Chronic hepatitis and HIV risks amongst Pakistani migrant men in a French suburb and insights into health promotion interventions: the ANRS Musafir qualitative study.

Publisher: BioMed Central Country of Publication: England NLM ID: 100968562 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2458 (Electronic) Linking ISSN: 14712458 NLM ISO Abbreviation: BMC Public Health Subsets: MEDLINE

Original Publication: London : BioMed Central, [2001-

Emigration and Immigration* ; Health Promotion* ; Risk-Taking* ; Transients and Migrants*; HIV Infections/*prevention & control ; Hepatitis B/*prevention & control ; Hepatitis C/*prevention & control; Adult ; Culture ; Ethnicity ; France ; Health Knowledge, Attitudes, Practice ; Hepacivirus ; Hepatitis B, Chronic/prevention & control ; Hepatitis C, Chronic/prevention & control ; Humans ; Male ; Middle Aged ; Pakistan ; Qualitative Research ; Risk Factors ; Sexual Behavior ; Suburban Population ; Young Adult

Background: Seine-Saint-Denis is a deprived departement (French administrative unit) in the North-East of Paris, France, hosting the majority of South Asian migrants in France. In recent years, the number of migrants from Pakistan, which has a high prevalence of hepatitis C globally, increased. As a corollary, this study addressed the high proportion of Pakistani patients in the infectious diseases clinic of a local hospital, diagnosed with hepatitis C, but also hepatitis B and Human Immunodeficiency Virus (HIV). It explored genealogies and beliefs about hepatitis and HIV transmission, including community, sexual and blood risk behaviours. The aim was to understand the ways these risk factors reduce or intensify both en route and once in France, in order to devise specific forms of community health intervention.
Methods: The study took place at Avicenne University-Hospital in Seine-Saint-Denis, and its environs, between July and September 2018. The design of the study was qualitative, combining semi-structured interviews, a focus group discussion, and ethnographic observations. The sample of Pakistani participants was selected from those followed-up for chronic hepatitis C, B, and/or HIV at Avicenne, and who had arrived after 2010 in Seine-Saint-Denis.
Results: Thirteen semi-structured interviews were conducted, until saturation was reached. All participants were men from rural Punjab province. Most took the Eastern Mediterranean human smuggling route. Findings suggest that vulnerabilities to hepatitis and HIV transmission, originating in Pakistan, are intensified along the migration route and perpetuated in France. Taboo towards sexuality, promiscuity in cohabitation conditions, lack of knowledge about transmission were amongst the factors increasing vulnerabilities. Participants suggested a number of culturally-acceptable health promotion interventions in the community, such as outreach awareness and testing campaigns in workplaces, health promotion and education in mosques, as well as web-based sexual health promotion tools to preserve anonymity.
Conclusions: Our findings highlight the need to look at specific groups at risk, related to their countries of origin. In-depth understandings of such groups, using interdisciplinary approaches such as were employed here, can allow for culturally adapted, tailored interventions. However, French colour-blind policies do not easily permit such kinds of targeted approach and this limitation requires further debate.

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ECTZ62614 Agence Nationale de Recherches sur le Sida et les Hépatites Virales

Keywords: Europe; HIV; Health promotion; Hepatitis C; Migration; Pakistan; Qualitative study; Risk; Vulnerability

Date Created: 20200913 Date Completed: 20200917 Latest Revision: 20231112

20240105

PMC7488669

10.1186/s12889-020-09459-x

32919467