HIV-testing among female sex workers on the border between Brazil and French Guiana: the need for targeted interventions

Enhancing sexual health and empowerment among migrant women sex workers: a community health worker-led intervention in Marseille, France

Introduction

Given the high infection rate of sexually transmitted infections (STI) among migrant women sex workers (WSWs), it is necessary to understand how to improve prevention, information and care for this vulnerable population. Community health workers (CHWs), by linking community to health services, are positioned to improve health outcomes in migrant communities. This article aims to describe a pilot innovative intervention performed by CHWs to improve sexual health in migrant WSWs.

Methods

This one-year intervention study used a respondent-driven sampling (RDS) to recruit a representative cohort of migrant WSWs in Marseille, France. Four CHWs were recruited from different communities and participated in all stages of the research. They performed individual and group interventions of prevention, support in care and empowerment. Data on participant characteristics, type of intervention and adherence to the intervention were reported via questionnaires given to participants. Simultaneously, semi-structured interviews and informal interviews of migrant WSW, CHWs and care providers were carried out.

Results

A total of 132 migrant WSWs were included in the cohort. Very few of them knew about PrEP (12%) or already used HIV post-exposure treatment (9%). Migrant WSWs were often victims of rape or racism, 15 and 21%, respectively. In two-thirds of cases the level of health literacy was low. Participants suffered from a combination of vulnerability factors: difficulties with access to social rights, food or housing. Only 13% reported having benefited from medical follow-up or assistance by an NGO in the 3 months prior to the program. By 3 months, more than one third of the participants had been tested for HIV (35%) and 63% knew about PrEP. A total retention rate of 70% was reported in the cohort after 6 months.

Conclusion

CHWs enabled to improve care access for migrant WSWs by improving the collaboration between care and social actors at a local level. Through these "bring-back-to" interventions for this hard-to-reach population, CHWs enabled an optimization of the care pathway. Our results also highlight the importance of a population-based approach for individual and group support of empowerment interventions in order to strengthen their capacity for action.

Contrasted life trajectories: reconstituting the main population exposomes in French Guiana

In French Guiana, life expectancy is between 2 and 3 years below that of France, reflecting differences in mortality rates that are largely sensitive to primary healthcare and thus preventable. However, because poverty affects half of the population in French Guiana, global measurements of life expectancy presumably conflate at least two distinct situations: persons who have similar life expectancies as in mainland France and persons living in precariousness who have far greater mortality rates than their wealthier counterparts. We thus aimed to synthesize what is known about statistical regularities regarding exposures and sketch typical French Guiana exposomes in relation to health outcomes. We conducted a narrative review on common exposures in French Guiana and made comparisons between French Guiana and mainland France, between rich and poor in French Guiana, and between urban and rural areas within French Guiana. The most striking fact this panorama shows is that being a fetus or a young child in French Guiana is fraught with multiple threats. In French Guiana, poverty and poor pregnancy follow-up; renouncing healthcare; wide variety of infectious diseases; very high prevalence of food insecurity; psychosocial stress; micronutrient deficiencies; obesity and metabolic problems; and frequent exposure to lead and mercury in rural areas constitute a stunningly challenging exposome for a new human being to develop into. A substantial part of the population's health is hence affected by poverty and its sources of nutrition.

HIV treatment cascade among female sex workers in Ethiopia: Assessment against the UNAIDS 90-90-90 targets

BACKGROUND

HIV treatment cascades for HIV-positive female sex workers (FSWs) have been challenged by the overlapping stigma and discrimination associated with both their sex work and HIV status. This study aims to assess the proportion of HIV-positive FSWs who access care and treatment in Ethiopia.

METHOD

A cross-sectional study with a respondent-driven sampling technique was used to enroll 6,085 female sex workers from January to June 2020. Interviews were conducted to assess the FSWs' HIV status awareness and access to ART. A blood sample was drawn to determine the current HIV status and viral load level. Logistic regression was run to identify factors associated with FSWs' HIV status awareness.

