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Ousseine YM, Lydié N, Velter A. Pre-exposure prophylaxis in France: How many MSM are eligible and how much will it cost? PLoS One 2022; 17:e0278016. [PMID: 36454940 PMCID: PMC9714876 DOI: 10.1371/journal.pone.0278016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 11/09/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) was definitively authorized in France in 2017 after a two-year probationary period. The fact that the estimated number of MSM eligible for PrEP is still unknown is a barrier to this prevention tool's roll-out at the national level. This study aimed to estimate the number of MSM eligible for PrEP in France, and to evaluate the direct cost of its roll-out. METHODS We used data from several sources including the Enquête Rapport au Sexe 2019-ERAS 2019 survey, the 2019 French population census from National Institute of Statistics and Economic Studies (INSEE), and the National Public Health Agency's (Santé Publique France) 2016 health barometer survey. We also used data from previous studies which estimated the proportion of MSM who were sexually active in the 12 months prior to the studies, and HIV prevalence in MSM in France. Furthermore, we used data on PrEP drug costs from the French public drug database and data on medical examinations costs from the IPERGAY study. RESULTS For 2019, the number of HIV seronegative MSM in France who were sexually active in the previous 12 months was estimated at 398,015. Of these, 142,379 (95%CI: 139,893-145,241) and 104,645 (95%IC: 102311-106979) were eligible for PrEP, based on the Menza score and on official French criteria, respectively. The overall estimated cost of PrEP roll-out in eligible MSM varied between € 317,685,216 and € 545,903,216 for official French criteria, which was higher than the estimated €432,240,851 and €742,753,074 according to the Menza score. CONCLUSIONS Our estimations will enable policy makers to make evidence-based decisions about PrEP roll-out to MSM in France. To accelerate the process, it is important to decentralize PrEP delivery, authorize general practitioners to write prescriptions, and promote this prevention tool through information campaigns.
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Affiliation(s)
- Youssoufa M. Ousseine
- Santé Publique France, French National Public Health Agency, Saint-Maurice Cedex, France
| | - Nathalie Lydié
- Santé Publique France, French National Public Health Agency, Saint-Maurice Cedex, France
| | - Annie Velter
- Santé Publique France, French National Public Health Agency, Saint-Maurice Cedex, France
- * E-mail:
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Velter A, Ousseine Y, Duchesne L, Lydie N. Non-use of combination HIV prevention tools and its determinants among men who have sex with men living in France. Infect Dis Now 2022; 52:341-348. [DOI: 10.1016/j.idnow.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/03/2022] [Accepted: 06/17/2022] [Indexed: 10/17/2022]
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Di Ciaccio M, Delabre RM, Vilotitch A, Corbelli GM, Villes V, Ros Sánchez A, Zantkuijl P, Sweers H, Sanchez F, Meulbroek M, Cairns G, Bernier A, Ghosn J, Carvalho Rocha LM, Cosmaro ML, Duken SB, Dan M, Schlegel V, Stranz R, Jonas KJ, Spire B, Rojas Castro D. PrEP in the Context of Other HIV Risk Reduction Strategies Among Men Who Have Sex with Men: Results from the Flash! PrEP in Europe Survey. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:2451-2464. [PMID: 35725849 PMCID: PMC9208709 DOI: 10.1007/s10508-022-02322-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 02/14/2022] [Accepted: 03/05/2022] [Indexed: 06/15/2023]
Abstract
Combination HIV prevention covers a range of biomedical, behavioral, and socio-structural interventions. Despite the growing availability of pre-exposure prophylaxis (PrEP), it is not always accessible in European Centre for Disease Prevention and Control reporting countries and may not meet the needs of all at-risk populations. Based on the Flash! PrEP in Europe data, multiple correspondence analysis and hierarchical clustering were used to identify patterns in HIV prevention strategies among 9980 men who have sex with men (MSM). PrEP interest was evaluated among four identified clusters: (A) "high condom use, sometimes Treatment as Prevention (TasP)"; (B) "mix of methods, infrequent condom use"; (C) "high condom use, tendency to choose partners based on serological status" and (D) "moderate use of condoms mixed with other prevention strategies". Clusters B and D had higher PrEP interest. These results suggest that MSM use a range of behavioral and biomedical risk reduction strategies that are often combined. On-demand PrEP may meet the needs of MSM who infrequently use condoms and other prevention methods.
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Affiliation(s)
- Marion Di Ciaccio
- Community-Based Research Laboratory, Coalition PLUS, Pantin, France.
- Groupe de Recherche en Psychologie Sociale (GRePS), Université Lyon 2, 69500, Bron, France.
