Migrant African women who have acquired HIV since moving to France are four times more likely to have experienced forced sex in France than other migrant women, researchers reported at the 21st International AIDS Conference (AIDS 2016) in Durban today. The study suggests that sexual violence is an important risk factor for migrant women acquiring HIV while living in Europe.
Data come from a cohort of 977 women attending health facilities in the Paris region. All participants were born in an African country and were now living in France.
Interviews focused on the women’s life histories, exploring key events both before and after migration, so as to understand the interviewee’s family history, education and employment, sexual relationships, and use of health services.
Most participants were born in countries in western and central Africa, especially Ivory Coast, Cameroon, Mali, the Democratic Republic of the Congo and Senegal. Around half the women had migrated to join a partner or family members. Some had fled their country because they were under threat there.
Data from this cohort has previously demonstrated that not all African migrants who are now living with HIV in European countries became HIV positive while they were in Africa. Analysis of CD4 cell counts and life history data showed that at least a quarter of those living with HIV were probably infected after migration and while living in France. Moreover, periods without a residence permit, secure housing or enough money were associated with transactional and casual sexual relationships, likely contributing to HIV infections.
The cohort includes 414 women who acquired HIV while living in Africa, 156 women who acquired HIV after migration, and 407 women who were not diagnosed with HIV.
During the life-history interview, women were asked if they had ever been forced to have sex against their will. Experiences of childhood sexual abuse (14 years and younger) were excluded from this analysis.
- Among HIV-negative women, 18% had experienced forced sex, including 4% who experienced it while living in France.
- Among women who acquired HIV while living in France, 24% had experienced forced sex, including 15% who experienced it while living in France.
Adjusting for demographic factors, migration history and living conditions, the frequency of forced sex in France was four times higher among women who had acquired HIV in France compared to that in HIV-negative women (adjusted odds ratio 4.39).
Women who had acquired HIV before migration were not more likely to have experienced forced sex in France.
Women who had migrated because of being threatened in their country of origin were six times more likely to have experienced forced sex in France (AOR 5.26). Similarly, not having stable housing in France (AOR 3.94) or staying with friends or family (AOR 2.58) were associated with a higher frequency of forced sex in France.
Women were most vulnerable to forced sex at the time of sexual debut (typically, this was before migration) and during their first year in France.
Migrants acquiring HIV in Europe
The French cohort study was one of the first to demonstrate that a substantial proportion of migrants acquire HIV in Europe, rather than in their countries of origin. UK researchers have also come to the same conclusion.
In order to see whether the phenomenon occurs in other European countries, researchers from Public Health England applied their method of determining when infection occurred (based on CD4 counts) to cohorts of migrants diagnosed with HIV in four European countries in 2011. The data includes migrants from all parts of the world, including other European countries.
In Italy, Sweden and Belgium, between 23 and 29% of migrants diagnosed with HIV were thought to have been infected since migration. This is a little lower than the 43% estimate for the UK but is still substantial.
“Our findings call for targeted prevention efforts to reduce HIV transmission among migrant populations living in Europe,” say the researchers.
Pannetier J et al. Forced sex, migration and HIV infection among women from sub-Saharan Africa living in France: results from the ANRS Parcours study. 21st International AIDS Conference, Durban, abstract TUAD0103, 2016.
Yin Z et al. HIV acquisition post-migration: evidence from four European countries. 21st International AIDS Conference, Durban, abstract TUPEC197, 2016.