Factors associated with sexual risk taking behavior by precarious urban migrants in French Guiana

Data collected by the Clinical Investigation Center Antilles-Guyane during a KABP study of HIV and migrants in 2012 was used. It consisted of a multicentric observational cross-sectional study carried out French Guiana. The target population was sexually active migrants in French Guiana in underprivileged neighborhoods in one of the 3 main cities -Cayenne, Kourou, and Saint Laurent du Maroni.

Only migrants were included in this study. A migrant is considered to be a foreign person, born abroad and residing in France, including French overseas territories. This definition of immigrants is used by the High Council of Integration and INSEE for their surveys. Only migrants 18 years or older and accepting to participate in the study were interrogated. Only participants engaging in sexual intercourse within the last 12 months of the study were included in the statistical analysis.

For this study, non-probabilistic sampling was used. Participants were chosen from neighborhoods defined as precarious, presenting at least one of the following three characteristics: no access to running water, no access to electricity, or not benefiting from municipal garbage collection. This information was obtained from the prefectoral authorities who also provided population size estimates and maps. In practice, the population in these neighborhoods mostly consists of immigrants, who usually spontaneously aggregate by country of origin. This detailed information on precarious urban areas is compiled by the municipalities and the prefectoral authorities for the purposes of urban development planning and social services development. Once these areas were identified the surveyors were sent to the neighborhoods on different days of the week and different hours of the day in order to ensure greater diversity. They were assisted by local mediators who know the population in order to facilitate the survey. The surveyors started at the center of the neighborhood anda random direction was determined with the aid of a spinner. They then walked in the randomly selected direction and knocked at one of every two housesand then, in each selected house, verified that the person was a migrant, and used the shortest straw method to select the surveyed individual. If the house was empty they came back twice. They did so until the end of the street and then came back to the center of the neighborhood where they selected another random direction and reiterated the above. The number of individuals surveyed was proportional to the neighborhood population size given by the prefectoral authorities. For selected participants, the study was a knowledge, attitudes, behavior and practices study (based on questionnaires by Family health international’s behavioral surveillance surveys). Among the questions, one was about sexual activity in the past 12 months, a question which allowed us to select the subgroup of persons having had sex within the past year.

The study was approved by the Comité d’Evaluation Ethique de l’Inserm (CEEI) (IRB N°12–057), the Comité Consultatif pour le Traitement de l’Information en matière de Recherche sur la Santé (CCTIRS) and the Commission Nationale Informatique et libertés (CNIL) (DR-2012-261). The study was funded by the Program INTERREG Caraibes IV, Fond Européen de Développement Régional (FEDER), the University Hospital of Pointe-à-Pitre, Cayenne Hospital, and AIDES.

The data were collected from an anonymous structured questionnaire of 108 questions, translated into five languages (French, English, Portuguese, Spanish and Haitian Creole) and administered in an individual interview setting. After the interview, a prevention kit was provided that included male and female condoms, lubricant gel, an information brochure on HIV and STIs in the context of French Guiana, and a gift coupon to compensate for the time spent on answering questions. The study was based on BSS questionnaires produced by Family Health International and followed their criteria. This KABP study was delivered by trained local interviewers specialized in administering surveys to vulnerable populations.

This study aimed to investigate two outcome variables: risky sexual behavior and perception of risk. Our analysis concerned migrants who were recently sexually active, meaning they were sexually active within the last twelve months. Using the 12-month reference period and the last sexual encounter were considered useful for capturing the most recent behavior and minimized recall errors [6]. After reviewing the literature, our hypothesis was that the following risky sexual behaviors were associated with increased susceptibility to HIV infection: non-systematic use of condoms with casual or commercial sex partners, having had multiple sexual partners and having engaged in concurrent partnerships. Multiple and concurrent partnerships are common in French Guiana and are a known driver of the HIV/AIDS epidemic [5]. In countries with little condom use, and high levels of multiple and concurrent sexual partners, individual sexual history is largely used to define HIV risk [7].

Due to the context in French Guiana, the high prevalence of HIV, and the associated risk, condom use was interpreted strictly as using condoms systematically (every time) or non-systematically (almost every time, sometimes, or never). This definition took into account the usage of condoms during the last sexual encounter with a casual or commercial partner as well as the frequency of condom use with these partners. Regular partners were defined as partners with whom participants had sex for at least 6 months. Commercial partners were defined as partners with whom participants bought or sold sex in exchange for money, services, goods or drugs. Casual sex partners were defined as partners who were not “regular” or “commercial.” Multiple partners meant the individual had more than one sexual partner during the last year. A concurrent relationship was defined as having had more than one partner simultaneously.

The dependent binary variable, “risk”, was created, coding 1 if the individual had engaged in risky sex defined as non systematic condom use with casual or commercial partners, or had multiple sexual partners or engaged in concurrent partnerships Otherwise they were coded as 0 and placed in the “no risk” group. The independent variables were chosen as potential HIV risk factors after reviewing the available literature.

A second outcome variable was defined to further explore individual’s HIV risk perception in those who were considered to have sexual risk. This was evaluated using a question asking “How would you rate your own risk of getting HIV?” The answers could be high risk, low risk, does not know or no response.

The statistical analysis was performed using Stata© 13.0 (Stata Corp LP, College Station, TX, USA).