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Finding the missing link: when community-based outreach in public space is key to engage migrants in health prevention programmes in Paris, France
  1. Anne Gosselin1,2,3,
  2. Karna Coulibaly3,4,
  3. Andrainolo Ravalihasy3,4,
  4. Séverine Carillon3,
  5. Valéry Ridde1,3,4,
  6. Nicolas Derche5,
  7. Romain Mbiribindi6,
  8. Annabel Desgrées du Loû1,3,4
  9. on behalf of the MAKASI Study Group
  1. 1French Collaborative Institute on Migrations, CNRS, Aubervilliers, France
  2. 2ERES, Social Epidemiology Unit, IPLESP, INSERM S1136, Faculté de Médecine de Saint Antoine, Paris, France
  3. 3Centre Population et Développement (Université Paris Descartes, IRD, ERL Inserm SAGESUD), Paris, France
  4. 4Institut de Recherche Pour le Développement, Marseille, France
  5. 5ARCAT, Paris, France
  6. 6Afrique Avenir, Paris, France
  1. Correspondence to Dr Anne Gosselin Eres, Iplesp, Faculté de Médecine de Saint Antoine, 27 rue Chaligny, Paris, 75012, France; anne.gosselin{at}


Background One of the classic challenges for prevention programmes is reaching the populations they serve. In France, a substantial number of African migrants living with HIV acquired their infection after migrating. The aim of this paper is to better understand the characteristics of the population reached by a community-based outreach approach.

Methods We compared sociodemographic characteristics across three different groups in the Paris greater area: (1) the general African migrant population (Population census), (2) the African migrant population using either the regular healthcare system or the system for vulnerable populations (PARCOURS Survey) and (3) the African migrant population reached through a community-based mobile unit (Afrique Avenir). Comparisons were conducted according to sex, age, region of origin, duration of residence and occupational and legal statuses using χ2 tests.

Results The migrants reached by the mobile unit were mostly men (69%), 52% of whom were younger than 35 years old. They more often lived in precarious situations than did the general sub-Saharan population (49% vs 35% were unemployed, respectively, p<0.001) and the ones accessing the regular healthcare system. Fewer of them lived in precarious situations than did migrants seeking healthcare consultations for vulnerable populations (42% in the mobile unit vs 54% in healthcare consultations were undocumented, p<0.028).

Conclusion Our study shows that the outreach approach can constitute a missing link in the prevention chain among sub-Saharan African migrants, reaching a group that differs from the general migrant population and from the migrant population in healthcare services—not only the newly arrived migrants who live in more precarious situations but also those who have been in France for several years and are still affected by social hardship.

  • outreach
  • migrants
  • prevention
  • HIV/aids
  • community-based organisations

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  • Contributors AG, KC, AR, SC, VR and ADDL conceived the study design. AG, KC, AR, ND, RM and MStudy Group collected and prepared the data. AG, KC and AR conducted the analyses. AG first drafted the paper. KC, AR, SC, VR, and ADDL critically revised the paper. All authors have read and approved the manuscript.

  • Funding The PARCOURS study was supported by the French National Agency for research on AIDS and Viral hepatitis (ANRS) and the Directorate-General of Health (DGS, French Ministry of Health). The funders of the study had no role in the study design, data collection, data analysis, data interpretation, or writing of the article. A.D.L. had full access to all the data and final responsibility for the decision to submit for publication.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Data sharing statement All data relevant to the study are included in the article or uploaded as supplementary information.

  • Provenance and peer review Not commissioned; externally peer reviewed.