changes in migration patterns and variations in transmission risk behaviors. Here we review the recently published literature on known HIV outcomes among migrants from low-income and middle-income countries living in high-income countries. RECENT FINDINGS High proportions of migrants acquire HIV after migration, and this group frequently presents to care late. Once established in care, migrants are often more likely to experience worse HIV treatment outcomes compared with native populations. Multiple individual and structural factors influence HIV diagnosis and treatment outcomes among migrants, including disruption of social networks, increased sexual risk behaviors, communication barriers, limited access to care, and stigma. Few studies have examined interventions targeted at improving HIV outcomes among migrants. SUMMARY Stigma and limited access to care appear to be primary drivers of poor HIV outcomes among migrants in high-income countries. Addressing these disparities is limited by difficulties in identifying and monitoring this population as well as a lack of evidence regarding appropriate interventions for migrants living with HIV. Improving outcomes for this group requires interventions that are specifically targeted at this marginalized and growing population.
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Marty L, Cazein F, Panjo H, Pillonel J, Costagliola D, Supervie V. Revealing geographical and population heterogeneity in HIV incidence, undiagnosed HIV prevalence and time to diagnosis to improve prevention and care: estimates for France. J Int AIDS Soc 2019; 21:e25100. [PMID: 29603879 PMCID: PMC5878416 DOI: 10.1002/jia2.25100] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 03/08/2018] [Indexed: 01/06/2023] Open
Abstract
Introduction To close gaps in HIV prevention and care, knowledge about locations and populations most affected by HIV is essential. Here, we provide subnational and sub‐population estimates of three key HIV epidemiological indicators, which have been unavailable for most settings. Methods We used surveillance data on newly diagnosed HIV cases from 2004 to 2014 and back‐calculation modelling to estimate in France, at national and subnational levels, by exposure group and country of birth: the numbers of new HIV infections, the times to diagnosis, the numbers of undiagnosed HIV infections. The denominators used for rate calculations at national and subnational levels were based on population size (aged 18 to 64) estimates produced by the French National Institute of Statistics and Economic Studies and the latest national surveys on sexual behaviour and drug use. Results We estimated that, in 2014, national HIV incidence was 0.17‰ (95% confidence intervals (CI): 0.16 to 0.18) or 6607 (95% CI: 6057 to 7196) adults, undiagnosed HIV prevalence was 0.64‰ (95% CI: 0.57 to 0.70) or 24,197 (95% CI: 22,296 to 25,944) adults and median time to diagnosis over the 2011 to 2014 period was 3.3 years (interquartile range: 1.2 to 5.7). Three mainland regions, including the Paris region, out of the 27 French regions accounted for 56% of the total number of new and undiagnosed infections. Incidence and undiagnosed prevalence rates were 2‐ to 10‐fold higher than the national rates in three overseas regions and in the Paris region (p‐values < 0.001). Rates of incidence and undiagnosed prevalence were higher than the national rates for the following populations (p‐values < 0.001): born‐abroad men who have sex with men (MSM) (respectively, 108‐ and 78‐fold), French‐born MSM (62‐ and 44‐fold), born‐abroad persons who inject drugs (14‐ and 18‐fold), sub‐Saharan African‐born heterosexuals (women 15‐ and 15‐fold, men 11‐ and 13‐fold). Importantly, affected populations varied from one region to another, and in regions apparently less impacted by HIV, some populations could be as impacted as those living in most impacted regions. Conclusions In France, some regions and populations have been most impacted by HIV. Subnational and sub‐population estimates of key indicators are not only essential to adapt, design implement and evaluate tailored HIV interventions in France, but also elsewhere where similar heterogeneity is likely to exist.