RESULTS

Of the total 1140 HIV-positive FSWs, 50.38% knew they were HIV positive; 92.88% of those who knew their status were on ART, and 91.68% of those on ART had attained viral suppression of less than 1000 copies per milliliter. The adjusted odds of knowing HIV status was 3.20 (95% CI; 2.00, 5.13) among those aged 35 years and older, 1.81 (95% CI; 1.05, 3.12) among widowed, and 1.73 (95% CI; 1.28, 2.32) in those who did not perceive the risk of HIV acquisition.

CONCLUSION

Only about half of HIV-positive FSWs knew they were HIV positive. More than 90% of those who knew their status were put on ART and achieved viral suppression. The weakest point in achieving HIV control among FSWs is the identification of those living with HIV.

Sexual and addictive risk behaviors and sexually transmitted infections in illegal gold miners in French Guiana: A multicenter observational study

Objectives

Common representations of the world of gold mining–especially illegal–are usually negative: the activity conjures up images of drug trafficking, human exploitation, the sex trade, environmental destruction, and infectious diseases, in particular sexually transmitted infections (STIs). The aim of the present article is to describe the levels of risk behaviors such as transactional sex, multiple sexual partners, and the frequency of condom use, addictive substance consumption, and the prevalence of STIs among the population of illegal gold miners in French Guiana (FG), a French overseas entity in Amazonia, in order to guide potential interventions.

Methods

An observational multicenter cross-sectional study was carried out from October to December 2019 along the two borders of FG with Suriname and Brazil at rest sites used by the miners.

Results

Among the 499 participants, transactional sex was very prevalent, declared by 33.5% of men and 8.4% of women. Condoms were more frequently used for transactional sex than with a non-commercial partner (93.4% versus 42.1%). More women were tested for HIV than men (91.1% versus 55.2%). Excessive alcohol consumption (57.3%%) and tobacco use (41.2%) were very frequent, but cocaine or crack consumption was low (1.2%), which refuted our initial assumption. Consumers of alcohol had more sexual partners and reported condom use more frequently. Prevalence of HIV, HCV, HBV, and syphilis was respectively 0.5% (95% CI: 0.1–2.1), 2.1% (95% CI: 0.7–3.6), 1.6% (95% CI: 0.3–2.8), and 12.4% (95% CI: 9.0–15.7), which was higher than in the local population, especially for syphilis.

Conclusion

This study documents for the first time the risk behaviors of gold miners in FG. Although the level of condom use was high, the prevalence of STIs combined with the high rate of transactional sex should encourage an increase in prevention and screening, in particular through rapid tests, given the mobility of the population concerned.

What can lead to late diagnosis of HIV in an illegal gold mining environment? A qualitative study at the French Guiana's border with Brazil

OBJECTIVE

The present study aimed to understand what factors can lead to late HIV diagnosis of illegal gold miners at French Guiana's border with Brazil.

DESIGN

An exploratory qualitative study with in-depth interviews and observations was conducted between November 2019 and February 2020.

SETTING

The study was conducted in the main medical healthcare service and two non-governmental organisation premises in the Oyapock border region, which is a supply area for illegal gold mining sites.

PARTICIPANTS

Fifteen people living with HIV diagnosed with CD4 count <350 cells 106/L were interviewed. Seven women and eight men participated; they were between 31 and 79 years old, and the median time since HIV diagnosis was 6 years. Eight had links to illegal gold mining.

FINDINGS

Three key themes for late HIV diagnosis emerged: (1) the presence of economic and political structural factors which constitute risks for this illegal activity, specifically the repression of gold mining sites by French Armed Forces and the distance from healthcare facilities; (2) representations of the body and health, related to the living conditions of this population; prioritisation of health emergencies and long-term self-medication; and (3) gender roles shaping masculinity and heterosexuality contributing to a perception of not being at risk of HIV and delaying testing.

CONCLUSION

This study highlights structural, group-based and individual factors that reduce access to HIV testing and healthcare in general for a population of migrant workers in an illegal gold mining area. Faced with harsh living conditions and state repression, these workers develop a vision of health which prioritises the functionality of the body. Associated with gender roles which are partly shaped both by the mining activity and its geographical location, this vision can lead to late HIV diagnosis.

