A NEW OUTPATIENT CARE FACILITY FOR HIV-INFECTED DESTITUTE POPULATIONSIN PARIS, FRANCE

In France, the entire population theoretically has access to health co verage, but in fact a section of the poorest population does not. Inst itutions have therefore been set up to provide medical care for the de stitute. The objectives of this study were to describe the social char acteristics of the HIV/positive destitute population attending an out- patient clinic providing free health care for the destitute in a Paris University Hospital, to compare their clinical-epidemiological charac teristics with those of non-destitute HIV-positive patients, and to ev aluate the quality of their care. We performed a historical prospectiv e study wherein a cohort of 115 HIV-positive destitute patients (defin ed as having no health coverage at their first consultation) was compa red with a control cohort of 183 HIV-positive non-destitute patients a ttending the same clinic. Ninety-five per cent of the destitute patien ts had no stable employment, 32% had no source of income, 75% had no p ermanent residence and 27% were IV drug abusers. Fifty-nine per cent w ere foreigners, most of whom had legal residence papers and had been i n France for more than 3 years. When comparing the control and the des titute groups, the latter had a three times greater risk of developing tuberculosis (RH=3.2, CI 95% = [1.1-9.4]). Medical compliance, access to antiretroviral treatment and hospitalization were identical in bot h groups. No difference was observed in terms of occurrence of a new A IDS-related disease during follow-up when full-blown AIDS before entry , CD4 count at entry and transmission group were taken into account in multivariate analysis. From the moment that destitute patients attend ed this adapted medico-social facility, their access to care was the s ame as, if not better than, that of the other patients. The developmen t of out-patient medico-social facilities for HIV-positive destitute p atients must be a public health priority even for those countries theo retically providing generalized health coverage.