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Affiliation(s)
- Lise Marty
- INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | - Françoise Cazein
- Santé publique France, French National Public Health Agency, Saint-Maurice, France
| | - Henri Panjo
- Paris Sud University, Orsay, France.,Centre de Recherche en Epidémiologie et Santé des populations (CESP), INSERM U1018, Villejuif, France
| | - Josiane Pillonel
- Santé publique France, French National Public Health Agency, Saint-Maurice, France
| | - Dominique Costagliola
- INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | - Virginie Supervie
- INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
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Semenza JC, Ebi KL. Climate change impact on migration, travel, travel destinations and the tourism industry. J Travel Med 2019; 26:5445924. [PMID: 30976790 PMCID: PMC7107585 DOI: 10.1093/jtm/taz026] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 04/02/2019] [Accepted: 04/05/2019] [Indexed: 12/19/2022]
Abstract
Background: Climate change is not only increasing ambient temperature but also accelerating the frequency, duration and intensity of extreme weather and climate events, such as heavy precipitation and droughts, and causing sea level rise, which can lead to population displacement. Climate change-related reductions in land productivity and habitability and in food and water security can also interact with demographic, economic and social factors to increase migration. In addition to migration, climate change has also implications for travel and the risk of disease. This article discusses the impact of climate change on migration and travel with implications for public health practice. Methods: Literature review. Results: Migrants may be at increased risk of communicable and non-communicable diseases, due to factors in their country of origin and their country of destination or conditions that they experience during migration. Although migration has not been a significant driver of communicable disease outbreaks to date, public health authorities need to ensure that effective screening and vaccination programmes for priority communicable diseases are in place.Population growth coupled with socio-economic development is increasing travel and tourism, and advances in technology have increased global connectivity and reduced the time required to cover long distances. At the same time, as a result of climate change, many temperate regions, including high-income countries, are now suitable for vector-borne disease transmission. This is providing opportunities for importation of vectors and pathogens from endemic areas that can lead to cases or outbreaks of communicable diseases with which health professionals may be unfamiliar. Conclusion: Health systems need to be prepared for the potential population health consequences of migration, travel and tourism and the impact of climate change on these. Integrated surveillance, early detection of cases and other public health interventions are critical to protect population health and prevent and control communicabledisease outbreaks.
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Affiliation(s)
- Jan C Semenza
- Scientific Assessment Section, European Centre for Disease Prevention and Control (ECDC), Gustav III:s boulevard 40, Solna, Sweden
| | - Kristie L Ebi
- Department of Global Health, University of Washington, PO Box 354695, Suite 2330, Seattle, WA, USA
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Favarato G, Bailey H, Burns F, Prieto L, Soriano-Arandes A, Thorne C. Migrant women living with HIV in Europe: are they facing inequalities in the prevention of mother-to-child-transmission of HIV?: The European Pregnancy and Paediatric HIV Cohort Collaboration (EPPICC) study group in EuroCoord. Eur J Public Health 2019; 28:55-60. [PMID: 28449111 DOI: 10.1093/eurpub/ckx048] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background In pregnancy early interventions are recommended for prevention of mother-to-child-transmission (PMTCT) of HIV. We examined whether pregnant women who live with HIV in Europe and are migrants encounter barriers in accessing HIV testing and care. Methods Four cohorts within the European Pregnancy and Paediatric HIV Cohort Collaboration provided data for pooled analysis of 11 795 pregnant women who delivered in 2002-12 across ten European countries. We defined a migrant as a woman delivering in a country different from her country of birth and grouped the countries into seven world regions. We compared three suboptimal PMTCT interventions (HIV diagnosis in late pregnancy in women undiagnosed at conception, late anti-retroviral therapy (ART) start in women diagnosed but untreated at conception and detectable viral load (VL) at delivery in women on antenatal ART) in native and migrant women using multivariable logistic regression models. Results Data included 9421 (79.9%) migrant women, mainly from sub-Saharan Africa (SSA); 4134 migrant women were diagnosed in the current pregnancy, often (48.6%) presenting with CD4 count <350 cells/µl. Being a migrant was associated with HIV diagnosis in late pregnancy [OR for SSA vs. native women, 2.12 (95% CI 1.67, 2.69)] but not with late ART start if diagnosed but not on ART at conception, or with detectable VL at delivery once on ART. Conclusions Migrant women were more likely to be diagnosed in late pregnancy but once on ART virological response was good. Good access to antenatal care enables the implementation of PMTCT protocols and optimises both maternal and children health outcomes generally.
