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Epidemiology
Original research
When and why? Timing of post-migration HIV acquisition among sub-Saharan migrants in France
  1. Anne Gosselin1,2,3,
  2. Andrainolo Ravalihasy3,4,
  3. Julie Pannetier1,3,5,
  4. France Lert3,
  5. Annabel Desgrées du Loû1,3,4
  6. for the PARCOURS Study Group
    1. 1 French Collaborative Institute on Migrations, CNRS, Paris, Ile-de-France, France
    2. 2 Social Epidemiology Department, iPLESP, Inserm S1136, Paris, Ile-de-France, France
    3. 3 CEPED, Paris Descartes University, IRD, ERL Inserm SAGESUD, Paris, Ile-de-France, France
    4. 4 IRD, French National Institute for Sustainable Development, Bondy, Ile-de-France, France
    5. 5 Cresppa-GTM, Paris-Nanterre University, Paris 8 University, CNRS, Nanterre, Île-de-France, France
    1. Correspondence to Dr Anne Gosselin, French Collaborative Institute on Migrations, Paris 75055, France; anne.gosselin{at}icmigrations.fr

    Objective

    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.

    Methods Within the PARCOURS retrospective survey conducted in 2012–2013 in 74 healthcare facilities in the Paris region, life-event data were collected among a random sample of 926 patients living with HIV in HIV services and 763 patients undiagnosed with HIV in primary care centres born in sub-Saharan Africa (reference group). Based on previous analysis, we considered the first 6 years in France after migration as a settlement period. Among the persons who acquired HIV after migration, we estimated the proportion of persons infected during settlement (0–6 years after migration) and after settlement (>6 years after migration) by using an algorithm that combines life-event data and a modelisation of CD4+ T-cell count decline. We then assessed the determinants of HIV acquisition during settlement and after settlement using bivariate logistic regression models.

    Results Overall, 58% of sub-Saharan migrants who acquired HIV after migration were infected during the first 6 years in France. HIV acquisition during settlement was found to be linked to short/transactional partnerships and lack of a resident permit. 42% of migrants had contracted HIV after settlement. After settlement, HIV acquisition was associated with short/transactional but also with concurrent partnerships and not with social hardship.

    Conclusion Two profiles of HIV post-migration acquisition emerged. The majority of HIV post-migration acquisition occurs during the settlement period: comprehensive combination prevention programmes among recently arrived migrants are needed. However, long-term migrants are also at risk for HIV through multiple partnerships. Prevention programmes should address the different profiles of migrants at risk for post-migration HIV acquisition.

    • life-event history survey
    • sub-saharan africa
    • france
    • prevention
    http://creativecommons.org/licenses/by-nc/4.0/

    This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

    https://doi.org/10.1136/sextrans-2019-054080

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      Footnotes

      • Handling editor Professor Anna Maria Geretti

      • Collaborators The PARCOURS Study Group included A Desgrées du Loû, F Lert, R Dray Spira, N Bajos, N Lydié (scientific coordinators), J Pannetier, A Ravalihasy, A Gosselin, E Rodary, D Pourette, J Situ, P Revault, P Sogni, J Gelly, Y Le Strat and N Razafindratsima.

      • Contributors AG, FL, JP and ADdL conceived the objective and analysis plan of this paper. AG and AR conducted the statistical analysis. AG first drafted the paper and it was critically revised by AR, FL, JP and ADdL.

      • Funding The ANRS Parcours Study was supported by the French National Agency for research on AIDS and Viral hepatitis (ANRS) and the Directorate General of Health (DGS, French Ministry of Health).

      • Disclaimer The sponsor of the study had no role in study design, data collection, data analysis, data interpretation or writing of the paper.

      • Competing interests None declared.

      • Patient consent for publication Obtained.

      • Ethics approval The Advisory Committee on Data Collection in Health Research (CCTIRS) and the French Data Protection Authority (CNIL) (DR-2011-484).

      • Provenance and peer review Not commissioned; externally peer reviewed.

      • Data availability statement Data are available on reasonable request.