The role of social vulnerability after migration in France on transactional and forced sex: the case of Sub-Saharan immigrants living in Paris in the PARCOURS ANRS survey 2012-2013
Background: In France,
sub-Saharan immigrants are disproportionally affected by the HIV epidemic.
Virological data suggest that among them, a fourth of HIV infection cases occur
in France. Migration may induce social and economic disruptions leading to social vulnerability which might
facilitate transactional or forced sexuality, known to be at-risk for HIV. We
aimed to evaluate the role of social vulnerability after migration on
transactional and forced sexual intercourse among sub-saharan men and women
immigrants living in France.
Methods: In 2012-2013, we conducted a
retrospective life-event history survey among two random samples of migrants
from sub-Saharan Africa in Paris region: 923 HIV-infected recruited in HIV
hospital departments (352 men, 571 women : HIV group) and 762 immigrants
recruited in general medicine settings (355 men, 407 women : GM group). Associations
between history of transactional or forced sexual intercourse after migration and
administrative, residential and economic vulnerability in France were measured
using logistic regression adjusted for sex and age, separately by group.
Results: Transactional sex and forced intercourse were reported by 5% and 7.5%
of women in the HIV group (vs 3.6 and 1.4% of men, p= 0.6 and 0.002) and 2.7%
and 3.9% of women in GM group (vs 0.9% and 0.7% of men, p= 0.003 and 0.02). Periods
with no residence permit, no stable housing, no financial resources were reported
by, respectively, 55%, 34%, 12% of immigrants in HIV group and 49%, 33% and 9% in GM
group. Experiences of social vulnerability
and transactional sex mainly occurred (95%) within the first three years after
immigration. In both groups, probability of transactional sex increased with
social vulnerability experience (no stable housing: ORa =
4.4[2.3-8.3] in HIV group and 4.8[1.7-13.0] in GM group; no residence permit: ORa=
4.0[1.7-9.3] in HIV group and 5.4[1.8-15.9] in GM group). Probability of forced
sex was less related to social vulnerability experiences, whereas it increased
among those who had slept in the street (ORa = 2.0[1.0-4.4]).
Conclusions: Residential, administrative
and economic insecurity of immigrants favours transactional sexuality and
should be addressed to prevent HIV infection among sub-Saharan immigrants in
France, especially during the first years following immigration.
A. Desgrées du Lou1, J. Pannetier1, N. Bajos2, A. Gosselin1, A. Ravalihasy1, F. Lert2, N. Lydie3, R. Dray-Spira2, the PARCOURS Study Group
1IRD, CEPED, Paris, France, 2INSERM, CESP, Paris, France, 3INPES, Paris, France