Skip to Main content Skip to Navigation
Journal articles

Renunciation of health care by people living with HIV in France is still associated with discrimination in health-care services and social insecurity - results from the ANRS-VESPA2 survey

Abstract : Background: This study aimed to estimate the frequency of renunciation of health care among people living with HIV (PLHIV) in France, including health care unrelated to HIV, and to characterize associated socioeconomic and psychosocial risk factors. Methods: The cross-sectional ANRS-VESPA2 survey was conducted on adult PLHIV attending French hospitals in 2011. Correlates of health-care renunciation in the 12 months before the survey were assessed through logistic modelling. Results: Among the 3,020 PLHIV included in the sample, 17% declared health-care renunciation during the preceding year and 42% had a high level of social insecurity. During the previous 2 years, 8% and 11%, respectively, were discriminated against by medical staff and family. In multivariate analysis, positive associations were found between health-care renunciation and a high level of social insecurity (adjusted odds ratio [95% CI] 3.44 [2.54, 4.65]; P<0.001), having children (1.52 [1.10, 2.10]; P=0.01), smoking tobacco (1.50 [1.13, 1.98]; P=0.01), discrimination by medical staff (1.53 [1.22, 2.29]; P=0.04) or family (2.48 [1.75, 3.52]; P<0.001), major depressive episodes (1.46 [1.02, 2.09]; P=0.04), past or current drug injection (1.54 [1.03, 2.301; P=0.04), and younger age (0.98 [0.97, 1.00]; P=0.03). Health-care renunciation was also negatively associated with HIV diagnosis after 1996 (1996-2002: 0.64 [0.46, 0.90]; P=0.01; >= 2003: 0.56 [0.40, 0.77]; P=0.001). Conclusions: In spite of universal health insurance in France, barrier- and refusal-renunciation of health care by PLHIV remain frequent. Poor psychosocial outcomes and discrimination by families and health-care providers compound the negative effect of social insecurity on health-care seeking in this population. To ensure optimal medical care, strategies are needed to prevent discrimination against PLHIV in health-care services. Special attention must be provided to patients experiencing social insecurity.
Complete list of metadatas

Cited literature [51 references]  Display  Hide  Download

https://hal-amu.archives-ouvertes.fr/hal-02146906
Contributor : Jean-Charles Dufour <>
Submitted on : Friday, July 12, 2019 - 5:23:20 PM
Last modification on : Wednesday, September 16, 2020 - 5:33:01 PM

File

the ANRS-VESPA2 Study Group et...
Files produced by the author(s)

Identifiers

Citation

Marion Fiorentino, Marie Suzan-Monti, Antoine Vilotitch, Luis Sagaon-Teyssier, Rosemary Dray-Spira, et al.. Renunciation of health care by people living with HIV in France is still associated with discrimination in health-care services and social insecurity - results from the ANRS-VESPA2 survey. Antiviral Therapy, International Medical Press, 2018, 23 (5), pp.443-450. ⟨10.3851/IMP3220⟩. ⟨hal-02146906⟩

Share

Metrics

Record views

184

Files downloads

317