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Affiliation(s)
- G Favarato
- Faculty of Population Health Sciences, UCL, UCL Great Ormond Street Institute of Child Health, London, UK
| | - H Bailey
- Faculty of Population Health Sciences, UCL, UCL Great Ormond Street Institute of Child Health, London, UK
| | - F Burns
- Research Department of Infection and Population Health, UCL, London, UK.,Royal Free London NHS Foundation Trust, London, UK
| | - L Prieto
- Department of Paediatrics, Hospital Universitario de Getafe, Madrid, Spain
| | - A Soriano-Arandes
- Paediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - C Thorne
- Faculty of Population Health Sciences, UCL, UCL Great Ormond Street Institute of Child Health, London, UK
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Pottie K, Lotfi T, Kilzar L, Howeiss P, Rizk N, Akl EA, Dias S, Biggs BA, Christensen R, Rahman P, Magwood O, Tran A, Rowbotham N, Pharris A, Noori T, Pareek M, Morton R. The Effectiveness and Cost-Effectiveness of Screening for HIV in Migrants in the EU/EEA: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15081700. [PMID: 30096905 PMCID: PMC6121945 DOI: 10.3390/ijerph15081700] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 07/19/2018] [Accepted: 08/01/2018] [Indexed: 01/08/2023]
Abstract
Migrants, defined as individuals who move from their country of origin to another, account for 40% of newly-diagnosed cases of human immunodeficiency virus (HIV) in the European Union/European Economic Area (EU/EEA). Populations at high risk for HIV include migrants, from countries or living in neighbourhoods where HIV is prevalent, and those participating in high risk behaviour. These migrants are at risk of low CD4 counts at diagnosis, increased morbidity, mortality, and onward transmission. The aim of this systematic review is to evaluate the effectiveness and cost-effectiveness of HIV testing strategies in migrant populations and to estimate their effect on testing uptake, mortality, and resource requirements. Following a systematic overview, we included four systematic reviews on the effectiveness of strategies in non-migrant populations and inferred their effect on migrant populations, as well as eight individual studies on cost-effectiveness/resource requirements. We assessed the certainty of our results using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. The systematic reviews reported that HIV tests are highly accurate (rapid test >90% sensitivity, Western blot and ELISA >99% sensitivity). A meta-analysis showed that rapid testing approaches improve the access and uptake of testing (risk ratio = 2.95, 95% CI: 1.69 to 5.16), and were associated with a lower incidence of HIV in the middle-aged women subgroup among marginalised populations at a high risk of HIV exposure and HIV related stigma. Economic evidence on rapid counselling and testing identified strategic advantages with rapid tests. In conclusion, community-based rapid testing programmes may have the potential to improve uptake of HIV testing among migrant populations across a range of EU/EEA settings.
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Affiliation(s)
- Kevin Pottie
- Bruyère Research Institute, 85 Primrose Ave, Annex E, Ottawa, ON K1R 7G5, Canada.
- Departments of Family Medicine & Epidemiology and Community Medicine, University of Ottawa, Ottawa, ON K1N 6N5, Canada.
| | - Tamara Lotfi
- Faculty of Health Sciences, American University of Beirut, Beirut 1107 2020, Lebanon.
- AUB GRADE Center, Clinical Research Institute, American University of Beirut, Beirut 1107 2020, Lebanon.
| | - Lama Kilzar
- Faculty of Health Sciences, American University of Beirut, Beirut 1107 2020, Lebanon.
| | - Pamela Howeiss
- Department of Internal Medicine, American University of Beirut, Beirut 1107 2020, Lebanon.
| | - Nesrine Rizk
- Department of Internal Medicine, American University of Beirut, Beirut 1107 2020, Lebanon.
| | - Elie A Akl
- Faculty of Health Sciences, American University of Beirut, Beirut 1107 2020, Lebanon.
- AUB GRADE Center, Clinical Research Institute, American University of Beirut, Beirut 1107 2020, Lebanon.
- Department of Internal Medicine, American University of Beirut, Beirut 1107 2020, Lebanon.
| | - Sonia Dias
- National School of Public Health, Centro de Investigação em Saúde Pública & GHTM/IHMT, Universidade Nova de Lisboa, 2825-149 Caparica, Portugal.
| | - Beverly-Ann Biggs
- Department of Medicine/RMH at the Doherty Institute, The University of Melbourne Vic Australia, Parkville 3010, Australia.
| | - Robin Christensen
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, 2000 Frederiksberg, Denmark.
- Department of Rheumatology, Odense University Hospital, 5000 Odense, Denmark.
| | - Prinon Rahman
- Bruyère Research Institute, 85 Primrose Ave, Annex E, Ottawa, ON K1R 7G5, Canada.
| | - Olivia Magwood
- Bruyère Research Institute, 85 Primrose Ave, Annex E, Ottawa, ON K1R 7G5, Canada.
| | - Anh Tran
- NHMRC Clinical Trials Centre, The University of Sydney, Campbell 2006, Australia.
| | - Nick Rowbotham
- NHMRC Clinical Trials Centre, The University of Sydney, Campbell 2006, Australia.
| | - Anastasia Pharris
- European Centre for Disease Prevention and Control, 16973 Solna, Sweden.
| | - Teymur Noori
- European Centre for Disease Prevention and Control, 16973 Solna, Sweden.
| | - Manish Pareek
- Department of Infection, Immunity and Inflammation, University of Leicester, Leicester LE1 7RH, UK.
| | - Rachael Morton
- NHMRC Clinical Trials Centre, The University of Sydney, Campbell 2006, Australia.