Using phylogenetic surveillance and epidemiological data to understand the HIV-1 transmission dynamics in French Guiana

OBJECTIVE

The aim of this study was to understand the transmission dynamics of the HIV-1 subtype B epidemic in French Guiana and the factors that shaped the expansion of major phylogenetic transmission clusters.

DESIGN

HIV-1 subtype B pol sequences with associated epidemiological data obtained from 703 treatment-naive patients living in French Guiana between 2006 and 2012, which correspond to 91% of all HIV cases diagnosed in that period, were employed in this study.

METHODS

Maximum likelihood and Bayesian methods were used to construct phylogenetic trees, identify transmission clusters and estimate intervals between successive infections. Statistical analysis was performed to evaluate epidemiological characteristics associated with cluster membership.

RESULTS

HIV-1 subtype B pol sequences from French Guiana were distributed in 10 large/medium transmission clades (LMTC, n > 10, 55%), 19 small transmission clades (STC, n = 3-8, 10%), 36 dyads (10%) or were nonclustered (25%). The rate of clustering did not differ by sex or clinical stage, but sex workers, crack-cocaine users, young individuals (15-20 years) and nationals or migrants from neighbouring South American countries were more likely to cluster within LMTC than individuals from other groups. We estimated that 53-63% of immigrants were infected after the arrival in French Guiana and that 50% of HIV transmissions within LMTC occurred during the first 2 years after infection.

CONCLUSION

These findings reinforce the notion that high-risk sexual behaviours among young individuals and migrants (postmigration) combined with late HIV diagnosis are key drivers of onward dissemination of major HIV transmission clusters in French Guiana.

E6/E7 Sequence Diversity of High-Risk Human Papillomaviruses in Two Geographically Isolated Populations of French Guiana

Amerindian and Maroon populations of French Guiana have been living in isolation for generations and sexual networks remained mostly endogamous. The present study aimed to describe the phylogeny of E6 and E7 sequences of the most common high-risk HPV genotypes in these regions, to ascertain the diversity of intra-type variants and describe evolutionary relationships. There were 106 women with at least one of HPV16, 18, 31, 52, 58, and 68 genotypes. The most clear-cut phylogenetic pattern was obtained for HPV18 and HPV58 for which the major branches were crisply divided between Amerindian villages on the Oyapock and Maroon villages on the Maroni. Such clustering was less clear for HPV31 and 52. For HPV16, there was also some evidence of clustering on the Oyapock with type A European viruses and on the Maroni with type B and C African viruses among Maroon women. HPV68 showed the largest sequence heterogeneity of the six genotypes at both nucleotide and amino acid levels and was restricted to Maroon women. The present results show that there were significant geographically based differences of E6 and E7 oncogenes. These differences were compatible with different ancestral virus populations and local virus evolution in a context of prolonged population isolation.

Social Capital and HIV Testing Uptake among Indirect Female Sex Workers in Bali, Indonesia

Indirect female sex workers (FSWs), a type of FSW working under the cover of entertainment enterprises (e.g., karaoke lounge, bar, etc.), remain as an important key population for HIV transmission, signaling the need of appropriate interventions targeting HIV-related behaviors. This study aimed to investigate the association between social capital and HIV testing uptake. A cross-sectional study was conducted among 200 indirect FSWs in Denpasar, Bali. The dependent variable was HIV testing uptake in the last six months preceding the survey. The main independent variables were social capital constructs: social cohesion (perceived peer support and trust) and social participation. Variables of socio-demographic characteristics were controlled in this study to adjust the influence of social capital. Binary logistic regression was performed. The prevalence of HIV testing in the last six months was 72.50%. The multivariate analysis showed that only peer support from the social capital constructs was associated with HIV testing uptake. Indirect FSWs who perceived a high level of support within FSWs networks were 2.98-times (95% CI = 1.43–6.24) more likely to report for HIV testing. Meanwhile, perceived trust and social participation did not show significant associations in relation to HIV testing uptake. As social cohesion (support) within FSWs’ relationships can play an important role in HIV testing uptake, existing HIV prevention programs should consider support enhancement to develop a sense of belonging and solidarity.

