Assessement of Awareness of, Concerns and Attitudes Towards HIV-Related Court-Case Sentences in France in a Representative Sample of People Living with HIV (ANRS VESPA2 Survey).

Some of the 12 criminal trials and sentences in France for HIV transmission in 1998-2011 attracted substantial public attention, with a possible negative impact on people living with HIV (PLWH) through reinforced stigma and discrimination. This analysis aimed to characterize PLWH enrolled in the representative ANRS-VESPA2 survey, aware of and concerned about convictions for HIV transmission. Being a migrant from Sub-Saharan Africa, having difficult socio-economic conditions, having unprotected sex with one's main partner and concealing one's HIV status were all factors statistically associated with concern about the sentences. Participants tempted to press charges against someone for infecting them were more likely to be younger, women, not living in a couple, unemployed, and to report a major depressive disorder. Concern about HIV-related criminal proceedings among the most vulnerable PLWH do not reflect the actual risk of prosecution they are exposed to.

[HIV infection and social condition: a disease which remains singular]. / Infection par le VIH et société: une maladie qui demeure singulière.

Increased efficacy of HIV therapy has resulted in a dramatic improvement in patient's health condition regarding life expectancy and life quality. However, such favorable evolution had no significant impact on the social condition of the population living with HIV, which remains more exposed to socio-economical difficulties and to different forms of stigmatization and discrimination. Public policies do address these issues. The national HIV/AIDS and STI strategic plan 2010-2014 provides a range of actions aimed at fighting against discriminations and improving social care for the most vulnerable people living with HIV. It notably tries to achieve equal access to programs and services developed for patients with chronic diseases and to improve their condition regarding access to care, employment, housing and income. Implementation of these measures, however, proves difficult. Addressing social and societal concerns that HIV infection still raises is part of the care and support that should be offered to patients. Providing this comprehensive approach remains critical for ensuring optimized individual therapeutic outcomes as well as an efficient collective response to the epidemic.

Economic and public health consequences of delayed access to medical care for migrants living with HIV in France.

In 2013, migrants accounted for 46% of newly diagnosed cases of HIV (human immunodeficiency virus) infection in France. These populations meet with specific obstacles leading to late diagnosis and access to medical care. Delayed access to care (ATC) for HIV-infected migrants reduces their life expectancy and quality of life. Given the reduction of infectivity under antiretroviral (ARV) treatment, delayed ATC for HIV-infected migrants may also hinder the control of the HIV epidemic. The objective of this study is to measure the public health and economic consequences of delayed ATC for migrants living with HIV in France. Using a healthcare payer perspective, our model compares the lifetime averted infections and costs of early vs. late ATC for migrants living with HIV in France. Early and late ATC are defined by an entry into care with a CD4 cell count of 350 and 100/mm3, respectively. Our results show that an early ATC is dominant, even in the worst-case scenario. In the most favorable scenario, early ATC generates an average net saving of €198,000 per patient, and prevents 0.542 secondary infection. In the worst-case scenario, early ATC generates an average net saving of €32,000 per patient, and prevents 0.299 secondary infection. These results are robust to various adverse changes in key parameters and to a definition of late ATC as an access to care at a CD4 level of 200/mm3. In addition to individual health benefits, improving ATC for migrants living with HIV proves efficient in terms of public health and economics. These results stress the benefit of ensuring early ATC for all individuals living with HIV in France.