Date Published: January 27, 2017
Publisher: Public Library of Science
Author(s): Anne Gosselin, Eva Lelièvre, Andrainolo Ravalihasy, Nathalie Lydié, France Lert, Annabel Desgrées du Loû, Joan A. Caylà.
Migrants account for 35% of HIV diagnoses in the European Union (ECDC/WHO 2014). Little is known about the impact of such a lifelong infection diagnosis on lives that are already disrupted by migration. In this paper, we assess the impact of HIV diagnosis on activity, union, well-being among African migrants living in France, the second group most affected by HIV after MSM. We compare it with the impact of the diagnosis of Hepatitis B, another lifelong infection affecting African migrants.
We use the ANRS PARCOURS survey, a retrospective life-event survey led in 2012–2013 in 74 health structures in Paris greater area which collected 926 life histories of Sub-Saharan migrants living with HIV and 779 with Hepatitis B. We modelled the probability year by year since 18 years of age until data collection to lose one’s activity, to experience a conjugal break up and degradation of well-being and we estimated the impact of migration and of HIV and Hepatitis B diagnoses on these probabilities, after adjustment on other factors, thanks to discrete-time logistic regressions.
Migration entailed loss of activity and conjugal break up, though HIV diagnosis after migration did not statistically impact on these outcomes. Yet HIV diagnosis had a massive negative impact on well-being (aOR = 11.31 [4.64–27.56] for men and 5.75 [2.79–11.86] for women). This negative impact on well-being tended to diminish for persons diagnosed after 2004. The negative impact of HIV diagnosis on African migrants’ well-being seems to be attenuated in the last decade, which hints at a normalization of the subjective experience of HIV diagnosis.
Migrants living in Europe account for 35% of HIV incident diagnoses of HIV/AIDS  and persons coming from Sub-Saharan Africa represented 31% of new HIV diagnoses in France in 2013 . HIV/AIDS may entail a biographical disruption in people’s lives  and impact many spheres, such as patients’ professional lives, intimate ties, social networks, sexuality, and more generally life expectations and well-being. This was especially the case at the beginning of the AIDS era, when an HIV-positive diagnosis was tantamount to a death sentence. Previous work has shown that HIV-infection negatively affected persons’ chances of accessing employment, particularly among women [4,5]. It was also shown that persons living with HIV (PLHIV) could experience negative reactions from their partners and spouse when they learned about their infection  as well as within the family circle . However, the arrival of HIV can give access to a legal permit for health reasons for undocumented migrants and it was also shown in other population to be a moment of self-reconstruction . Migrants arriving in France have already experienced a disruption of their lives because they have left their home countries. Indeed, the migration pathway often has its pitfalls, provokes long-lasting separations of families  and causes occupational downgrading [10,11]. What, then, is the impact of HIV diagnosis on lives that are already disrupted by migration?
In this study, we aimed at assessing the impact of HIV diagnosis on activity loss, conjugal break up (objective experience) and also on the degradation of well-being (subjective experience). The results show that HIV diagnosis does not impact on activity nor on union, at a population level, but it has a strong negative impact on well-being which still exists, even though it tends to diminish after the generalization of effective ARTs. In comparison, Hepatitis B diagnosis did not have any significant impact of the three indicators aforementioned, at a population level. These results suggest that HIV diagnosis remains a traumatic experience in the Sub-Saharan migrant population living in France, even if it does not have significant impact in terms of activity or partner loss. These findings also bring new elements on the respective influence of migration and HIV diagnosis on the difficulties encountered by African migrants living with HIV, and on the so-called “normalization” of HIV.
Migration entails great consequences for people’s lives. Public policy aiming at improving life with HIV should thus specifically address the difficult situation faced by Sub-Saharan migrants when they arrive in France. HIV diagnosis can trigger a degradation of well-being, but times are changing: with the generalization of effective ARTs, HIV diagnosis is less frightening that it used to be. Nevertheless, even if the situation is improving, hardship around diagnosis is still observed and further research is needed to understand why stigmatization remains important in the era of generalized antiretroviral therapy and how this can interact with persons’ well-being. On the other hand, migrants have to face the recent degradation of economic and social situation that has consequences on their lives. At a time when migrants are enduring renewed forms of fear and rejection in European societies, our results plead for appropriate social support at the critical moment of diagnosis which closely follows migration and constitutes a moment of important disruption.