ABSTRACT
In both the United States and France, the AIDS epidemic began among gay and bisexual men. But it has now expanded to those who inject drugs with potentially contaminated needles – injection drug users (IDUs) – and those who engage in sex without condoms and with multiple partners – sexual high-risk behaviours (SRBs). In the United States, the most rapid increase in diagnosed AIDS cases is among IDUs and SRBs in African-American inner city and rural communities and in France among IDUs and heterosexuals, often of foreign descent, in central cities and their surrounding suburbs (CDC 2001, IVS 2004). Gay and bisexual men are a declining proportion of those infected by HIV as the proportion of HIV risk takers among African-Americans and immigrants increases (CDC 2003, Corbie-Smith et al. 2002, IVS 2004). Those at highest risk of contracting HIV in both the US and France are very difficult for public health authorities to reach and to get to change their behaviours. In the United States, the first difficulty is getting through their ethnic cultures and suspicion of authorities to reach highrisk takers and, secondly, they are hard to reach because their existence is often denied within their ethnic culture and communities, where they are stigmatized and hidden (Corbie-Smith et al. 2002). While these factors may also play a role in France, French public health authorities have been slow to recognize the specific prevention needs of immigrant populations and have only recently addressed the over-representation of foreigners in its AIDS epidemic (Fassin 1999). In order to respond to this alarming situation, public health authorities in both countries have come to depend on local and national non-governmental organizations (NGOs) in order to prevent HIV among hard-to-reach populations and help those who are infected with the virus.
