Drawing on hospital-based interviews and fieldwork in a deprived Parisian suburb, this paper anal... more Drawing on hospital-based interviews and fieldwork in a deprived Parisian suburb, this paper analyses the spatio-temporal dynamics of risk, exposure, and mobilities in individual stories of undocumented Pakistani male migrants, and asylum seekers-receiving treatment for single and combined diagnoses of HIV, and Hepatitis C and B. Inviting alignments with the 'sexual' turn in mobility studies, it prioritises the interface of all-male undocumented migration, mobility, sexuality, and homosociality in circumscribing disease transmission geneaologies. It questions the extent to which illegal migration routes are transmission routes, and risk environments assume different levels of intensity in everyday life in Pakistan, during the journey, and in France. It emphasises inadequately addressed epidemics of HIV and hepatitis in Pakistan, the significance of unequal routes to migrant healthcare in France, and the transnational adaptation of homosocial and sexual behaviours, including MSM. These factors interplay with intensified vulnerabilities relating to childhood sexual abuse, family traumas, sexual risks related to illegal migration and undocumented status in France, chronic stresses leading to depleted mental and physical health, and restrictions on heterosexual sex facing marginalised migrants. Further, temporal vulnerabilities relate to the colonial criminalisation of homosexuality in Pakistan, widespread sexual violence-and forms of contemporary exclusion and hostility regarding Muslim migrants in Europe. Particularly, we emphasise the paradox, and need to sensitively address, a complex confluence of hidden risks that are deeply embedded in ethnic communities of solidarity and support. The findings trouble the tendency to partition global hepatitis and HIV prevalence rates by 'developed' and 'developing' country variation.
Background: France has long been a country of immigration and in some respects may be seen to hav... more Background: France has long been a country of immigration and in some respects may be seen to have a generous policy with respect to asylum seekers and access to health care for migrants. The French state notably provides healthcare access for undocumented migrants, through state medical aid and since 1998 has had a humanitarian policy for granting temporary residence permits for medical reason (TRPMR) to migrants. Within a context of political debate, reform and tightening immigration control we will examine this latter policy focusing especially on the dilemmas that arise for physicians of migrant patients when they are requested to write medical certificates as part of a TRPMR application. In a 2017 reform the key role of making recommendations on the granting or not of permits was handed over to Ministry of the Interior health inspectors. Recommendations are made after perusal of medical certificates established by the migrant's physician and complementary evidence.
Background: Seine-Saint-Denis is a deprived departement (French administrative unit) in the North... more Background: Seine-Saint-Denis is a deprived departement (French administrative unit) in the NorthEast of Paris, France, hosting the majority of South Asian migrants in France. In recent years, the number of migrants from Pakistan, which has a high prevalence of hepatitis C globally, increased. As a corollary, this study addressed the high proportion of Pakistani patients in the infectious diseases clinic of a local hospital, diagnosed with hepatitis C, but also hepatitis B and Human Immunodeficiency Virus (HIV). It explored genealogies and beliefs about hepatitis and HIV transmission, including community, sexual and blood risk behaviours. The aim was to understand the ways these risk factors reduce or intensify both en route and once in France, in order to devise specific forms of community health intervention. Methods: The study took place at Avicenne University-Hospital in Seine-Saint-Denis, and its environs, between July and September 2018. The design of the study was qualitative, combining semi-structured interviews, a focus group discussion, and ethnographic observations. The sample of Pakistani participants was selected from those followed-up for chronic hepatitis C, B, and/or HIV at Avicenne, and who had arrived after 2010 in Seine-Saint-Denis. Results: Thirteen semi-structured interviews were conducted, until saturation was reached. All participants were men from rural Punjab province. Most took the Eastern Mediterranean human smuggling route. Findings suggest that vulnerabilities to hepatitis and HIV transmission, originating in Pakistan, are intensified along the migration route and perpetuated in France. Taboo towards sexuality, promiscuity in cohabitation conditions, lack of knowledge about transmission were amongst the factors increasing vulnerabilities. Participants suggested a number of culturally-acceptable health promotion interventions in the community, such as outreach awareness and testing campaigns in workplaces, health promotion and education in mosques, as well as web-based sexual health promotion tools to preserve anonymity.
