Access to employment among African migrant women living with HIV in France: opportunities and constraints

ABSTRACT

HIV in France particularly affects sub-Saharan migrants as they accounted for 31% of the new diagnoses in 2013. The objective of this study is to investigate the access to and the experience of employment among migrant women living with HIV in France. We use a mixed-method approach. The quantitative data come from the ANRS Parcours study, a life-event survey conducted in 2012–2013 in 70 health centres which collected year-by-year detailed information on living conditions about 755 sub-Saharan women migrants in the greater Paris region (470 with HIV and 285 without HIV). The qualitative data have been collected independently in the same region through socio-ethnographic observations and interviews conducted in 8 HIV-positive migrant organisations and among 35 women-members from 2011 to 2013. Two main results are noteworthy. First, being HIV-positive unexpectedly gives sub-Saharan migrant women a quicker access to employment thanks to the social support they find in migrant organisations: in the third year in France in median (versus 5th year among HIV-negative group). This effect of being HIV-positive on the access to employment remains all things being equal in a discrete-time logistic regression (aOR [95% CI] HIV+: 1.4[1.1;1.8]). Second, their employment situation remains strongly shaped by the racial division of work existing in France and they develop individual strategies to negotiate this constraint: for example, temporary jobs and working as health mediators. The type of jobs they find, mainly in the care sector, force them to carefully hide their HIV status because they fear discrimination at work. Not only migrant women endure structural discrimination in a segmented labour market, but they also anticipate HIV-related discrimination related to caring activities. Thus, the design and implementation of programmes that address stigma should consider structural discrimination to improve PLWHA’s working experiences.

KEYWORDS:

• Sub-Saharan migrant women
• employment
• HIV+ migrant organisations
• mixed method
• France

Acknowledgements

The authors would like to thank all the persons who participated in the ANRS Parcours Survey, the RAAC-Sida, COMEDE, FORIM and SOS hepatitis associations for their support in preparing and conducting the survey, G. Vivier, E. Lelièvre (INED) and A. Gervais (AP-HP) for their support in preparing the questionnaire, H. Panjo for statistical support, A. Guillaume for communication tools, the ClinSearch and Ipsos societies for data collection, and staff at all participating centres.

This article is the result of a mixed-method approach. The two authors (Marjorie Gerbier-Aublanc and Anne Gosselin) contributed equally to the study and should be both considered as “co-first” authors.

The PARCOURS Study Group included A Desgrées du Loû, F Lert, R Dray Spira, N Bajos, N Lydié (scientific coordinators), J Pannetier, A Ravalihasy, A Gosselin, E Rodary, D Pourette, J Situ, P Revault, P Sogni, J Gelly, Y Le Strat, N Razafindratsima.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

The ANRS Parcours Survey was supported by the French National Agency for research on AIDS and Viral Hepatitis (ANRS) and the General Direction of Health (DGS, French Ministry of Health). The quantitative study was supported by the French National Agency for research on AIDS and Viral Hepatitis (ANRS), under a doctoral grant. The qualitative part of this work was supported by Sidaction and the Fonds de Dotation Pierre Bergé, in the form of a doctoral grant.