[Factors associated with the lack of proposition for HIV-AIDS and hepatitis B and C screening to underprivileged immigrants].

BACKGROUND

Underprivileged immigrants from endemic areas cumulate risk factors for infections by HIV-AIDS and hepatitis B and C. Free primary care consultations are available to them in the four health centers of the city of Paris. The objective of our study was to identify socio-demographic and medical factors related to the lack of screening proposition for HIV-AIDS and hepatitis B and C to new immigrant patients in these centers in 2003.

METHODS

For each disease, the absence of screening proposition was analyzed according to geographical origin, length of stay in France, type of accommodation, type of health insurance and symptom motivating the encounter in logistic mixed models adjusted on sex and age.

RESULTS

About 500 patients were included in the analysis. Three-quarters of them were male and from Sub-Saharan Africa. They were 36years old on average. Half of them lived in shelters for homeless or immigrants. Their median stay lasted two years. They rarely came for screening (1%), sometimes for asthenia (6%) and two-thirds of them for uro-genito-digestive signs. The results were similar for the three screenings. The lack of screening proposition was about 45% and varied significantly between physicians. Factors significantly associated with the lack of screening proposition were: coming from non-Sub-Saharan Africa (especially from North Africa and Middle East; OR=1.7 to 3.6) and having a health insurance (OR=2.4 to 2.6) regardless of the disease; being a female (OR=2.0 to 2.3) in the case of hepatitis; and having a length of stay in France greater than or equal to five years (OR=1.9) for hepatitis B.

CONCLUSIONS

Our results should encourage practitioners to provide more screening to underprivileged immigrants and draws attention to immigrants from non-Sub-Saharan origin and those with health insurance. Factors that might explain doctor and gender-related variability observed in hepatitis are highlighted.