[Factors associated with the lack of proposition for HIV-AIDS and hepatitis B and C screening to underprivileged immigrants]. / Facteurs liés à l'absence de proposition de dépistage du VIH-sida et des hépatites B et C aux immigrés en situation de précarité

BACKGROUND: Underprivileged immigrants from endemic areas cumulate risk factors for infections by HIV-AIDS and hepatitis B and C. Free primary care consultations are available to them in the four health centers of the city of Paris. The objective of our study was to identify socio-demographic and medical factors related to the lack of screening proposition for HIV-AIDS and hepatitis B and C to new immigrant patients in these centers in 2003. METHODS: For each disease, the absence of screening proposition was analyzed according to geographical origin, length of stay in France, type of accommodation, type of health insurance and symptom motivating the encounter in logistic mixed models adjusted on sex and age. RESULTS: About 500 patients were included in the analysis. Three-quarters of them were male and from Sub-Saharan Africa. They were 36years old on average. Half of them lived in shelters for homeless or immigrants. Their median stay lasted two years. They rarely came for screening (1%), sometimes for asthenia (6%) and two-thirds of them for uro-genito-digestive signs. The results were similar for the three screenings. The lack of screening proposition was about 45% and varied significantly between physicians. Factors significantly associated with the lack of screening proposition were: coming from non-Sub-Saharan Africa (especially from North Africa and Middle East; OR=1.7 to 3.6) and having a health insurance (OR=2.4 to 2.6) regardless of the disease; being a female (OR=2.0 to 2.3) in the case of hepatitis; and having a length of stay in France greater than or equal to five years (OR=1.9) for hepatitis B. CONCLUSIONS: Our results should encourage practitioners to provide more screening to underprivileged immigrants and draws attention to immigrants from non-Sub-Saharan origin and those with health insurance. Factors that might explain doctor and gender-related variability observed in hepatitis are highlighted.

[Schistosoma haematobium among immigrants consulting in municipal free clinics in Paris in 2003]. / La schistosomose urinaire chez des migrants ayant consulté dans des centres médico-sociaux de Paris en 2003.

The "Consultations de Diagnostic et d'Orientation" (CDO) are free medical consultations for precarious populations, proposed by the Health Department of Paris. More than two-thirds of the CDO patients come from Sub-Saharan Africa. Schistosoma haematobium (SH) is one of the most frequent infectious diseases detected within CDO. More than a thousand people have consulted for the first time in CDO in 2003 in one of the municipal free Clinics which proposes this service. Parasitologic test of urine has been performed among 220 patients and found 24 positive results: viable eggs of SH (10.8%). All 24 patients are male, most of them are under 35 years-old and come from the region of the Senegal River that lies in the junction of Mali, Senegal and Mauritania. We want to remind physicians in non-tropical setting to think of SH when they see a patient originating from Africa. To ask him if he presents haematuria and if not, to prescribe a parasitologic test of urine. If all patients from endemic regions had undergone this screening in 2003, we would have detected about 20 more cases of SH. If treated early enough, it could avoid severe uronephrological complications, which are rare but represent a high health care cost (bladder tumor, renal failure).

[From the apprehension of sexually transmissible diseases to the prevention of HIV]. / De l'appréhension des maladies sexuellement transmissibles à la prévention du VIH.

Over the past few years in France, the incidence of human immunodeficiency virus (HIV) has not decreased. Among the most frequent sexually transmissible diseases (STD) in France (condyloma, genitoanal herpes, chlamydia infections), certain STD, considered as negligible, have reappeared: gonorrhoea and syphilis affect male homosexuals and, to a lesser degree, men and women whose epidemiological profile remains to be determined. The health organization is not in favour of associating STD with HIV in its anti-aids strategy. However, acute STD are not only indicator of habits at risk for HIV, but are also potent co-factors of its sexual transmission. Fighting against HIV without creating a dialogue on STD is a waste of time and efficiency. From our experience with the STD, anonymous and free screening and the inter-disciplinary health education centres, we recommend the following: improved screening for HIV and other STD: concomitantly whenever possible, less invasive, free or reimbursed STD sampling, reliable and standardized techniques (polymerisation chain reaction or PCR and derivatives), itinerant screening for STD for persons who do not consult; ensured early, medical, social and psychological care of HIV and STD, emphasising the importance of compliance to treatment and prevention; ensured easy access and low cost of the male and female condoms; renewal and diversification of health relays, particularly in the private sector; staff training on STD and their epidemiological novelty; insisting on a transversal (HIV-other STD, curative-preventive, among others) and pragmatic approach (intervention studies resulting in local action); renewal of the information and advice for the public: information on the relationship between HIV and other STD, on the frequent STD that are lesser known, such as condyloma and chlamydia infections, emphasis on compliance to prevention measures (abstinence or use of condoms) during at least three months after a risk of HIV/STD transmission or after an STD has been identified and treated. The aim is to enhance the acceptation or the appropriation by the public of concomitant STD/HIV screening, prevention measures and treatments proposed. This can only be implemented after a change in the institutions', carers and public's attitude towards STD.