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Pareek M, Noori T, Hargreaves S, van den Muijsenbergh M. Linkage to Care Is Important and Necessary When Identifying Infections in Migrants. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E1550. [PMID: 30037142 PMCID: PMC6069072 DOI: 10.3390/ijerph15071550] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 07/16/2018] [Accepted: 07/17/2018] [Indexed: 11/17/2022]
Abstract
Migration is an important driver of population dynamics in Europe. Although migrants are generally healthy, subgroups of migrants are at increased risk of a range of infectious diseases. Early identification of infections is important as it prevents morbidity and mortality. However, identifying infections needs to be supported by appropriate systems to link individuals to specialist care where they can receive further diagnostic tests and clinical management. In this commentary we will discuss the importance of linkage to care and how to minimise attrition in clinical pathways.
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Affiliation(s)
- Manish Pareek
- Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, LE1 7RH, UK.
- Department of Infection and Tropical Medicine, University Hospitals Leicester NHS Trust, Leicester LE1 5WW, UK.
| | - Teymur Noori
- European Centre for Disease Prevention and Control, 16973 Solna, Sweden.
| | - Sally Hargreaves
- Section of Infectious Diseases and Immunity, Department of Medicine, Imperial College London, Hammersmith Hospital, London W12 0HS, UK.
- The Institute for Infection and Immunity, St George's, University of London, London WC1E 7HU, UK.
| | - Maria van den Muijsenbergh
- Department of Primary and Community Care, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands.
- Pharos, Dutch Centre of Expertise on Health Disparities, 3507 LH Utrecht, The Netherlands.
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Factors associated with late presentation for HIV care in a single Belgian reference center: 2006-2017. Sci Rep 2018; 8:8594. [PMID: 29872068 PMCID: PMC5988738 DOI: 10.1038/s41598-018-26852-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 05/18/2018] [Indexed: 01/20/2023] Open
Abstract
Late presentation for HIV care is a major issue and the cause of higher morbidity, mortality and transmission. In this regard, we analyzed the characteristics of patients presenting for care at our center from January 2006 to July 2017 (n = 687). The majority of the studied population was of African origin (54.3%) with heterosexual women representing the main group (n = 292; 42.5%). 44% of the patients were late presenters (LP) (presenting for care with CD4 T cells <350/mm3 or an AIDS defining event) and 24% were late presenters with advanced disease (LP-AD) (presenting for care with CD4 T cells <200/mm3 or an AIDS defining event). A very high risk of being LP and LP-AD was associated with Sub-Saharan origin (OR 3.4 and 2.6 respectively). Other factors independently associated with LP or LP-AD were age (OR 1.3), male gender (OR 2.0 and 1.5 respectively) and heterosexual route of transmission (OR 2.4 and 2.3 respectively). A significant increase in HIV screening without forgetting those groups would contribute to earlier HIV diagnosis, a key element to end the HIV epidemic. To achieve this goal, addressing the specific hurdles to HIV testing in the migrant population is critical.
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Kerani RP, Herbeck JT, Buskin SE, Dombrowksi JC, Bennett A, Barash E, Barbee LA, Golden MR. Evidence of Local HIV Transmission in the African Community of King County, Washington. J Immigr Minor Health 2018; 19:891-896. [PMID: 27395379 DOI: 10.1007/s10903-016-0458-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Little is known about the frequency of ongoing HIV transmission within U.S. African immigrant communities. We used HIV surveillance and partner services data to describe African-born persons newly reported with HIV infection in King County (KC), WA from 1/1/2010 to 12/31/2013. We performed phylogenetic clustering analysis of HIV-1 pol to identify putative transmission events within this population. From 2010 to 2013, 1148 KC adults were reported with HIV, including 102 (9 %) born in Africa. Forty-one African-born cases were interviewed and reported diagnosis after arrival in the U.S. Fourteen (34 %) reported ≥1 negative test prior to diagnosis, and 9 (26 %) reported ≥1 negative test after U.S. arrival. Pol genotypes were available for seven of these nine. For two of these seven, a KC case was the nearest phylogenetic neighbor; two others were infected with subtype B virus. We found substantial evidence of ongoing HIV transmission in the African community of KC.
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Affiliation(s)
- Roxanne P Kerani
- HIV/STD Program, Public Health - Seattle and King County, Seattle, WA, USA. .,Department of Medicine, University of Washington, Seattle, WA, USA. .,Department of Epidemiology, University of Washington, Seattle, WA, USA.
