1. www.aids2014.org The role of social vulnerability after migration in France on “at-risk” sex: the case of Subsaharan immigrants living in Paris area. A. Desgrées du Loû, J. Pannetier, N. Bajos, A. Gosselin, A. Ravalihasy, F. Lert, N. Lydié, R. Dray-Spira, and the PARCOURS Study group. (1) CEPED, IRD, Paris ; (2) CESP, INSERM, Paris ; (3) INPES, Paris ; (4) IPLESP, INSERM, Paris Abstract n° WEPDD0202

2. www.aids2014.org Background In France, 31% of new HIV diagnoses in 2012 were among immigrants from Subsaharan Africa (Cazein et al., 2014) Virological data suggest that among them, at least a fourth of HIV infection cases might have occured in France (Lucas et al., 2012). It is then necessary to identify conditions that expose Subsaharan immigrants to the risk of HIV infection in France. We aimed to evaluate the role of social vulnerability after migration on occasional, transactional and forced sex among Subsaharan men and women immigrants living in France.

3. www.aids2014.org Methods  The PARCOURS survey 2012-2013 : a cross-sectional study in the Paris area among migrants from Subsaharan Africa (aged 18-59)  Two random samples: HIV-infected outpatients N=926 HIV uninfected outpatients N=763  Recruitment in health care centers  Retrospective life-event questionnaire Study indicators Casual sex After arrival in France Transactional sex Forced sex ByGroup (HIV/ non HIV) Sociodemographic characteristics Administrative, housing and financial situations in France Sexual experiences before migration

4. www.aids2014.org Results After arrival in France, experiences of social vulnerabilities were frequent:  1 in 2 people had at least one year without resident permit  1 in 3 people had at least one year without stable housing 92% occurred during the first five years following arrival After arrival in France, experiences of social vulnerabilities were frequent:  1 in 2 people had at least one year without resident permit  1 in 3 people had at least one year without stable housing 92% occurred during the first five years following arrival

5. www.aids2014.org Correlates of sexual situations (women) Casual sex Transactional sex Forced sex Women OR a [95% CI] Women RR a [95% CI] Women RR a [95% CI] HIV (vs non HIV)1.30[1.09-1.56]2.09 [1.23-3.53]3.26 [1.69-6.28] Situation at arrival in France Single Stable partner in France Stable partner abroad 1 0.38 [0.31-0.47] 0.78 [0.54-1.13] 1 0.37 [0.20-0.66] 0.31 [0.11-0.88] 1 0.45 [0.22-0.90] 0.05 [0.01-0.40] Housing situation* No stable house Hosted by family Hosted by institutions Own house 2.03 [1.46-2.84] 1.51 [1.20-1.92] 1.45 [0.96-2.18] 1 10.26 [5.0-21.12] 1.99 [0.76-5.31] 16.20 [8.2-32.95] 1 3.37 [1.48-7.67] 1.37 [0.71-2.62] 0.46 [0.13-1.59] 1

6. www.aids2014.org Conclusion Among women, residential insecurity was frequent, especially in the first years following migration, and favoured casual and transactional sexuality and sexual abuse in France. are more common among HIV infected Subsaharan migrants Experiences in France of : Casual relationships Transactional relationships Forced sex Casual relationships Transactional relationships Forced sex Recommendations : -Residential and financial insecurity of immigrants after arrival in France should be addressed in order to reduce their risk to engage in at-risk sex, specially for women. -Both for men and women, prevention of sexual risks should be strenghtened in the first years following arrival in France. Recommendations : -Residential and financial insecurity of immigrants after arrival in France should be addressed in order to reduce their risk to engage in at-risk sex, specially for women. -Both for men and women, prevention of sexual risks should be strenghtened in the first years following arrival in France.

7. www.aids2014.org Aknowledgements The PARCOURS survey was funded by the French National Agency for Research on Aids and Viral Hepatitis (ANRS). We thank all patients who agreed to participate in the PARCOURS survey, all medical staff members in the participating hospitals, as well as the community-based organisations RAAC- Sida, COMEDE and SOS hepatites who supported the survey. The PARCOURS Study Group: A. Desgrées du Loû, F.Lert, R Dray-Spira, N. Bajos, N.Lydié (scientific coordinators), J. Pannetier, A. Ravalihasy, A. Gosselin, D. Pourette, with the support of A. Guillaume. Methodological and ground support: Y. Le Strat, J. Gelly, N. Razafindratsima, P. Revault, J. Situ, P. Sogni, G. Vivier Data collection: The ClinSearch firm and the social research institute Ipsos. www.parcours-sante-migration.com