title: Discrimination against HIV-infected people and the spread of HIV: some evidence from France.
abstract: BACKGROUND
  Many people living with HIV/AIDS (PLWHA) suffer from stigma and discrimination. There is an ongoing debate, however, about whether stigma, fear and discrimination actually fuel the persisting spread of HIV, or slow it down by reducing contacts between the whole population and high-risk minorities. To contribute to this debate, we analysed the relationship between perceived discrimination and unsafe sex in a large sample of French PLWHAs.
  
  
  RESULTS
  In 2003, we conducted a national cross-sectional survey among a random sample of HIV-infected patients. The analysis was restricted to sexually active respondents (N = 2,136). Unsafe sex was defined as sexual intercourse without a condom with a seronegative/unknown serostatus partner during the prior 12 months. Separate analyses were performed for each transmission group (injecting drug use (IDU), homosexual contact, heterosexual contact). Overall, 24% of respondents reported experiences of discrimination in their close social environment (relatives, friends and colleagues) and 18% reported unsafe sex during the previous 12 months. Both prevalences were higher in the IDU group (32% for perceived discrimination, 23% for unsafe sex). In multivariate analyses, experience of discrimination in the close social environment was associated with an increase in unsafe sex for both PLWHAs infected through IDU and heterosexual contact (OR = 1.65 and 1.80 respectively).
  
  
  CONCLUSIONS
  Our study clearly confirms a relationship between discrimination and unsafe sex among PLWHAs infected through either IDU or heterosexual contact. This relationship was especially strong in the heterosexual group that has become the main vector of HIV transmission in France, and who is the more likely of sexual mixing with the general population. These results seriously question the hypothesis that HIV-stigma has no effect or could even reduce the infection spread of HIV.
authors.affiliation: Institut National de la Santé et de la Recherche Médicale (INSERM), Unit 379, Social Sciences Applied to Medical Innovation, Marseille, France. peretti@marseille.inserm.fr
authors.forename: Patrick
authors.initials: P
authors.lastname: Peretti-Watel
authors.forename: Bruno
authors.initials: B
authors.lastname: Spire
authors.forename: Yolande
authors.initials: Y
authors.lastname: Obadia
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Moatti
mesh_terms: D003430:Cross-Sectional Studies; D005602:France / Q000453:epidemiology; D015658:HIV Infections / Q000453:epidemiology / Q000523:psychology* / Q000635:transmission; D006801:Humans; D011287:Prejudice; D012307:Risk Factors; D012725:Sexual Behavior; D015819:Substance Abuse, Intravenous; D047568:Unsafe Sex