| | - Joshua T Herbeck
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Susan E Buskin
- HIV/STD Program, Public Health - Seattle and King County, Seattle, WA, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Julia C Dombrowksi
- HIV/STD Program, Public Health - Seattle and King County, Seattle, WA, USA.,Department of Medicine, University of Washington, Seattle, WA, USA
| | - Amy Bennett
- HIV/STD Program, Public Health - Seattle and King County, Seattle, WA, USA
| | - Elizabeth Barash
- HIV/STD Program, Public Health - Seattle and King County, Seattle, WA, USA
| | - Lindley A Barbee
- HIV/STD Program, Public Health - Seattle and King County, Seattle, WA, USA.,Department of Medicine, University of Washington, Seattle, WA, USA
| | - Matthew R Golden
- HIV/STD Program, Public Health - Seattle and King County, Seattle, WA, USA.,Department of Medicine, University of Washington, Seattle, WA, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA
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Vignier N, Desgrées du Loû A, Pannetier J, Ravalihasy A, Gosselin A, Lert F, Lydié N, Bouchaud O, Dray Spira R. Access to health insurance coverage among sub-Saharan African migrants living in France: Results of the ANRS-PARCOURS study. PLoS One 2018; 13:e0192916. [PMID: 29447257 PMCID: PMC5814022 DOI: 10.1371/journal.pone.0192916] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 01/20/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Migrants' access to care depends on their health insurance coverage in the host country. We aimed to evaluate in France the dynamic and the determinants of health insurance coverage acquisition among sub-Saharan migrants. METHODS In the PARCOURS life-event retrospective survey conducted in 2012-2013 in health-care facilities in the Paris region, data on health insurance coverage (HIC) each year since arrival in France has been collected among three groups of sub-Saharan migrants recruited in primary care centres (N = 763), centres for HIV care (N = 923) and for chronic hepatitis B care (N = 778). Year to year, the determinants of the acquisition and lapse of HIC were analysed with mixed-effects logistic regression models. RESULTS In the year of arrival, 63.4% of women and 55.3% of men obtained HIC. But three years after arrival, still 14% of women and 19% of men had not obtained HIC. HIC acquisition was accelerated in case of HIV or hepatitis B infection, for migrants arrived after 2000, and for women in case of pregnancy and when they were studying. Conversely, it was slowed down in case of lack of a residency permit and lack of financial resources for men. In addition, women and men without residency permits were more likely to have lost HIC when they had one. CONCLUSION In France, the health insurance system aiming at protecting all, including undocumented migrants, leads to a prompt access to HIC for migrants from sub-Saharan Africa. Nevertheless, this access may be impaired by administrative and social insecurities.
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Affiliation(s)
- Nicolas Vignier
- INSERM, Sorbonne Université, Institut Pierre Louis d’Épidémiologie et de Santé Publique (IPLESP), Department of Social Epidemiology, Paris, France
- Groupe hospitalier Sud Ile-de-France, Department of Infectious and Tropical Diseases, Melun, France
| | | | - Julie Pannetier
- Sorbonne Paris Cités, IRD, CEPED, ERL INSERM 1244 SAGESUD, Paris, France
| | | | - Anne Gosselin
- Sorbonne Paris Cités, IRD, CEPED, ERL INSERM 1244 SAGESUD, Paris, France
| | - France Lert
- INSERM, Centre for Research in Epidemiology and Population Health (CESP-U 1018), Villejuif, France
| | - Nathalie Lydié
- Santé Publique France, French National Agency of Public Health, Saint-Maurice, France
| | - Olivier Bouchaud
- Paris 13 University, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Infectious and Tropical diseases, and Laboratoire Educations et Pratiques de Santé (LEPS EA 3412), Bobigny, France
| | - Rosemary Dray Spira
- INSERM, Sorbonne Université, Institut Pierre Louis d’Épidémiologie et de Santé Publique (IPLESP), Department of Social Epidemiology, Paris, France
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Nacher M, Adriouch L, Van Melle A, Parriault MC, Adenis A, Couppié P. Country of infection among HIV-infected patients born abroad living in French Guiana. PLoS One 2018; 13:e0192564. [PMID: 29420591 PMCID: PMC5805311 DOI: 10.1371/journal.pone.0192564] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 01/25/2018] [Indexed: 11/19/2022] Open
Abstract
Background Over 75% of patients in the HIV cohort in French Guiana are of foreign origin. Our objective was to estimate what proportion of the migrant population of HIV-infected patients in Cayenne had been infected in French Guiana. Methods We included patients of known foreign origin who were followed in Cayenne, for whom the year of arrival in French Guiana was known and the initial CD4 count at the time of diagnosis was available. The time between seroconversion and time at diagnosis was estimated using the formula [square root (CD4 at seroconversion)-square root(CD4 at HIV diagnosis)] / slope of CD4 decline.CD4 counts at the time of infection and the slope were computed in an age and ethnicity-dependent variable. Results The median estimated time between infection and diagnosis was 4.5 years (IQR = 0.2–9.2). Overall, using a median estimate of CD4 count at the time of infection, it was estimated that 53.2% (95% CI = 48.3–58%) of HIV infected foreign patients had acquired HIV after having arrived in French Guiana. Patients having arrived in French Guiana before and during the 1990s and those receiving their HIV diagnosis before 2010 were more likely to have been infected in French Guiana. Conclusions Contrary to widespread belief suggesting that most migrants are already HIV-infected when they arrive in French Guiana, a large proportion of foreign HIV patients seem acquire the virus in French Guiana.There is still much to do in terms of primary prevention and testing among migrants.
