Forced sex, migration and HIV infection among women from sub-Saharan Africa living in France: results from the ANRS Parcours study

Background: In Europe, sub-Saharan African migrant women are a key population for HIV infection. Social hardships during migration may increase women vulnerability to sexual violence and HIV infection. The aim of this study is to assess the association between forced sex, migration and HIV infection among sub-Saharan African women living in France.
Methods: Parcours is a life-event survey conducted from February 2012 to May 2013 in health-care facilities in the Paris region, among two random samples of sub-Saharan migrant women: 570 receiving HIV care (156 acquired HIV in France) and 407 not diagnosed with HIV (reference group). Women were retrospectively asked whether they had ever been forced to have sex against their will and if happened, during which calendar year(s). Using mixed-effects logistic regression models, characteristics associated with an experience of forced sex after 14 years old in France, including migration history and living conditions each year after arrival in France, were first identified. Then, the frequency of forced sex after 14 years old in France was compared, adjusting for these characteristics, between women having acquired HIV either before or after migration and those HIV-uninfected.
Results: Overall, 22.2%, 23.1% and 18.3% of women HIV-infected before migration, HIV-infected after migration and HIV-uninfected, respectively, reported an experience of forced sex after 14 years old (childhood sexual abuse was about 4%), and, 3.8%, 17.3% and 4.2%, respectively, reported an experience of forced sex after arrival in France. Having migrated because of being threatened in the country of origin (aOR=5.96[1.57-22.61]) and absence of stable (aOR=4.64[1.69-12.79]) or own (aOR=2.72[1.13,6.53]) housing in France were associated with a higher frequency of forced sex in France. Adjusting for migration history and living conditions, the frequency of forced sex in France was higher among women having acquired HIV in France compared to those HIV-uninfected (aOR=4.97[1.63-15.12]), while no difference was found for those HIV-infected before migration (aOR=2.18[0.78-6.04]).
Conclusions: Among sub-Saharan African migrant women, HIV acquisition in France may be related to a context of sexual violence. Women whose migration was motivated by violence and those who experience social hardships in the host country are at high risk of sexual violence.

J. Pannetier1, A. Ravalihasy1, M. Le Guen1,2, N. Lydié3, R. Dray-Spira4, N. Bajos2, F. Lert2, A. Desgress du Lou1,5, Parcours Study Group
1Université Paris Descartes-IRD, Centre Population et Développement, Paris, France, 2INSERM, CESP-U 1018, Villejuif, France, 3INPES, Saint-Denis, France, 4INSERM, IPLESP UMRS 1136, Paris, France, 5IRD, Paris, France