Knowledge, attitudes, practices about HIV and implications in risk and stigma prevention among French Guianese and Brazilian border inhabitants : Beliefs about HIV among border inhabitants

BACKGROUND

The border area between French Guiana and Brazil is an active HIV-transmission zone. The aim of the present study was to describe HIV knowledge, risk and the level of stigma among inhabitants of this border area.

METHODS

A cross-sectional study was conducted among 621 inhabitants over 18 years of age in the border cities of Saint-Georges-de-l'Oyapock in French Guiana and Oiapoque in Brazil. It was conducted between October 2017 and February 2018. An anonymous standardized questionnaire was filled out by culturally-trained mediators, then analyzed using STATA 12.

RESULTS

Almost half (45.9%) of the individuals had a low education level. Participants whose native language was Portuguese or French demonstrated better HIV knowledge than other populations, notably native Amerindian and creole-speaking people. HIV risk behavior was more frequent in men and in younger age groups. People with good HIV knowledge reported having performed more HIV tests in the last year than participants with poor knowledge. The stigma level was high and reported in 74.8% of respondents.

CONCLUSIONS

These results illustrate the need for initiatives to improve HIV prevention among autochthonous populations on both sides of this border area. Cross-border collaboration on health policies could produce common key messages adapted to the education level and multi-linguistic populations who live in this area.

HIV testing coverage among female sex workers, Brazil, 2016

INTRODUCTION

Knowing the factors associated with periodic HIV testing among female sex workers (FSW) is essential to expand testing coverage and to broaden programs of treatment as prevention.

METHODS

We used data from 4,328 FSWs recruited by the respondent-driven sampling (RDS) method in 12 Brazilian cities in 2016. Data analysis considered the complex sampling design. The prevalence of HIV testing in the last year and periodic HIV test were estimated. Factors associated with regular HIV testing were identified through logistic regression models.

RESULTS

The testing coverage in the last year was 39.3%. Only 13.5% of FSW reported having performed a periodic HIV test in the last year. Among the factors associated with the higher probability of HIV testing in the last year were a better level of education, living with a partner, working indoors, consistent use of condoms, and regular use of public and private health services stood out.

DISCUSSION

Periodic HIV testing allows early diagnosis and immediate treatment of cases, reducing the chances of spreading the infection to the population. However, factors such as stigma and discrimination hinder the use of regular health services.

CONCLUSION

It is necessary to expand awareness campaigns, especially among FSWs with low educational level and greater vulnerability, in order to broaden the perception of risk and the importance of periodic testing, in addition to encouraging regular health care.

Construct validation: coping with HIV/AIDS in Primary Health Care

OBJECTIVE

To validate the construct and measure the trustworthiness of a questionnaire aimed at assessing HIV/AIDS coping actions developed by health professionals in Primary Health Care.

METHOD

A methodological study carried out with 397 primary health care professionals in two municipalities in the Northeast region of Brazil. The construct validity was developed by the exploratory and confirmatory factor analysis, and the reliability analyzed by the reliability and reproducibility.

RESULTS

The validation determined six factors retention that composed the six domains of the questionnaire. Internal consistency was 0.91 and quality of the confirmatory analysis adjustment was 0.998 for Goodness of Fit Index. The domains presented Kappa values between 0.833 and 0.997.

CONCLUSIONS

The final questionnaire was composed of 18 items and presented feasibility of application, and potential to evaluate actions for HIV/AIDS control in Primary Health Care.

