HIV acquisition after arrival in France among sub-Saharan African migrants living with HIV in Paris area. Estimations from the ANRS PARCOURS study
Background: HIV acquisition among sub-Saharan migrants living
in Europe has long been considered to predominantly occur before migration
because of generalized HIV epidemics in sub-Saharan African countries. Recent
evidence suggests that a substantial proportion have acquired HIV while they
were living in Europe. In the UK, this proportion was recently estimated at 31%
using a CD4-based modelling approach. Such an estimate is not currently
available for France.
Methods: We estimated the proportion of
sub-Saharan migrants who acquired HIV infection after their arrival in France
using life-event and clinical information on a random sample of HIV-infected hospital outpatients born in sub-Saharan Africa in Paris
region. We assumed that HIV infection had probably been acquired in France if
at least one of the following life-event criterion was fulfilled: i) HIV
diagnosis >10 years after arrival in France, ii) ≥1 negative HIV test in
France, iii) sexual debut after arrival in France. If none of these criteria
was fulfilled, we estimated the duration from HIV infection based on
first CD4 count measurement using statistical modelling. Infection was assigned in
France if, out of 500 durations estimated for each individual, >50% (median scenario)
or >95% (conservative scenario) fell within the period while individuals were living in France.
[Flow chart - assignment of HIV acquisition]
Results: Of the 898 HIV-infected adults born
in sub-Saharan Africa included in the analysis, we estimated that 49% [95%
confidence interval: 45-53] in the median scenario and 35% [31-39] in the
conservative scenario acquired HIV while living in France. This proportion was
lower for women than men (30% [25-35] versus 44% [37-51] in the conservative
scenario) and increased with duration in France.
| Men | Women | ||||||||
| N | Weighted % | 95%CI | p value | N | Weighted % | 95% CI | p value | ||
| Overall | 348 | 43.9 | 37.4-50.6 | 550 | 30.0 | 25.1-35.4 | |||
| Age at arrival in France | <25 y | 84 | 78.1 | 65.5-87.1 | <0.001 | 171 | 54.1 | 46.5-61.5 | <0.001 |
| 25-34 y | 139 | 44.3 | 35.9-53.2 | 251 | 24.5 | 17.7-32.8 | |||
| 35 y and more | 125 | 19.8 | 13.0-28.8 | 128 | 8.4 | 4.4-15.5 | |||
| Number of years in France prior to diagnosis | 0 to 2 | 137 | 10.3 | 4.9-20.6 | <0.001 | 254 | 5.4 | 3.2-8.9 | <0.001 |
| 3 to 5 | 45 | 19.3 | 7.0-43.0 | 93 | 23.4 | 18.6-29.0 | |||
| 6 to 9 | 39 | 54.0 | 36.2-70.9 | 67 | 52.5 | 36.3-68.3 | |||
| 10 or more | 106 | 93.5 | 85.4-97.3 | 95 | 86.0 | 77.0-91.9 |
Conclusions: The proportion of sub-Saharan African migrants having acquired HIV infection while living in France is high, highlighting the need for improved focused HIV prevention. This requires a better understanding of the determinants of HIV infection in France in this population.
A. Desgrees du Lou1, J. Pannetier1, A. Ravalihasy1, A. Gosselin1, V. Supervie2, N. Bajos3, F. Lert4, N. Lydie5, R. Dray-Spira2
1IRD, CEPED, Paris, France, 2INSERM, IPLESP, Paris, France, 3INSERM, CESP, Le Kremin Bicêtre, France, 4INSERM, CESP, Villejuif, France, 5INPES, Saint Denis, France