Migratory Paths, Experiences of HIV/AIDS, and Sexuality: African Women Living withHIV/AIDS in France

Abstract

The AIDS epidemic in Europe includes a growing number of women who have emigrated from sub-Saharan Africa. This contribution presents the results of a qualitative anthropological study on African women living with HIV/AIDS in France. It shows how their migratory paths – including the reasons for their migration and their social and administrative situation in the country – can have varying influences on how the disease is experienced in the context of migration. Married women who have established long-term residence in France experience HIV/AIDS as essentially a conjugal issue that can reinforce unequal relations between partners. For women who discovered they were HIV positive shortly after arriving in France, HIV/AIDS leads to social isolation, altered migratory plans, and greater vulnerability. For those who migrated to access medical treatment, the virus is the driving force behind the migratory strategies and a new socialization in France built around HIV/AIDS.

Keywords:

• Migration
• HIV/AIDS
• African women
• gender
• sexuality
• JEL Codes: I1, I18

Acknowledgments

I would like to thank Cecilia Conrad, Cheryl Doss, and the anonymous reviewers for their comments and suggestions. I also thank Nathalie Bajos, Meegan Davis, Isabelle Delpech, Sidaction, la Fondation de France, and Inserm U 822. Special thanks must also go to the women who agreed to participate in this research.

Notes

See Nigel O'Farrell, R. Lau, Kathir Yoganathan, C.S. Bradbeer, G.E. Griffin, and Anton Pozniak 1995; J. Del Amo, A. Petruckevitch, A.N. Phillips, A.M. Johnson, J.M. Stephenson, N. Desmond, T. Hanscheid, N. Low, A. Newell, A. Obasi, K. Paine, A. Pym, C.M. Theodore, and K.M. De Cock 1996; N. Low, K. Paine, R. Clark, M. Mahalingam, and A.L. Pozniak 1996; Françoise F. Hamers and Angela Downs 2004; France Lert 2004; Cornelia Staehelin, Niklaus Egloff, Martin Rickenbach, Christine Kopp, and Hansjakob Furrer 2004.

This data deals with persons that tested positive for the first time.

It is estimated that 25 million of the world's 39 million living with HIV/AIDS are in sub-Saharan Africa (Joint United Nations Programme on HIV/AIDS [UNAIDS]2006).

In sub-Saharan Africa, women represent about 60 percent of the total number of people infected (UNAIDS 2006). See, in particular, for further work on the dynamics of AIDS in Africa: Israel O. Orubuloye, John Caldwell, and Pat Caldwell 1994; Paul Farmer, Margaret Connors, and Janie Simmons 1996; Laurent Vidal 1996; Alice Desclaux and Annabel Desgrées du LoÛ2006 (list not exhaustive).

Martha Chinouya, Oliver Davidson, and Kevin Fenton 2000; Mike Kesby, Kevin Fenton, Paul Boyle, and Robert Power 2003; Florence Lot, Christine Larsen, Nadia Valin, Pascal Gouëzel, Thierry Blanchon, and Anne Laporte 2004; Christine C. Chee, Eva Mortier, Christine Dupont, Martine Bloch, Anne-Marie Simonpoli, and Elisabeth Rouveix 2005; Audrey Prost 2006; Dolorès Pourette 2006a.

The study “Women from Africa Living with HIV in France: Managing Risks and Reproductive Choices” is my post-doctoral research. I conducted it in Inserm Unit 569 (National Institute for Health and Medical Research, France). This research was coordinated by Nathalie Bajos, Research Director at Inserm. It was financed by Sidaction, a French non-governmental AIDS organization, and La Fondation de France. I am an anthropologist, and I have conducted several research studies on sensitive issues such as AIDS, sexuality, and domestic violence (Dolorès Pourette 2003, 2006a, 2007, 2008).

As such, I interviewed each woman once, with the exception of four women who were each interviewed twice.

The women in this study come from former French colonies and are French-speaking. Only one interview was conducted in English (with a woman from South Africa).

The women in this study come from former French colonies and are French-speaking. For these reasons, they choose to migrate to France rather than to another European country.

