European Journal of Public Health
Volume 28, Issue 5, 2018, Pages 904-910

Refusal to provide healthcare to sub-Saharan migrants in France: A comparison according to their HIV and HBV status (Article) (Open Access)

Vignier N.* , Spira R.D. , Pannetier J. , Ravalihasy A. , Gosselin A. , Lert F. , Lydie N. , Bouchaud O. , Du Lou A.D. , Chauvin P.
  • a Department of Social Epidemiology, INSERM, Institut Pierre Louis d’Épidémiologie et de Santé Publique (IPLESP), Sorbonne Université, Paris, France, Department of Infectious and Tropical Diseases, Groupe hospitalier Sud Ile-de-France, Sorbonne Université, Melun, France, Equipe de Recherche en Epidémiologie Sociale (Department of Social Epidemiology), Institut Pierre Louis d’Épidémiologie et de Santé Publique (IPLESP), Université Pierre et Marie Curie Paris 6 (UPMC Univ Paris 06), UMRS 1136, Faculté de Médecine Saint-Antoine, 27 rue de Chaligny, Paris Cedex 12, 75571, France
  • b Department of Social Epidemiology, INSERM, Institut Pierre Louis d’Épidémiologie et de Santé Publique (IPLESP), Sorbonne Université, Paris, France
  • c Santé, vulnérabilité et relations de genre (Sagesud), Sorbonne Paris Cités, IRD, CEPED, ERL INSERM 1244 SAGESUD, Université Paris Descartes, Paris, France
  • d Santé, vulnérabilité et relations de genre (Sagesud), Sorbonne Paris Cités, IRD, CEPED, ERL INSERM 1244 SAGESUD, Université Paris Descartes, Paris, France
  • e Santé, vulnérabilité et relations de genre (Sagesud), Sorbonne Paris Cités, IRD, CEPED, ERL INSERM 1244 SAGESUD, Université Paris Descartes, Paris, France
  • f Center for Research in Epidemiology and Population Health (CESP-U 1018), INSERM, Université Paris Sud, Villejuif, France
  • g Direction de la prévention et de la promotion de la santé-Unité Santé sexuelle, Santé Publique France, French National Agency of Public Health, Saint-Maurice, France
  • h Department of Infectious and Tropical diseases, Laboratoire Educations et Pratiques de Santé (LEPS EA 3412), Paris 13 University, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Bobigny, France
  • i Santé, vulnérabilité et relations de genre (Sagesud), Sorbonne Paris Cités, IRD, CEPED, ERL INSERM 1244 SAGESUD, Université Paris Descartes, Paris, France
  • j Department of Social Epidemiology, INSERM, Institut Pierre Louis d’Épidémiologie et de Santé Publique (IPLESP), Sorbonne Université, Paris, France

Abstract

Background: In this study, we aim to measure and compare the frequency of reported denial of care in sub-Saharan African migrants living in the Paris area, according to their HIV and HBV status and social and migration characteristics. Methods: The ANRS-PARCOURS study is a life-event survey conducted in 2012–13 in healthcare facilities in the Paris area, among three groups of sub-Saharan migrants recruited in primary care centres (N = 760; reference group), in dedicated centres for HIV care (N = 922; HIV group) and in centres for chronic hepatitis B care (N = 777; CHB group). Characteristics associated with refusal of care since arrival in France were identified using a logistic regression model. Results: Compared to the reference group (6%, P < 0.001), the reported refusal of care was twice as high in the HIV group (12%) and the CHB group (10%). In the multivariate analysis, men and women living with HIV were at greater risk of being denied care (aOR = 2.20[1.14–4.25] and 2.24[1.25–4.01]). Women covered by the specific health insurance (HI) for precarious or undocumented migrants were also at higher risk (aOR = 2.07[1.10–3.89] and 2.69[1.18–6.10], respectively). The risk was also increased in men who remained for at least one year without permit of residence or without HI and among those who were threatened in their country. Conclusion: Refusals to provide healthcare are frequent and deleterious situations especially for migrants living with HIV. Health decision makers, public insurance bodies and health professional councils must address this issue to improve equity in the healthcare system. © The Author 2018.

Author Keywords

[No Keywords available]

Index Keywords

HIV Infections Africa south of the Sahara Human immunodeficiency virus infection France human middle aged statistics and numerical data comparative study health status ethnology Young Adult Humans migrant Adolescent male Emigrants and Immigrants female Retrospective Studies adult migration Paris treatment refusal Transients and Migrants retrospective study hepatitis B Health Services Accessibility health care delivery
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85059269368&doi=10.1093%2feurpub%2fcky118&partnerID=40&md5=cdc20d51b367f4bfd0e6474b9313d938
DOI: 10.1093/eurpub/cky118
ISSN: 11011262
Original Language: English