title: Is hardship during migration a determinant of HIV infection? Results from the ANRS PARCOURS study of sub-Saharan African migrants in France.
abstract: OBJECTIVE
  In Europe, sub-Saharan African migrants are a key population for HIV infection. We analyse how social hardships during settlement in France shape sexual partnerships and HIV risk.
  
  
  METHODS
  PARCOURS is a life-event survey conducted in 2012-2013 in 74 health-care facilities in the Paris region, among three groups of sub-Saharan migrants: 926 receiving HIV care (296 acquired HIV in France), 779 with chronic hepatitis B, and 763 with neither HIV nor hepatitis B (reference group).
  
  
  METHODS
  Hardships (lack of residence permit, economic resources and housing) and sexual partnerships were documented for each year since arrival in France. For each sex, reported sexual partnerships were compared by group and their associations with hardships each year analysed with mixed-effects logistic regression models.
  
  
  RESULTS
  Hardships were frequent: more than 40% had lived a year or longer without a residence permit, and more than 20% without stable housing. Most of the migrants had nonstable and concurrent partnerships, more frequent among those who acquired HIV in France compared with reference group, as were casual partnerships among men (76.7 vs. 54.2%; P = 0.004) and women (52.4 vs. 30.5%; P = 0.02), concurrent partnerships among men (69.9 vs. 45.8%; P = 0.02), and transactional partnerships among women (8.6 vs. 2.3%; P = 0.006). Hardship increased risky behaviours: in women, lacking a residence permit increased casual and transactional partnerships [resp. odds ratio (OR) = 2.01(1.48-2.72) and OR = 6.27(2.25-17.44)]. Same trends were observed for lacking stable housing [OR = 3.71(2.75-5.00) and OR = 10.58 (4.68-23.93)].
  
  
  CONCLUSIONS
  Hardships faced by migrants increase HIV risks. Women, especially during the period without stable housing, appear especially vulnerable.
authors.affiliation: aIRD bCEPED, UMR 196 Université Paris Descartes-IRD, Sorbonne Paris Cités, Paris cINSERM, CESP-U 1018, Villejuif dINPES, Saint-Denis eSorbonne Universités, UPMC Univ Paris 06, Inserm, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France.
authors.forename: Annabel
authors.initials: A
authors.lastname: Desgrees-du-Lou
authors.forename: Julie
authors.initials: J
authors.lastname: Pannetier
authors.forename: Andrainolo
authors.initials: A
authors.lastname: Ravalihasy
authors.forename: Mireille
authors.initials: M
authors.lastname: Le Guen
authors.forename: Anne
authors.initials: A
authors.lastname: Gosselin
authors.forename: Henri
authors.initials: H
authors.lastname: Panjo
authors.forename: Nathalie
authors.initials: N
authors.lastname: Bajos
authors.forename: Nathalie
authors.initials: N
authors.lastname: Lydie
authors.forename: France
authors.initials: F
authors.lastname: Lert
authors.forename: Rosemary
authors.initials: R
authors.lastname: Dray-Spira
mesh_terms: D000293:Adolescent; D000328:Adult; D018562:Disease Transmission, Infectious; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000635:transmission*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010297:Paris; D012189:Retrospective Studies; D012725:Sexual Behavior; D012934:Social Isolation / Q000523:psychology*; D012959:Socioeconomic Factors; D014171:Transients and Migrants; D055815:Young Adult