PUBLI : Johann Cailhol and Nichola Khan, « Chronic hepatitis and HIV risks amongst Pakistani migrant men in a French suburb and insights into health promotion interventions : the ANRS Musafir qualitative study », BMC Public Health [en ligne], vol. 20, n° 1393, 2020


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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