Drawing on hospital-based interviews and fieldwork in a deprived Parisian suburb, this paper anal... more Drawing on hospital-based interviews and fieldwork in a deprived Parisian suburb, this paper analyses the spatio-temporal dynamics of risk, exposure, and mobilities in individual stories of undocumented Pakistani male migrants, and asylum seekers-receiving treatment for single and combined diagnoses of HIV, and Hepatitis C and B. Inviting alignments with the 'sexual' turn in mobility studies, it prioritises the interface of all-male undocumented migration, mobility, sexuality, and homosociality in circumscribing disease transmission geneaologies. It questions the extent to which illegal migration routes are transmission routes, and risk environments assume different levels of intensity in everyday life in Pakistan, during the journey, and in France. It emphasises inadequately addressed epidemics of HIV and hepatitis in Pakistan, the significance of unequal routes to migrant healthcare in France, and the transnational adaptation of homosocial and sexual behaviours, including MSM. These factors interplay with intensified vulnerabilities relating to childhood sexual abuse, family traumas, sexual risks related to illegal migration and undocumented status in France, chronic stresses leading to depleted mental and physical health, and restrictions on heterosexual sex facing marginalised migrants. Further, temporal vulnerabilities relate to the colonial criminalisation of homosexuality in Pakistan, widespread sexual violence-and forms of contemporary exclusion and hostility regarding Muslim migrants in Europe. Particularly, we emphasise the paradox, and need to sensitively address, a complex confluence of hidden risks that are deeply embedded in ethnic communities of solidarity and support. The findings trouble the tendency to partition global hepatitis and HIV prevalence rates by 'developed' and 'developing' country variation.
Background: France has long been a country of immigration and in some respects may be seen to hav... more Background: France has long been a country of immigration and in some respects may be seen to have a generous policy with respect to asylum seekers and access to health care for migrants. The French state notably provides healthcare access for undocumented migrants, through state medical aid and since 1998 has had a humanitarian policy for granting temporary residence permits for medical reason (TRPMR) to migrants. Within a context of political debate, reform and tightening immigration control we will examine this latter policy focusing especially on the dilemmas that arise for physicians of migrant patients when they are requested to write medical certificates as part of a TRPMR application. In a 2017 reform the key role of making recommendations on the granting or not of permits was handed over to Ministry of the Interior health inspectors. Recommendations are made after perusal of medical certificates established by the migrant's physician and complementary evidence.
Background: Seine-Saint-Denis is a deprived departement (French administrative unit) in the North... more Background: Seine-Saint-Denis is a deprived departement (French administrative unit) in the NorthEast of Paris, France, hosting the majority of South Asian migrants in France. In recent years, the number of migrants from Pakistan, which has a high prevalence of hepatitis C globally, increased. As a corollary, this study addressed the high proportion of Pakistani patients in the infectious diseases clinic of a local hospital, diagnosed with hepatitis C, but also hepatitis B and Human Immunodeficiency Virus (HIV). It explored genealogies and beliefs about hepatitis and HIV transmission, including community, sexual and blood risk behaviours. The aim was to understand the ways these risk factors reduce or intensify both en route and once in France, in order to devise specific forms of community health intervention. Methods: The study took place at Avicenne University-Hospital in Seine-Saint-Denis, and its environs, between July and September 2018. The design of the study was qualitative, combining semi-structured interviews, a focus group discussion, and ethnographic observations. The sample of Pakistani participants was selected from those followed-up for chronic hepatitis C, B, and/or HIV at Avicenne, and who had arrived after 2010 in Seine-Saint-Denis. Results: Thirteen semi-structured interviews were conducted, until saturation was reached. All participants were men from rural Punjab province. Most took the Eastern Mediterranean human smuggling route. Findings suggest that vulnerabilities to hepatitis and HIV transmission, originating in Pakistan, are intensified along the migration route and perpetuated in France. Taboo towards sexuality, promiscuity in cohabitation conditions, lack of knowledge about transmission were amongst the factors increasing vulnerabilities. Participants suggested a number of culturally-acceptable health promotion interventions in the community, such as outreach awareness and testing campaigns in workplaces, health promotion and education in mosques, as well as web-based sexual health promotion tools to preserve anonymity.
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Papers by Johann Cailhol