Multiple discriminations experienced by people living with HIV in France: results from the ANRS-Vespa2 study

Abstract

Since the advent of AIDS, discrimination has remained at the core of the experience of people living with HIV (PLHIV). PLHIV who belong to minority groups are exposed to discrimination not only on the grounds of their HIV infection but also because of rejecting attitudes towards drug users, homosexuals and black people. This article aimed to measure the frequency of discrimination and assess its correlates among PLHIV in France. We used data from a national representative survey, the ANRS-Vespa2 study, conducted in France in 2011 among 3022 male and female HIV-positive patients followed at hospitals. Respondents answered a face-to-face questionnaire documenting their health status and living conditions. Discrimination was documented during the previous two years on the grounds of HIV infection, gender, country of birth, skin colour, sexual orientation, place of residence, and substance abuse in a variety of contexts. For each context, we performed logistic regressions on discrimination, controlling for socio-epidemiological group, age, education level and employment status. Discrimination is frequently experienced by PLHIV in France (26%), particularly when applying for a job (24%), interacting with family (11%) or seeking health services (8%). Women from sub-Saharan Africa reported the highest levels of discrimination, whereas heterosexual non-African men reported the lowest. Men who have sex with men experienced levels of discrimination that fell between those of these two groups. The major perceived reason for discrimination was HIV status (13%). Nationality, skin colour and sexual orientation were cited by 5% each, whereas gender was cited by 1% of respondents. Our analyses show that discrimination is a frequent and cross-cutting experience with differences across the various contexts and among the diverse subpopulations. The intertwining of HIV-related stigma with sexism, racism and homophobia needs to be addressed to understand why discrimination against PLHIV persists when the disease itself has greatly evolved.

Keywords:

• discrimination
• structural approach
• quantitative data
• France

Acknowledgements

The authors wish to thank the PLHIV who agreed to participate in the study and all medical investigators. Thanks also go to community-based organizations – AIDES and ACT-UP Paris – and the persons who provided the methodological and ground support: Yann Le Strat (InVS, Saint-Maurice), Lise Cuzin (Hôpital Purpan, Toulouse), Laurence Meyer (Cesp, Inserm, Le Kremlin Bicêtre); Daniela Rojas-Castro (Aides, Pantin) and Hugues Fischer (Act-Up Paris). The VESPA2 study group: France Lert (co-PI), Bruno Spire (co-PI), Patrizia Carrieri, Rosemary Dray-Spira, Christine Hamelin, Nicolas Lorente, Marie Préau, Marie Suzan, with the collaboration of Marion Mora and Gwenaelle Maradan.

Funding

This work was funded by The French National Agency for Research on AIDS and Viral Hepatitis and Sidaction, a French AIDS-funding agency.

Additional information

Funding

Funding: This work was funded by The French National Agency for Research on AIDS and Viral Hepatitis and Sidaction, a French AIDS-funding agency.