1. #AIDS2016 | @AIDS_conference Forced sex, m Forced sex, migration and HIV infection among women from sub-Saharan Africa living in France : Results from the ANRS PARCOURS study J. Pannetier, A. Ravalihasy, M. Le Guen, A. Gosselin, N. Bajos, N. Lydié, F. Lert, R. Dray-Spira, A. Desgrées du Loû

2. #AIDS2016 | @AIDS_conference Immigration in Europe, Sexual violence and HIV infection In Europe, female immigrants are facing many forms of hardships increasing exposure to sexual risks (Desgrées du Loû et al. AIDS 2016) : – Social hardships after migration, especially among refugees increase vulnerability to sexual violence (Keygnaert et al. Cult Health Sex 2015). Evidence of an association between sexual violence and HIV infection in Sub-Saharan Africa countries (Durevall & Lindskog Lancet 2013). No information about the association between sexual violence after migration and post-migration acquisition of HIV among migrants in Europe.

3. #AIDS2016 | @AIDS_conference Objectives The aim of this study is to assess the association between forced sex, migration and HIV infection among sub- Saharan African women living in France. – Prevalence of forced sex after migration. – Association between forced sex after migration and post-migration acquisition of HIV. – Factors associated with forced sex after migration.

4. #AIDS2016 | @AIDS_conference Sub-Saharan African women in France Largest immigrant group after people from Maghreb: – 13% of immigrants, 1% of the French population. – 51% of SSA immigrants are women (INSEE, 2012). – Difficult settlement: it takes 6 years after migration to have basic elements of a settled life (Gosselin et al. Pop & Soc, 2016). Key population for HIV infection: – 60% of women diagnosed with HIV in 2014 (Cazein BEH 2015). – At least, 30% of post-migration acquisition of HIV (Desgrées du Loû et al. Eurosurveillance, 2015).

5. #AIDS2016 | @AIDS_conference Methods ANRS Parcours Study 2012-2013 « Life Course, HIV and Hepatitis B among African Migrants Living in France ». Representative life-event history survey conducted in 74 health-care facilities in the Paris metropolitan area. 2 randomized groups of migrants born in sub-Saharan Africa: – 570 women receiving HIV care (156 acquired HIV in France). – 407 not diagnosed with HIV (reference group).

6. #AIDS2016 | @AIDS_conference Forced sex Women were retrospectively asked whether they had ever been forced to have sex against their will and if happened, during which calendar year(s) Indicators: Forced sex in childhood Forced sex ≥ 15 years old Before migration After migration 2010- Forced sex 2008- Migration

7. #AIDS2016 | @AIDS_conference Statistical analysis Associated factors to forced sex, each year, at 15 or older while in the host country (mixed- effect logistic regressions): – Study group (HIV acquisition pre-migration, HIV acquisition post-migration, not diagnosed with HIV), – Main reason for migration, – Living conditions in France each year (housing, residence permit, resources). Ajusted for: – Sexual partnerships each year since migration, – Time since migration, – Age, education level and occupational status.

8. #AIDS2016 | @AIDS_conference Proportions of women subjected to forced sex

9. #AIDS2016 | @AIDS_conference Distribution of the proportions of women subjected to forced sex over the life course (Relative time graph)

10. #AIDS2016 | @AIDS_conference Forced sex each year since migration (aOR) According to place of HIV infection acquisition Ajudsted for main reason for migration, housing conditions, sexual partnerships, time since migration, age, education level and occupational status.

11. #AIDS2016 | @AIDS_conference Forced sex each year since migration (aOR) According to type of housing Ajudsted for study group, main reason for migration, sexual partnerships, time since migration, age, education level and occupational status.

12. #AIDS2016 | @AIDS_conference Forced sex each year since migration (aOR) According to reasons of migration Ajudsted for study group, housing conditions, sexual partnerships, time since migration, age, education level and occupational status.

13. #AIDS2016 | @AIDS_conference Conclusion 15% of women who acquired HIV after migration have reported forced sex after migration: forced sex after migration is strongly associated to HIV acquisition post-migration, after adjustment. Women seem particularly vulnerable to forced sex in France: – when they lack personal dwelling, – when they escaped their country because of a threat for their life.

14. #AIDS2016 | @AIDS_conference Conclusion Among the many facets of hardship faced by migrant women, sexual violence should be addressed by both a political, social and health response.

15. #AIDS2016 | @AIDS_conference 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 contact: julie.pannetier@ceped.orgjulie.pannetier@ceped.org