Prevalence and Risk Factors for Human Immunodeficiency Virus Infection Among Female Sex Workers: Distinct Offers of Sexual Services in a Municipality of the Brazilian Amazon

This study determined the prevalence of human immunodeficiency virus (HIV) infection and its associated factors in female sex workers (FSWs) from the municipality of Bragança in the state of Pará, Brazil. A cross-sectional study using a respondent-driven sampling method was used to investigate 137 FSWs. They were interviewed using a questionnaire for the collection of data on their characteristics and risk behavior. Blood samples were collected for serological and molecular testing for HIV. Poisson regression models were used to estimate the reasons of prevalence (RP). The majority was single, young, poorly educated, had a low monthly income, and had worked in the sex trade for more than 7 years. Sexual services were offered either directly (easy identification of FSWs in street markets, town squares, street corners, bars, and gas stations) or indirectly/discretely (more complex identification of FSWs, offering services through a cryptic approach or an intermediary). Overall, 22 (16.06%) FSWs had anti-HIV-1/2 antibodies, and 21 (15.33%) also had complementary DNA-HIV. The use of illicit drugs [adjusted RP (aRP) = 3.13; 95% confidence interval (CI) = 1.27-8.41], unprotected sex (aRP = 4.09; 95% CI = 1.34-11.62), anal sex (aRP = 4.01; 95% CI = 1.37-10.15), the exemption of condoms for clients paying extra (aRP = 4.71; 95% CI = 1.52-10.89), more than 7 years working as a sex worker (aRP = 6.04; 95% CI = 1.20-16.33), low levels of education (aRP = 3.55; 95% CI = 1.15-11.02), and a lack of regular medical or gynecological examinations were all associated with HIV infection (aRP = 5.87; 95% CI = 1.26-15.71). The FSWs who offered their services indirectly suffered significantly less physical and sexual aggression, charged more for encounters, had a significantly higher monthly income, and were more likely to have undergone a medical or gynecological examination within the preceding 12 months. This study identified information relevant to the control and prevention of HIV in FSWs.

HIV- and AIDS-related knowledge and attitude of residents in border regions of Vietnam

BACKGROUND

Residents in border areas are vulnerable to HIV/AIDS due to high rates of risk behaviors such as unprotected sexual practices or illicit drug use. Improving knowledge and attitude toward HIV/AIDS prevention and treatment are vital to diminish the burden of the HIV epidemic in this setting. However, evidence about this issue in Vietnam has been limited. This study aims to explore the knowledge and attitude toward HIV/AIDS among people in Vietnam border zones.

METHODS

We conducted a cross-sectional study in three border communes in Thanh Hoa province with 600 HIV(-) residents. Data about socio-demographic characteristics, general HIV knowledge, knowledge about prevention of mother-to-child transmission, treatment and care, HIV testing services, and attitude toward HIV/AIDS were collected. Multivariate Tobit regression was used to determine related factors with the knowledge and attitude.

RESULTS

The highest percentage of people having correct statements was for "HIV could be transmitted from mother to child" (98.2%), while the lowest percentage was for item "Know health facilities where HIV-positive people could register for care and check-up" (28.2%). People had the highest score in "Knowledge about HIV transmission routes" and the lowest score in "Knowledge about HIV/AIDS prevention measures". Most of the people were not afraid of being exposed to HIV-positive individuals (66.0%), willing to buy goods from HIV-positive sellers (78.9%), and willing to take care of people living with HIV in their family (90.1%). Education, ethnic, marital status, occupations, and HIV/AIDS information sources were found to be associated with knowledge and attitude toward HIV/AIDS.

CONCLUSIONS

The general knowledge and attitude on HIV/AIDS of residents were relatively good. Educational campaigns to improve knowledge and attitude toward PLWH, involving peer educators and local associations, are potential strategies for sustaining HIV intervention in this remote setting.

Spatial dynamics and epidemiology for AIDS in remote areas in French Guiana

Although AIDS care is generally improving in French Guiana, disparities among regions and certain key populations remain significant. The purpose of this study was to describe the spatial and clinical characteristics of people living with HIV (PLHIV) in remote areas in comparison to those followed in hospitals on the urban coast of French Guiana. The data presented were obtained from outpatient on primary care centers located in rural regions away from the urban coast. Data were compared with that from medical records of PLHIV treated in French Guiana's urban care. The evolution of the annual rate of discovery of HIV seropositivity indicates a lag in remote areas as compared to urban and coastal areas. In recent years, the epidemic appeared as particularly active in rural areas among Brazilian patients. The median age of PLHIV in remote areas was 43.8 years, the sex ratio (M/F) was 0.93. Nearly 37% of PLHIV were discovered with advanced disease (<200 CD4/mm3). The percentage of virological success after six months of HAART was 80% and 88% in remote areas and urban area, respectively. Efforts must be made to control and halt the spread of the HIV epidemic, as these remote sites represent strategic points.

