Nicolas Vignier1,2, Rosemary Dray Spira1, Julie Pannetier3, Andrainolo Ravalihasy3, Anne Gosselin3, France Lert4, Nathalie Lydie5, Olivier Bouchaud6, Annabel Desgrees Du Lou3, Pierre Chauvin1. 1. Department of Social Epidemiology, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), Sorbonne Université, Paris, France. 2. Department of Infectious and Tropical Diseases, Groupe hospitalier Sud Ile-de-France, Sorbonne Université, Melun, France. 3. Santé, vulnérabilité et relations de genre (Sagesud), Sorbonne Paris Cités, IRD, CEPED, ERL INSERM 1244 SAGESUD, Université Paris Descartes, Paris, France. 4. Center for Research in Epidemiology and Population Health (CESP-U 1018), INSERM, Université Paris Sud, Villejuif, France. 5. 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. 6. Department of Infectious and Tropical diseases, and Laboratoire Educations et Pratiques de Santé (LEPS EA 3412), Paris 13 University, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Bobigny, 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.
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.
Authors: Tafireyi Marukutira; Nick Scott; Sherrie L Kelly; Charles Birungi; Joseph M Makhema; Suzanne Crowe; Mark Stoove; Margaret Hellard Journal: PLoS One Date: 2020-01-15 Impact factor: 3.240