According to France's National Institute of Statistics and Economic Studies (INSEE), an immigrant is a person born abroad residing in France, whether or not French nationality has been acquired. These figures do not take into consideration illegal immigrants, whose numbers tend to increase in a context of restricted migratory flow.

Foreigners who have their papers in order may benefit from the RMI as long as they are over 26 years of age, have resided in France for more than three months, and are listed as job-seekers. The RMI is set at 440 euros per month for a single person. By comparison, the guaranteed minimum wage in France is 8.27 euros per hour gross (1,254 euros per month gross). On average, it costs 600 euros per month to rent a one-room apartment in Paris.

Housing supplement is granted according to resources.

Persons diagnosed with HIV/AIDS may become ill from opportunistic diseases. These are diseases caused by usually harmless viruses or bacteria that can become life threatening because of the person's impaired immune defense.

No woman in the study was involved in a homosexual relationship.

Names have been changed to safeguard the identity of the people concerned.

Very often, the women avoid telling their loved ones and family that they are HIV positive for fear of worrying them. The ones that did tell them were not greeted with reactions of rejection, but, rather, speak of emotional, if not financial, support.

“Seropositivity” means the presence of antibody to HIV as detected by appropriate laboratory tests.

In the hospitals in question, there are social services offices.

In the Paris region, there are several African associations that offer help with medical and social services formalities to African HIV/AIDS sufferers.

Some arrived with no visa, while most had a tourist visa, which enables the bearer to stay in France for three months.

The doctor's role therefore stretches beyond the purely medical realm and takes on a political aspect (Didier Fassin 2000).

Thanks to the state medical care benefit (AME).

From six months to a year according to the women interviewed.

A qualification (Diplôme universitaire d'Etudes Approfondies) similar to a Master's degree.

Studies emphasize the condom's negative image in Africa. It is supposed to dampen the effect of sexual pleasure and is associated with transient or casual sexual relations (Laurent Vidal 2000; Alice Desclaux and Annabel Desgrées du LoÛ2006). Women in the study also reported that African men usually refuse to use condoms. For instance, Anne said about her ex-partner: “He didn't want to use condoms. As any African man. He didn't want. African men don't like condoms” (Anne, from Congo-Kinshasa, 51 years of age). Another woman, from South Africa, explained: “African men, they don't believe in condoms” (Mary, 39 years of age).

This is confirmed by the analysis of viral sub-types found in screened patients showing that the presence of sub-type B in African patients (a sub-type that is infrequent in Africa) suggests HIV transmission between French and African subjects (Institut de Veille Sanitaire 2006).

Pauline (from Côte d'Ivoire, 32 years of age) was screened during a fertility test she undertook when she could not conceive a fourth child. She was very attached to her husband and worried that the disclosure of her infection might harm their relationship. However since her diagnosis, Pauline and her husband systematically use condoms. She told him that she was undergoing fertility treatment and that a pregnancy was not recommended during this treatment. They use condoms as a contraceptive.

Medical examinations.

She was married ten years earlier as a bride in an arranged marriage. She had a son with her first husband.

The child is HIV negative. This was the first child from the marriage between Mariama and her second husband.

PLWHA can be over-infected by the AIDS virus. It is therefore recommended to use condoms during sexual intercourse between HIV-positive partners.

The attitude shown by Barbara's husband is not uncommon and demonstrates that the act of informing one's partner of one's seropositivity does not necessarily mean that the couple's sexual habits change, as has been shown by Annick Tijou Traoré (2006) in her study of HIV-positive/negative couples in Côte d'Ivoire.

The women working full-time are the most qualified and they obtained their professional qualification in France. But not all of the qualified women found work.

The “employment rate for women born in sub-Saharan Africa … is still, in France, lower than that for the overall number of active women” (Laurence Roulleau Berger and Marie-Thérèse Lanquetin 2004: 21).

In France, job insecurity (part-time positions, unemployment) is greater for migrant women than for non-migrant women: in 1999, 42.3 percent of working migrant women held a part-time position and 31.7 percent of total working women held a part-time position (Suzanne Thave 2000: 2).

Some restrictions apply to migrants from a growing list of countries.