Addressing sexuality and sexual health with migrants. Practice guidelines.

Sexual health is an integral part of overall health and should be discussed with all people who seek help. The Vaccination and Prevention working group of the French Infectious Diseases Society (SPILF) and the Migrant Commission of the French AIDS Society (SFLS) developed recommendations to address this issue with migrants presenting vulnerability factors. After defining sexual health and target migrants, practical recommendations were issued. Sexual health can be discussed simply with migrants or people with an immigrant background. Some migrants are exposed to sexual vulnerability due to their migration route, social isolation, administrative and housing insecurity, gender inequalities, and discrimination. Situations of sexual vulnerability, sexual violence, and female genital mutilation should be systematically identified and followed by appropriate care that respects the migrant's needs. Extended screening for HIV and sexually transmitted infections (STI) should be systematically offered as part of a "migrant health checkup" and completed, if necessary, with information on preventing tools for HIV, STIs, unwanted pregnancies, and sexual violence. In this population, it is important to check if vaccinations are up to date. Sexology and addiction counselling is sometimes useful. The specific needs of LGBTQIA+ people with an immigrant background should be taken into account.

[Medical specific approach of persons in social deprivation]. / Particularités de la prise en charge médicale des personnes en situation de précarité.

Medical specific approach of persons in social deprivation. Many social situations interfere with medical care. This consideration is an integral part of the physician mission. The evaluation is based on housing and feeding conditions, financial and job situation, relationship environment, social integration and access to care. The identification of these insecurity areas enables to assess the impact on the health status, to adapt the medical care and to choose reasonable therapeutic targets. The first medical consultation is decisive and sufficient time should be taken. The physician must ensure to create a caring and non-binding environment and must know the suffering caused by the social deprivation. His support position makes the adherence and the continuation of care easier. He can direct the patient towards institutional or associative social assistance organisations, which requires knowledge of local network. These patients, who may be confusing for the practitioners, require patience, perseverance, collaborative work and humanity, essential keys for helping those most in need.

Particularités de la prise en charge médicale des personnes en situation de précarité. Nombre de situations sociales interfèrent avec la prise en charge médicale. Aussi, leur prise en compte fait partie intégrante des missions du soignant. Leur évaluation se fonde sur les conditions de logement et d'alimentation, sur la situation financière et d'emploi, sur l'entourage relationnel et l'intégration sociale, ainsi que sur l'accès aux soins. Ce repérage des domaines d'insécurité est essentiel à trois titres ; il permet d'apprécier leur retentissement sur l'état de santé, d'adapter les soins proposés et de choisir des objectifs thérapeutiques raisonnables. La première consultation est souvent déterminante. Il convient d'y accorder le temps suffisant. Le praticien doit veiller à instaurer un cadre bienveillant, non contraignant, en reconnaissant la souffrance générée par la situation de précarité. Son rôle d'accompagnement facilite l'adhésion et la poursuite des soins. Il peut orienter vers des structures d'aide sociale institutionnelles ou associatives, ce qui nécessite une connaissance du réseau de proximité. Ces patients, parfois déroutants pour les soignants, exigent de la patience, de la persévérance, un travail collaboratif et de l'humanité, indispensables pour les soins aux plus démunis.

[What recourse in the event of the identification of a precarious subject?] / Quels recours en cas de repérage d'un sujet précaire ?

What recourse in the event of the identification of a precarious subject? People in situation of deprivation have multiple and complex needs. Their healthcare management needs to be global and multidisciplinary, requiring the coordination of various medical and social workers. Identify available structures, their methods of access, is the first step for healthcare professionals who receive a vulnerable person: they can be medical, social or associative. The institutional sites allow to identify a part of these structures.

Quels recours en cas de repérage d'un sujet précaire ? Les personnes en situation de précarité ont des besoins multiples et complexes. Leur prise en charge doit être globale, elle nécessite la coordination de différents acteurs médicaux et sociaux travaillant en multidisciplinarité et en complémentarité. Repérer les structures disponibles et leurs modalités d'accès est la première étape pour le professionnel de santé qui reçoit une personne vulnérable ou démunie : elles peuvent être médicales, sociales ou associatives. Les sites institutionnels de l'Agence régionale de santé, des départements et des collectivités locales recensent une partie de ces structures.

Utility of the Tétanos Quick Stick® in the vaccine catch-up of adult migrants without proof of prior vaccination.

BACKGROUND: Unknowing immunity status make migrants vaccine catch-up difficult. The interest of using a rapid tetanus immunotest as the Tétanos Quick Stick® (TQS®) to assess immunity status against tetanus has been evaluated in emergency rooms and it is now commonly used. The study aim was to evaluate TQS® as a tool for migrants' vaccine catch-up. METHODS: From December 2018 to February 2019, a prospective study was performed and included consecutively migrants who attented to the primary medicine outconsultation of a health care centre in Paris. Migrants above 18, without any records of tetanus immunization were included and a TQS® was performed during a medical consultation. Adapted vaccine catch-up was then proposed. Immunity against tetanus among migrants, factors associated with positive TQS® and costs savings were evaluated. RESULTS: TQS® test was positive for 32% of the 310 included patients. In the univariable analysis, factors associated to the presence of a positive TQS® test were a female gender (OR = 1.69 CI95% [1.02-2.80]) and an urban living in the country of origin (OR = 1.79 CI95% [1.07-3.02]). In the multivariable analysis, these factors were not significantly associated to a positive TQS®. Anamnesis was not correlated to the immunity status: only 26% of the migrants who reported vaccinations in childhood, adolescence and adulthood had a positive TQS® test. The use of TQS® test allowed savings of 6,522 US$ as compared to the immediate catch-up strategy for the 310 patients. CONCLUSION: The TQS® test is an acceptable, simple, rapid and cost saving test that could find a place in the migrants' vaccine catch-up.