HIV Testing and Counseling Among Female Sex Workers: A Systematic Literature Review

HIV testing uptake continues to be low among Female Sex Workers (FSWs). We synthesizes evidence on barriers and facilitators to HIV testing among FSW as well as frequencies of testing, willingness to test, and return rates to collect results. We systematically searched the MEDLINE/PubMed, EMBASE, SCOPUS databases for articles published in English between January 2000 and November 2017. Out of 5036 references screened, we retained 36 papers. The two barriers to HIV testing most commonly reported were financial and time costs—including low income, transportation costs, time constraints, and formal/informal payments—as well as the stigma and discrimination ascribed to HIV positive people and sex workers. Social support facilitated testing with consistently higher uptake amongst married FSWs and women who were encouraged to test by peers and managers. The consistent finding that social support facilitated HIV testing calls for its inclusion into current HIV testing strategies addressed at FSW.

The HIV-1 Subtype B Epidemic in French Guiana and Suriname Is Driven by Ongoing Transmissions of Pandemic and Non-pandemic Lineages

The HIV-1 subtype B epidemic in French Guiana and Suriname is characterized by the co-circulation of the globally disseminated “B_PANDEMIC” lineage and of non-pandemic subtype B lineages of Caribbean origin (B_CAR). To reconstruct the spatiotemporal pattern of spread of those viral lineages circulating in these two countries, a total of 361 HIV-1 subtype B pol sequences recovered from treatment-naive adult patients from French Guiana and Suriname between 2006 and 2012 were combined with B_PANDEMIC and B_CAR reference sequences. Major Guianese/Surinamese B_PANDEMIC and B_CAR lineages were identified by Maximum Likelihood phylogenetic analysis and the spatiotemporal and demographic parameters estimated using a Bayesian coalescent-based method. We detected four B_CAR and three B_PANDEMIC transmission chains of large size that together comprise most pandemic and non-pandemic subtype B sequences from French Guiana (≥52%) and Suriname (≥70%) here analyzed. These major lineages were probably introduced into French Guiana and Suriname from the Caribbean (B_CAR) and North/South America (B_PANDEMIC) between the middle 1970s and the late 1980s and spread among populations from both countries with roughly comparable demographic growth rates. We detected a significant trend for higher viral loads and higher proportion of homosexual/bisexual men among subjects infected with B_PANDEMIC relative to B_CAR strains in French Guiana. These results show that the HIV subtype B epidemic in French Guiana and Suriname has been driven by multiple active B_CAR and B_PANDEMIC transmission chains that arose since the middle 1970s onward and operate in both countries simultaneously. Although no significant differences in the epidemic potential of major B_CAR and B_PANDEMIC lineages were observed, relevant associations between the infecting subtype B lineage and epidemiological and clinical characteristics were detected in French Guiana.

Growth scaling for the early dynamics of HIV/AIDS epidemics in Brazil and the influence of socio-demographic factors

