Abstract
We estimated the proportion of migrants from sub-Saharan Africa who acquired human immunodeficiency virus (HIV) while living in France. Life-event and clinical information was collected in 2012 and 2013 from a random sample of HIV-infected outpatients born in sub-Saharan Africa and living in the Paris region. We assumed HIV infection in France if at least one of the following was fulfilled: (i) HIV diagnosis at least 11 years after arrival in France, (ii) at least one negative HIV test in France, (iii) sexual debut after arrival in France. Otherwise, time of HIV infection was based on statistical modelling of first CD4(+) T-cell count; infection in France was assumed if more than 50% (median scenario) or more than 95% (conservative scenario) of modelled infection times occurred after migration. We estimated that 49% of 898 HIV-infected adults born in sub-Saharan Africa (95% confidence interval (CI): 45-53) in the median and 35% (95% CI: 31-39) in the conservative scenario acquired HIV while living in France. This proportion was higher in men than women (44% (95% CI: 37-51) vs 30% (95% CI: 25-35); conservative scenario) and increased with length of stay in France. These high proportions highlight the need for improved HIV policies targeting migrants.
Highlights
In France, as in most countries in Western Europe, migrants from sub-Saharan Africa are disproportionally affected by the human immunodeficiency virus (HIV) epidemic [1,2]
In 2012, people born in sub-Saharan Africa accounted for 31% of new HIV diagnoses [3] and for 24% of the whole population of persons living with HIV (PLWHIV) in France [4], they represented only ca 1% of the French general population [5]
As we did not have information related to the seroconversion for PARCOURS respondents, we modelled the decline in CD4+ T-cell using a cohort of West African seroconverters: the ANRS 1220 PRIMO-CI cohort of HIV-1 seroconverters in Abidjan, Côte d’Ivoire [13,14]
Summary
In France, as in most countries in Western Europe, migrants from sub-Saharan Africa are disproportionally affected by the human immunodeficiency virus (HIV) epidemic [1,2]. In 2012, people born in sub-Saharan Africa accounted for 31% of new HIV diagnoses [3] and for 24% of the whole population of persons living with HIV (PLWHIV) in France [4], they represented only ca 1% of the French general population [5]. Among people from sub-Saharan Africa, the number of new diagnoses has decreased in France since 2003, incidence remains 29 times higher in men and 69 times higher in women compared with Frenchnational heterosexuals [6]. Evidence from various European countries in the past decade suggests that a substantial proportion of migrants from sub-Saharan Africa acquired HIV while they were living in Europe [8]. In the United Kingdom (UK), this proportion was recently estimated at 31% using a modelling approach based on CD4+ T-cell counts [9]
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