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

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.

"Times Are Changing": The Impact of HIV Diagnosis on Sub-Saharan Migrants' Lives in France.

BACKGROUND: Migrants account for 35% of HIV diagnoses in the European Union (ECDC/WHO 2014). Little is known about the impact of such a lifelong infection diagnosis on lives that are already disrupted by migration. In this paper, we assess the impact of HIV diagnosis on activity, union, well-being among African migrants living in France, the second group most affected by HIV after MSM. We compare it with the impact of the diagnosis of Hepatitis B, another lifelong infection affecting African migrants. METHODS: We use the ANRS PARCOURS survey, a retrospective life-event survey led in 2012-2013 in 74 health structures in Paris greater area which collected 926 life histories of Sub-Saharan migrants living with HIV and 779 with Hepatitis B. We modelled the probability year by year since 18 years of age until data collection to lose one's activity, to experience a conjugal break up and degradation of well-being and we estimated the impact of migration and of HIV and Hepatitis B diagnoses on these probabilities, after adjustment on other factors, thanks to discrete-time logistic regressions. RESULTS: Migration entailed loss of activity and conjugal break up, though HIV diagnosis after migration did not statistically impact on these outcomes. Yet HIV diagnosis had a massive negative impact on well-being (aOR = 11.31 [4.64-27.56] for men and 5.75 [2.79-11.86] for women). This negative impact on well-being tended to diminish for persons diagnosed after 2004. The negative impact of HIV diagnosis on African migrants' well-being seems to be attenuated in the last decade, which hints at a normalization of the subjective experience of HIV diagnosis.

Increasing HIV testing among male partners.

OBJECTIVE: Couple-oriented posttest HIV counselling (COC) provides pregnant women with tools and strategies to invite her partner to HIV counselling and testing. We conducted a randomized trial of the efficacy of COC on partner HIV testing in low/medium HIV prevalence settings (Cameroon, Dominican Republic, Georgia, India). METHODS: Pregnant women were randomized to receive standard posttest HIV counselling or COC and followed until 6 months postpartum. Partner HIV testing events were notified by site laboratories, self-reported by women or both combined. Impact of COC on partner HIV testing was measured in intention-to-treat analysis. Socio-behavioural factors associated with partner HIV testing were evaluated using multivariable logistic regression. RESULTS: Among 1943 pregnant women enrolled, partner HIV testing rates (combined indicator) were 24.7% among women from COC group versus 14.3% in standard posttest HIV counselling group in Cameroon [odds ratio (OR) = 2.0 95% CI (1.2-3.1)], 23.1 versus 20.3% in Dominican Republic [OR = 1.2 (0.8-1.8)], 26.8 versus 1.2% in Georgia [OR = 29.6 (9.1-95.6)] and 35.4 versus 26.6% in India [OR = 1.5 (1.0-2.2)]. Women having received COC did not report more conjugal violence or union break-ups than in the standard posttest HIV counselling group. The main factors associated with partner HIV testing were a history of HIV testing among men in Cameroon, Dominican Republic and Georgia and the existence of couple communication around HIV testing in Georgia and India. CONCLUSION: A simple prenatal intervention taking into account the couple relationship increases the uptake of HIV testing among men in different socio-cultural settings. COC could contribute to the efforts towards eliminating mother-to-child transmission of HIV.

When do HIV-infected women disclose their HIV status to their male partner and why? A study in a PMTCT programme, Abidjan.