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Affiliation(s)
- Mathieu Nacher
- Centre d’Investigation Clinique Antilles Guyane, CIC INSERM1424 ; Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana
- Coordination Régionale de la lutte contre le VIH (COREVIH Guyane) Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana
- * E-mail:
| | - Leila Adriouch
- Coordination Régionale de la lutte contre le VIH (COREVIH Guyane) Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana
| | - Astrid Van Melle
- Centre d’Investigation Clinique Antilles Guyane, CIC INSERM1424 ; Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana
| | - Marie-Claire Parriault
- Centre d’Investigation Clinique Antilles Guyane, CIC INSERM1424 ; Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana
| | - Antoine Adenis
- Centre d’Investigation Clinique Antilles Guyane, CIC INSERM1424 ; Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana
| | - Pierre Couppié
- Service de Dermatologie Vénéréologie, Centre hospitalier Andrée Rosemon, Cayenne, French Guiana
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Limousi F, Lert F, Desgrées du Loû A, Dray-Spira R, Lydié N. Dynamic of HIV-testing after arrival in France for migrants from sub-Saharan Africa: The role of both health and social care systems. PLoS One 2017; 12:e0188751. [PMID: 29267347 PMCID: PMC5739385 DOI: 10.1371/journal.pone.0188751] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 11/13/2017] [Indexed: 11/24/2022] Open
Abstract
Objective HIV testing is an important tool in the management of the HIV epidemic among key populations. We aimed to explore the dynamic of first-time HIV testing in France for sub-Saharan migrants after their arrival. Methods ANRS-Parcours is a retrospective life-event survey conducted from 2012 to 2013 in healthcare facilities in the Paris region, among 926 sub-Saharan HIV-infected migrants and 763 non-infected migrants. After describing the time to first HIV test in France and associated circumstances, we performed a discrete-time logistic regression to analyze the influence of socioeconomic position, contact with the healthcare system and sexual behaviors, on first-time HIV testing in France in migrants who arrived after 2000. Results Median first-time HIV testing occurred during the second year spent in France for non-infected men and women in both groups, and during the first year for men of the HIV group. The probability of testing increased with hospitalization and pregnancy for women of both groups. For non-infected men unemployment and absence of a residence permit were associated with an increased probability of HIV testing [respectively, OR = 2.2 (1.2–4.1) and OR = 2.0 (1.1–3.5)]. Unemployment was also associated with an increased probability of first-time HIV-testing for women of the HIV group [OR: 1.7 (1.0–2.7)]. Occasional and multiple sexual relationships were associated with an increased probability of first-time testing only for HIV-infected women [OR: 2.2 (1.2–4.0) and OR = 2.4 (1.3–4.6)]. Conclusion Access to first HIV testing in France is promoted by contact with the health care system and is facilitated for unemployed and undocumented migrants after arrival.However, testing should be offered more systematically and repeated in order to reduce time between HIV infection and diagnosis, especially for deprived people which are particularly vulnerable regarding HIV infection.
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Affiliation(s)
| | - France Lert
- Institut National de la Santé et de la Recherche Médicale (INSERM), CESP-U 1018, Villejuif, France
| | - Annabel Desgrées du Loû
- CEPED, UMR Institut de Recherche pour le développement (IRD)-Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Rosemary Dray-Spira
- Sorbonne Universités, UPMC Univ Paris 06, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Pierre Louis d’Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
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Pannetier J, Lert F, Jauffret Roustide M, du Loû AD. Mental health of sub-saharan african migrants: The gendered role of migration paths and transnational ties. SSM Popul Health 2017; 3:549-557. [PMID: 29349245 PMCID: PMC5769072 DOI: 10.1016/j.ssmph.2017.06.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 05/17/2017] [Accepted: 06/26/2017] [Indexed: 11/27/2022] Open
Abstract
In Europe, migrants are at higher risk of common mental disorders or psychological distress than are natives. Little is known regarding the social determinants of migrant mental health, particularly the roles played by migration conditions and transnational practices, which may manifest themselves in different ways for men and for women. The goal of this paper was to understand the gendered roles of migration paths and transnational ties in mental health among sub-Saharan African migrants residing in the Paris, France, metropolitan area. This study used data from the Parcours study conducted in 2012-2013, which employed a life-event approach to collect data from a representative sample of migrants who visited healthcare facilities (n = 2468). We measured anxiety and depressive symptoms at the time of data collection with the Patient Health Questionnaire-4 (PHQ-4). Reasons for migration, the living conditions in the host country and transnational ties after migration were taken into account by sex and after adjustment. Our study demonstrates that among sub-Saharan African migrants, mental health is related to the migratory path and the migrant's situation in the host country but differently for women and men. Among women, anxiety and depressive symptoms were strongly related to having left one's home country because of threats to one's life. Among men, residing illegally in the host country was related to impaired mental health. For both women and men, cross-border separation from a child less than 18 years old was not independently associated with anxiety and depressive symptoms. In addition, social and emotional support from relatives and friends-both from the society of origin and of destination-were associated with lower anxiety and depressive symptoms. Migrant mental health may be impaired in the current context of anti-migrant policies and an anti-immigrant social environment in Europe.
