Social and structural factors and engagement in HIV care of sub-Saharan African migrants diagnosed with HIV in the Paris region

AIDS Care. 2019 Jul;31(7):897-907. doi: 10.1080/09540121.2019.1576842. Epub 2019 Feb 1.

Abstract

Migrants from sub-Saharan Africa (SSA) are often diagnosed at an advanced stage of HIV, and many of them have harsh living conditions. We aimed to evaluate the entry into care after HIV diagnosis and examine the related social determinants. The ANRS PARCOURS study is a life-event survey conducted in 2012-2013 in the Paris region among. Time between HIV diagnosis of SSA migrants living diagnosed HIV positive in France and HIV care and the determinants was assessed yearly by using mixed-effects logistic regression models. Among a total of 792 participants, 94.2% engaged in HIV care within the year of HIV diagnosis, 4.3% in the following year and 2.5% beyond the second year after diagnosis. The participants were more likely to engage in HIV care during years when they were effectively covered by health insurance and if the HIV test was carried out at the initiative of the doctor. Immigration for economic reasons or owing to threats in his/her country of origin was associated with delayed engagement in HIV care. Additionally, 4.3% of treated participants discontinued HIV care at least once at the time of the survey and more often if diagnosed at an advanced HIV disease stage and financially dependent.

Keywords: African migrants; HIV; Health insurance; access; and Evaluation; healthcare Quality; undocumented migrants.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Africa South of the Sahara / ethnology
  • Black People / ethnology
  • Black People / statistics & numerical data*
  • Emigration and Immigration
  • Female
  • France / epidemiology
  • HIV Infections / diagnosis*
  • HIV Infections / drug therapy
  • HIV Infections / epidemiology
  • Health Services Accessibility*
  • Humans
  • Insurance, Health*
  • Male
  • Mass Screening
  • Middle Aged
  • Quality of Health Care*
  • Socioeconomic Factors
  • Surveys and Questionnaires
  • Transients and Migrants / statistics & numerical data*