BACKGROUND: In Africa, women tested for HIV during antenatal care are counselled to share with their partner their HIV test result and to encourage partners to undertake HIV testing. We investigate, among women tested for HIV within a prevention of mother-to-child transmission of HIV (PMTCT) programme, the key moments for disclosure of their own HIV status to their partner and the impact on partner HIV testing. METHODS AND FINDINGS: Within the Ditrame Plus PMTCT project in Abidjan, 546 HIV-positive and 393 HIV-negative women were tested during pregnancy and followed-up for two years after delivery. Circumstances, frequency, and determinants of disclosure to the male partner were estimated according to HIV status. The determinants of partner HIV testing were identified according to women's HIV status. During the two-year follow-up, disclosure to the partner was reported by 96.7% of the HIV-negative women, compared to 46.2% of HIV-positive women (chi(2) = 265.2, degrees of freedom [df] = 1, p < 0.001). Among HIV-infected women, privileged circumstances for disclosure were just before delivery, during early weaning (at 4 mo to prevent HIV postnatal transmission), or upon resumption of sexual activity. Formula feeding by HIV-infected women increased the probability of disclosure (adjusted odds ratio 1.54, 95% confidence interval 1.04-2.27, Wald test = 4.649, df = 1, p = 0.031), whereas household factors such as having a co-spouse or living with family reduced the probability of disclosure. The proportion of male partners tested for HIV was 23.1% among HIV-positive women and 14.8% among HIV-negative women (chi(2) = 10.04, df = 1, p = 0.002). Partners of HIV-positive women who were informed of their wife's HIV status were more likely to undertake HIV testing than those not informed (37.7% versus 10.5%, chi(2) = 56.36, df = 1, p < 0.001). CONCLUSIONS: In PMTCT programmes, specific psychosocial counselling and support should be provided to women during the key moments of disclosure of HIV status to their partners (end of pregnancy, weaning, and resumption of sexual activity). This support could contribute to improving women's adherence to the advice given to prevent postnatal and sexual HIV transmission.

[Refusal of prenatal HIV-testing: a case study in Abidjan (Côte d'Ivoire)]. / Le refus du dépistage VIH prénatal: étude de cas à Abidjan (Côte d'Ivoire).

One of the main obstacles to HIV prevention in Africa remains the insufficient number of HIV tests performed. The low percentage of individuals aware of their serostatus is due in part to the insufficient availability of HIV testing, but also to individuals' refusal to have the HIV test. Because affordable treatment is now available, it is possible to implement on a much greater scale programs of prevention of mother-to-child HIV transmission, accompanied by the expansion of prenatal HIV testing. It is therefore important to understand the reasons women refuse these tests. Here we analyse the women who refused the offer of prenatal HIV testing in the DITRAME Plus research program, intended to prevent mother-to-child transmission in Abidjan from 2001 through 2005. Three groups of women were followed for two years after they were offered HIV counselling and testing during an antenatal consultation: 347 HIV-infected women, 393 seronegative women, and 62 women who refused HIV testing. Nine months after delivery, HIV testing was again offered to the latter group. We collected quantitative data on social and demographic characteristics, sexual behavior, and communication with their male partners about STIs, HIV, and HIV testing, before and after the pregnancy. In-depth interviews were conducted with 15 women who refused HIV-testing. We sought to determine if their sociodemographic and behavioural profile was closer to that of HIV-positive or seronegative women, to assess the effects of prenatal counselling and the offer of testing on their attitudes about HIV risk, and to measure the percentage of women who accepted testing when the offer was repeated 9 months postpartum. Women who refused HIV-testing had a sociodemographic profile similar to that of the women who accepted testing and were seronegative. They did not have more at-risk behaviours. These women offered several reasons for their refusal, including avoidance of the anguish of a positive test result and the desire to ask their husbands first. Among the women who initially refused prenatal testing, only 23% had discussed STI/HIV issues with their male partner; after the testing offer, more than 90% suggested that their partner have an HIV test. Finally, 20% accepted the postpartum test offer, and those whose male partner had an HIV test were four times more likely than the others to accept (RR = 4.05 [1.55-10.58]). This study shows that prenatal counselling and the offer of HIV testing have beneficial effects on HIV prevention within the couple, even for women who refuse testing. It also points out that the decision to accept testing may take time and that repeating the offer is worthwhile. Finally, our results confirm the importance of the role of the regular partner in the acceptance of HIV testing, and reinforce the relevance of a couple-centred approach to voluntary counselling and testing.