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Affiliation(s)
- Julie Pannetier
- CEPED, Centre Population et Développement (IRD-Université Paris Descartes), Paris, France
| | - France Lert
- CEPED, Centre Population et Développement (IRD-Université Paris Descartes), Paris, France
| | - Marie Jauffret Roustide
- CERMES 3, Centre de Recherche Médecine, Sciences, Santé, Santé Mentale, Société, (CNRS-Inserm Université Paris Descartes), Paris, France
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Abstract
OBJECTIVE We aimed to estimate the proportion of postmigration HIV acquisition among HIV-positive migrants in Europe. DESIGN To reach HIV-positive migrants, we designed a cross-sectional study performed in HIV clinics. METHODS The study was conducted from July 2013 to July 2015 in 57 clinics (nine European countries), targeting individuals over 18 years diagnosed in the preceding 5 years and born abroad. Electronic questionnaires supplemented with clinical data were completed in any of 15 languages. Postmigration HIV acquisition was estimated through Bayesian approaches combining extensive information on migration and patients' characteristics. CD4 cell counts and HIV-RNA trajectories from seroconversion were estimated by bivariate linear mixed models fitted to natural history data. Postmigration acquisition risk factors were investigated with weighted logistic regression. RESULTS Of 2009 participants, 46% were MSM and a third originated from sub-Saharan Africa and Latin America & Caribbean, respectively. Median time in host countries was 8 years. Postmigration HIV acquisition was 63% (95% confidence interval: 57-67%); 72% among MSM, 58 and 51% in heterosexual men and women, respectively. Postmigration HIV acquisition was 71% for Latin America and Caribbean migrants and 45% for people from sub-Saharan Africa. Factors associated with postmigration HIV acquisition among heterosexual women and MSM were age at migration, length of stay in host country and HIV diagnosis year and among heterosexual men, length of stay in host country and HIV diagnosis year. CONCLUSION A substantial proportion of HIV-positive migrants living in Europe acquired HIV postmigration. This has important implications for European public health policies.
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Timing of combined antiretroviral treatment initiation in male and female migrants living with HIV in Western Europe. AIDS 2017; 31:835-846. [PMID: 28272136 DOI: 10.1097/qad.0000000000001411] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND We evaluate differences in timing of cART (combined antiretroviral treatment) initiation by geographical origin in male and female HIV-positive patients in the Collaboration of Observational HIV Epidemiological Research Europe, a large European Collaboration of HIV Cohorts. METHODS We included individuals recruited in Western Europe between January 1997 and March 2013, with known geographical origin and at least 1 CD4 cell count measurement while cART-naive. Timing of cART was assessed through modified time-to-event methods, in which a scale of CD4 cell counts was used instead of time, with cART being the outcome. We estimated the median CD4 cell count at cART initiation (estimated CD4 levels at which the probability of having started cART is 50%) using Kaplan-Meier and adjusted hazard ratios of cART initiation using Cox regression. RESULTS Of 151 674 individuals, 110 592 (72.9%) were men. Median (95% confidence interval) CD4 cell count falls far below 250 cells/μl in all groups and was lowest in sub-Saharan African [SSA: 161 (158-167)], Caribbean men [161 (150-174)] and in Asian women [Asian Continent and Oceania: 185 (165-197)]. Among men, the adjusted probability of cART initiation was lower in migrants compared with natives, but differences depended on initial CD4 cell count. For example, in the group with more than 500 CD4 at recruitment, they were 45% (36-53%), 30% (17-40%) and 25% (19-30%) lower for Caribbean, Eastern European and SSA men, respectively. In women, no meaningful differences were observed between natives and most migrant groups. However, SSA women had a 31% (24-38%) higher probability of cART initiation when recruited at a CD4 more than 500 cells/μl and 9% (4-14%) lower when recruited at CD4 less than 100 cells/μl. CONCLUSION Most migrant men initiate cART at lower CD4 cell count than natives, whereas this does not hold for migrant women.