The early dynamics of an infectious disease outbreak can be affected by various factors including the transmission mode of the disease and host-specific factors. While recent works have highlighted the presence of sub-exponential growth patterns during the early phase of epidemics, empirical studies examining the contribution of different factors to early epidemic growth dynamics are lacking. Here we aim to characterize and explain the early incidence growth patterns of local HIV/AIDS epidemics in Brazil as a function of socio-demographic factors. For this purpose, we accessed annual AIDS incidence series and state-level socio-demographic variables from publicly available databases. To characterize the early growth dynamics of the HIV/AIDS epidemic, we employed the generalized-growth model to estimate with quantified uncertainty the scaling of growth parameter (p) which captures growth patterns ranging from constant incidence (p=0) to sub-exponential (0 < p < 1) and exponential growth dynamics (p=1) at three spatial scales: national, regional, and state levels. We evaluated the relationship between socio-demographic variables and epidemic growth patterns across 27 Brazilian states using mixed-effect regression analyses. We found wide variation in the early dynamics of the AIDS epidemic in Brazil, displaying sub-exponential growth patterns with the p parameter estimated substantially below 1.0. The mean p was estimated to be 0.81 at the national level, with a range of 0.72-0.85 at the regional level, and a range of 0.28-0.96 at the state level. Our findings support the notion that socio-demographic factors contribute to shaping the early growth dynamics of the epidemic at the local level. Gini index and socio-demographic index were negatively associated with the parameter p, whereas urbanicity was positively associated with p_. The results could have theoretical significance in understanding differences in growth scaling across different sexually transmitted disease systems, and have public health implications to guide control.

Illegal gold miners in French Guiana: a neglected population with poor health

Background

In French Guiana, a French overseas territory in South America, 6 to 10 thousands undocumented persons work illegally in gold mining sites in the Amazonian forest. Precarious life conditions lead to poor health but few data exist on the health status of illegal gold miners in French Guiana. The objective of this article was to describe the sociodemographic and health status of this vulnerable population.

Method

A prospective cross-sectional survey was conducted in 2015 on gold mine supply sites at the border between French Guiana and Suriname. Health status was assessed through medical examination, past medical history, haemoglobin concentration, and HIV and malaria testing. A questionnaire was used to collect data about the migration itinerary and life conditions on mining sites.

Results

Among the 421 adults included in the study, 93.8% (395/421) were Brazilian, mainly from Maranhão (55.7%, 220/395), the poorest Brazilian state. The sex ratio was 2.4. Overall, 48% of persons never went to school or beyond the primary level. The median time spent in gold mining was quite long (10 years), with a high turn-over. One third of the surveyed population (37.1%, 156/421) had high blood pressure, and only two had a medical follow-up. Most persons had experienced malaria (89.3%, 376/421). They declared frequent arboviroses and digestive disorders. Active leishmaniasis was observed in 8.3% of gold miners. Among women, 28.5% were anemic. Concerning HIV, 36.6% (154/421) of persons, mainly men, never got tested before and 6 were tested positive, which represented an HIV prevalence of 1.43% (95%CI =0.29–2.5).

Conclusion

These findings support the hypothesis that mining in remote areas is linked to several specific illnesses. Theoretically, gold miners would be presumed to start their economical migration to French Guiana as a healthy group. However, their strenuous working and living conditions there lead to poor health caused by infectious and non infectious diseases. This description of their health status is precious for health policy planners in French Guiana given the importance of controlling communicable disease, and the severity and range of specific illnesses acquired by this neglected population.

Trial registration

Clinical trial registration PRS N° NCT02903706.

Retrospectively registered 09/13/2016.

The use of structural equation modelling and behavioural theory to target priority interventions to increase condom use among the intimate partners of sex workers in French Guiana

French Guiana is the French overseas territory that is most affected by HIV. Sex work seems to be an important driver of the epidemic. Although female sex workers are informed by local NGOs, they still have risky behaviours, including not using condoms with their intimate partner despite knowing HIV is highly prevalent. The objective of this study was to find intervention targets on this specific behaviour. For this, a structural equation model (SEM) was built using assumptions from behavioural theories. Behaviour theories attempt to connect research and practice. Within the health belief model framework, perceived threats, perceived benefits, and self-perceived efficacy were tested. Vulnerability was added because of the particular context of French Guiana. The results highlight that female sex workers' perceived self-efficacy was central in condom use with the intimate partner (with a significant correlation coefficient of 0.52 in the SEM). The perceived self-efficacy was strongly influenced by sociodemographic factors, particularly by nationality. Female sex workers from Brazil seemed to be more comfortable about asking their intimate partner to use condoms (OR: 7.81; CI: 1.87-32.63) than sex workers of other nationalities. These results emphasize that prevention interventions for female sex workers should emphasize their empowerment.