Low knowledge of antiretroviral treatments for the prevention of HIV among precarious immigrants from sub-Saharan Africa living in the greater Paris area: Results from the Makasi project

Abstract

Introduction In France, combination prevention tools, particularly antiretroviral treatment for HIV prevention has been available for several years. We described the knowledge of these antiretroviral treatments among immigrants from sub-Saharan Africa, who are particularly affected by HIV, and the factors associated with this knowledge. Methods The data come from the Makasi study, which was conducted between 2019 and 2020 among precarious immigrants from sub-Saharan Africa recruited through a community-based outreach approach in the greater Paris area (n = 601). We described levels of knowledge of HIV treatment effectiveness (HTE), treatment as prevention (TasP), post-exposure prophylaxis (PEP), and pre-exposure prophylaxis (PrEP), by sex with chi2 test. We investigated factors associated with their knowledge with logistic regressions adjusted for sociodemographic characteristics, living conditions and sexual behaviors (p≤0.2). Results Respondents were mostly men (76%), from West Africa (61%), in precarious situation: 69% were unemployed, 74% were undocumented and 46% had no health coverage. Among this population, knowledge of HIV preventive treatments was heterogeneous. While HTE was well known (84%); TasP was known by only half of the respondents (46%), and PEP and PrEP were hardly known: 6% and 5%, respectively. Multivariate regressions models showed that these antiretroviral treatments for the prevention of HIV was better known by people with a higher level of education (PEP: aOR = 3.33 [1.09–10.20], p = 0.03; HTE: aOR = 4.33 [1.87–10.04], p<0.001), those who had a social network in France (TasP: aOR = 1.90, [1.33–2.73], p<0.001), those who had access to the health system and those who were exposed to sexual risks (TasP: aOR = 3.17, [1.03–9.69], p = 0.04; PrEP: aOR = 2.60 [0.72–9.34], p = 0.14). Conclusions There is a need for specific communication on antiretroviral treatment for HIV prevention that targets sub-Saharan immigrants, particularly those who have no access to the health-care system and those who are less educated.