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An epidemiological modelling study to estimate the composition of HIV-positive populations including migrants from endemic settings. AIDS 2017; 31:417-425. [PMID: 27831947 DOI: 10.1097/qad.0000000000001329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Migrants account for a significant number of people living with HIV in Europe, and it is important to fully consider this population in national estimates. Using a novel approach with the UK as an example, we present key public health measures of the HIV epidemic, taking into account both in-country infections and infections likely to have been acquired abroad. DESIGN Mathematical model calibrated to extensive data sources. METHODS An individual-based stochastic simulation model is used to calibrate to routinely collected surveillance data in the UK. Data on number of new HIV diagnoses, number of deaths, CD4 cell count at diagnosis, as well as time of arrival into the UK for migrants and the annual number of people receiving care were used. RESULTS An estimated 106 400 (90% plausibility range: 88 700-124 600) people were living with HIV in the UK in 2013. Twenty-three percent of these people, 24 600 (15 000-36 200) were estimated to be undiagnosed; this number has remained stable over the last decade. An estimated 32% of the total undiagnosed population had CD4 cell count less than 350 cells/μl in 2013. Twenty-five and 23% of black African men and women heterosexuals living with HIV were undiagnosed respectively. CONCLUSION We have shown a working example to characterize the HIV population in a European context which incorporates migrants from countries with generalized epidemics. Despite all aspects of HIV care being free and widely available to anyone in need in the UK, there is still a substantial number of people who are not yet diagnosed and thus not in care.
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Vignier N, Spira RD, Lert F, Pannetier J, Ravalihasy A, Gosselin A, Lydié N, Bouchaud O, Desgrées du Loû A. Accès aux soins des personnes originaires d’Afrique subsaharienne vivant avec une hépatite B chronique. SANTE PUBLIQUE 2017. [DOI: 10.3917/spub.173.0361] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Pharris A, Quinten C, Tavoschi L, Spiteri G, Amato-Gauci AJ. Trends in HIV surveillance data in the EU/EEA, 2005 to 2014: new HIV diagnoses still increasing in men who have sex with men. ACTA ACUST UNITED AC 2016; 20:30071. [PMID: 26625124 DOI: 10.2807/1560-7917.es.2015.20.47.30071] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 11/24/2015] [Indexed: 11/20/2022]
Abstract
Human immunodeficiency virus (HIV) transmission remains significant in Europe. Rates of acquired immunodeficiency syndrome (AIDS) have declined, but not in all countries. New HIV diagnoses have increased among native and foreign-born men who have sex with men. Median CD4(+) T-cell count at diagnosis has increased, but not in all groups, and late diagnosis remains common. HIV infection and AIDS can be eliminated in Europe with resolute prevention measures, early diagnosis and access to effective treatment.
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Affiliation(s)
- Anastasia Pharris
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
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Is hardship during migration a determinant of HIV infection? Results from the ANRS PARCOURS study of sub-Saharan African migrants in France. AIDS 2016; 30:645-56. [PMID: 26558722 PMCID: PMC4732006 DOI: 10.1097/qad.0000000000000957] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Objectives: In Europe, sub-Saharan African migrants are a key population for HIV infection. We analyse how social hardships during settlement in France shape sexual partnerships and HIV risk. Design: PARCOURS is a life-event survey conducted in 2012–2013 in 74 health-care facilities in the Paris region, among three groups of sub-Saharan migrants: 926 receiving HIV care (296 acquired HIV in France), 779 with chronic hepatitis B, and 763 with neither HIV nor hepatitis B (reference group). Methods: Hardships (lack of residence permit, economic resources and housing) and sexual partnerships were documented for each year since arrival in France. For each sex, reported sexual partnerships were compared by group and their associations with hardships each year analysed with mixed-effects logistic regression models. Results: Hardships were frequent: more than 40% had lived a year or longer without a residence permit, and more than 20% without stable housing. Most of the migrants had nonstable and concurrent partnerships, more frequent among those who acquired HIV in France compared with reference group, as were casual partnerships among men (76.7 vs. 54.2%; P = 0.004) and women (52.4 vs. 30.5%; P = 0.02), concurrent partnerships among men (69.9 vs. 45.8%; P = 0.02), and transactional partnerships among women (8.6 vs. 2.3%; P = 0.006). Hardship increased risky behaviours: in women, lacking a residence permit increased casual and transactional partnerships [resp. odds ratio (OR) = 2.01(1.48–2.72) and OR = 6.27(2.25–17.44)]. Same trends were observed for lacking stable housing [OR = 3.71(2.75–5.00) and OR = 10.58 (4.68–23.93)]. Conclusion: Hardships faced by migrants increase HIV risks. Women, especially during the period without stable housing, appear especially vulnerable.
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