Criminalization of HIV transmission in France: knowledge of and concerns about HIV-related court-case verdicts in a representative sample of people living with HIV (ANRS VESPA2 survey)

Background: In France, criminal prosecution for HIV transmission resulted in approximately 10 trials and sentences between the very first trial in 1998 and 2011. Prison terms were handed down in all but one case. Media coverage of most trials remained limited to local newspapers but a few major cases attracted the attention of the wider public. This may have had a negative impact on people living with HIV (PLWH) by reinforcing stigma and discrimination. The objective of the present analysis was to characterize, among a representative sample of PLWH followed-up in French hospitals, those aware of and concerned about HIV criminalization.
Methods: ANRS-VESPA2 was a cross-sectional survey conducted in 2011 on 3022 adult PLWH attending French hospitals HIV-diagnosed >6 months. Socio-behavioural (face-to-face patient interviews) and medical (provided by medical staff) data were collected. Participants were asked if they were aware of HIV-related court case verdicts and if they were concerned about them. Multivariate analyses were performed on weighted and calibrated data.
Results: Among the 3022 PLWH enrolled in the survey, 2141 (71.2%) were aware of the verdicts of whom 1207 (56.4%) reported they were concerned about them. Migrants from Sub-Saharan Africa (reference group) were the population with the greatest concerns compared with men who have sex with men (OR[95%CI] 0.73[0,59;0,97], p=0.047), intravenous drug users (0.55[0,37;0,83], p=0.005), and other PLWH (0.7[0,49;0,98], p=0.04). Living in precarious conditions (0.76[0,59;0,97], p=0.03) and having unprotected anal/vaginal sex with one''s main partner (1.39[1,01;1,91], p=0.044) were also statistically associated with being concerned about the verdicts, while age, sex, educational level, disclosure to one''s main partner, time since HIV diagnosis and viral load were not.
Conclusions: Publicity about HIV criminalization affects the most vulnerable PLWH, especially foreigners living in precarious conditions who find it difficult to negotiate prevention with their main partner. Despite their greater concern, migrants are under-represented among victims and those convicted in French HIV-related cases. Further analyses are needed to understand the reasons explaining their fear. However, the study suggests that criminal risk perception among PLWH reflects more the level of stigma and discrimination they globally experience than the actual risk of prosecution they are exposed to.

M. Suzan-Monti1,2,3, B. Demoulin1,2,3, M. Celse4, R. Dray-Spira5,6, F. Lert7, B. Spire1,2,3, ANRS VESPA2 Study Group
1INSERM, UMR 912 (SESSTIM), Marseille, France, 2Aix Marseille Université, UMR_S 912, IRD, Marseille, France, 3ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France, 4French National AIDS Council, Paris, France, 5INSERM, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Team Research in Social Epidemiology, Paris, France, 6Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Team Research in Social Epidemiology, Paris, France, 7Centre de Recherche en Épidémiologie et Santé des Populations, Inserm U 1018, Villejuif, France