Large proportion of gay and bisexual migrants with HIV acquire the virus after arrival in France

At least 38% of gay and bisexual male migrants living with HIV had acquired HIV after moving to France, according to data from clinics in the Paris region presented at the International Congress on Drug Therapy in HIV Infection (HIV Glasgow) last week.

In France, gay and bisexual men born abroad have higher prevalence of HIV, a higher rate of new infections, and are more likely to remain undiagnosed. They are also highly concentrated in the Paris region.

The ANRS-MIE Ganymede study was designed to investigate whether gay and bisexual men born abroad acquired HIV before or after emigrating to France. The study recruited a random sample of 997 gay and bisexual men born abroad, receiving HIV care in the Paris region. Twenty-eight per cent came from Latin America and the Caribbean, 17% from Europe, 17% from north Africa and 14% from sub-Saharan Africa.

Participants had a median age of 27 years. The vast majority (83%) had migrated after the age of 15, most commonly to study, for reasons related to their sexual orientation or to discover another country. Economic reasons for migration were less common.

Study participants were asked if they knew of their HIV-positive status before moving to France and this information was confirmed from medical records. Exposure to HIV after moving to France was inferred if participants did not know of their HIV status before moving and had a negative HIV test after moving or a primary infection diagnosis at least one year after moving. Participants who did not report sexual intercourse before moving were also classified as having been exposed to HIV in France.

Of 829 participants who came to France after the age of 15, at least 38% acquired HIV after migration. If participants who came to France before the age of 15 were included, the proportion who acquired HIV after migration increased to 48%. In 27% of cases, it proved impossible to determine when HIV infection might have occurred.

HIV acquisition after arrival in France was more common in men from north Africa (73%), Asia and Oceania (61%) and sub-Saharan Africa (53%) than in men from Europe (47%) or Latin America and the Caribbean (39%).

Looking at various indicators of social integration, the researchers found that participants who had acquired HIV before migration were more likely to be unemployed, to be seeking asylum or have undocumented migrant status and to lack entitlement to health care.

Among those who migrated after the age of 15, one in four had no residence permit, 12% had no health coverage, 27% were unemployed and 45% lacked their own housing.

The study findings highlight a high level of HIV prevention and social need among gay and bisexual men migrating to France and emphasise the need for improved prevention and social inclusion measures, the study researchers conclude.