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