| | | | - Antoine Vilotitch
- INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de La Santé and Traitement de l'Information Médicale, ISSPAM, Aix Marseille Univ, Marseille, France
- ORS PACA, Observatoire Régional de La Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | | | - Virginie Villes
- Community-Based Research Laboratory, Coalition PLUS, Pantin, France
| | | | | | | | - Flor Sanchez
- Department of Social Psychology, Universidad Autónoma de Madrid, Madrid, Spain
| | | | | | - Adeline Bernier
- Community-Based Research Laboratory, Coalition PLUS, Pantin, France
| | - Jade Ghosn
- Hôpitaux Universitaires Paris Nord, Service des Maladies Infectieuses, Site Bichat-Claude Bernard, Paris, France
| | | | | | - Sascha Béla Duken
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Monica Dan
- Department of Research, Monitoring and Evaluation, ARAS, Bucarest, Romania
| | | | - Richard Stranz
- Community-Based Research Laboratory, Coalition PLUS, Pantin, France
- Community-based Laboratory, AIDES, Pantin, France
| | - Kai J Jonas
- Department of Work and Social Psychology, Maastricht University, Maastricht, The Netherlands
| | - Bruno Spire
- INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de La Santé and Traitement de l'Information Médicale, ISSPAM, Aix Marseille Univ, Marseille, France
| | - Daniela Rojas Castro
- Community-Based Research Laboratory, Coalition PLUS, Pantin, France
- INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de La Santé and Traitement de l'Information Médicale, ISSPAM, Aix Marseille Univ, Marseille, France
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4
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Stengaard AR, Combs L, Supervie V, Croxford S, Desai S, Sullivan AK, Jakobsen SF, Santos Q, Simões D, Casabona J, Lazarus JV, de Wit JBF, Amort FM, Pharris A, Nerlander L, Raben D. HIV seroprevalence in five key populations in Europe: a systematic literature review, 2009 to 2019. EURO SURVEILLANCE : BULLETIN EUROPEEN SUR LES MALADIES TRANSMISSIBLES = EUROPEAN COMMUNICABLE DISEASE BULLETIN 2021; 26. [PMID: 34823636 PMCID: PMC8619876 DOI: 10.2807/1560-7917.es.2021.26.47.2100044] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Background In Europe, HIV disproportionately affects men who have sex with men (MSM), people who inject drugs (PWID), prisoners, sex workers, and transgender people. Epidemiological data are primarily available from national HIV case surveillance systems that rarely capture information on sex work, gender identity or imprisonment. Surveillance of HIV prevalence in key populations often occurs as independent studies with no established mechanism for collating such information at the European level. Aim We assessed HIV prevalence in MSM, PWID, prisoners, sex workers, and transgender people in the 30 European Union/European Economic Area countries and the United Kingdom. Methods We conducted a systematic literature review of peer-reviewed studies published during 2009–19, by searching PubMed, Embase and the Cochrane Library. Data are presented in forest plots by country, as simple prevalence or pooled across multiple studies. Results Eighty-seven country- and population-specific studies were identified from 23 countries. The highest number of studies, and the largest variation in HIV prevalence, were identified for MSM, ranging from 2.4–29.0% (19 countries) and PWID, from 0.0–59.5% (13 countries). Prevalence ranged from 0.0–15.6% in prisoners (nine countries), 1.1–8.5% in sex workers (five countries) and was 10.9% in transgender people (one country). Individuals belonging to several key population groups had higher prevalence. Conclusion This review demonstrates that HIV prevalence is highly diverse across population groups and countries. People belonging to multiple key population groups are particularly vulnerable; however, more studies are needed, particularly for sex workers, transgender people and people with multiple risks.
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Affiliation(s)
- Annemarie Rinder Stengaard
- Centre of Excellence for Health, Immunity and Infections (CHIP), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lauren Combs
- Centre of Excellence for Health, Immunity and Infections (CHIP), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Virginie Supervie
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | | | | | - Ann K Sullivan
- Directorate of HIV and Sexual Health, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Stine Finne Jakobsen
- Centre of Excellence for Health, Immunity and Infections (CHIP), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Quenia Santos
- Centre of Excellence for Health, Immunity and Infections (CHIP), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Daniel Simões
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, n° 135, Porto, Portugal.,Grupo de Ativistas em Tratamentos (GAT), Lisboa, Portugal
| | - Jordi Casabona
- Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - John B F de Wit
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, Netherlands
| | - Frank M Amort
- FH JOANNEUM, University of Applied Sciences, Bad Gleichenberg, Austria
| | - Anastasia Pharris
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Lina Nerlander
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Dorthe Raben
- Centre of Excellence for Health, Immunity and Infections (CHIP), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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5
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Trouiller P, Velter A, Saboni L, Sommen C, Sauvage C, Vaux S, Barin F, Chevaliez S, Lot F, Jauffret-Roustide M. Injecting drug use during sex (known as "slamming") among men who have sex with men: Results from a time-location sampling survey conducted in five cities, France. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 79:102703. [PMID: 32259771 DOI: 10.1016/j.drugpo.2020.102703] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 02/02/2020] [Accepted: 02/16/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND In the last decade, European cities saw the development of "slamming," a practice related to chemsex that combines three elements: a sexual context, psychostimulant drug use, and injection practices. Epidemiological data on this practice is still sparse and media attention might have unintentionally distorted the size of this phenomenon. Therefore, we aimed to estimate the prevalence of men practicing slam and to identify factors associated with this practice. METHODS We used data from the Prevagay 2015 bio-behavioral survey to estimate the prevalence of slamming practices. A time-location sampling was performed among gay-labeled venues in five French cites. Behavioral information was recorded using a self-administered questionnaire. The HIV and HCV serostatus were investigated using ELISA tests on dried blood spots. The factors associated with slamming were assessed using a multiple logistic regression. We applied a weighting mechanism to enhance the generalizability of the estimates. RESULTS Among the 2646 men who have sex with men (MSM) included in our study, 3.1% reported slamming at least once during their lifetime (95% confidence interval (CI) = 2.2-4.3) and 1.6% (95% CI = 1-2.3) said they participated in a slamming session in the last 12 months. In the multivariate analysis, both HCV and HIV biological status were strongly associated with practicing "slam" in the last 12 months (OR = 13.37 (95% CI = 3.26-54.81) and 4.73 (95% CI = 1.58-14.44), respectively). Furthermore, a ten-point decrease in mental health scores was linked with the practice with an OR of 1.37 (95% CI = 1.08-1.73), indicating poorer mental health. CONCLUSION Even though slamming seems to involve a relatively small proportion of MSM, the vulnerability of this sub-group is high enough to justify setting up harm reduction measures and specific care. Training health professionals and creating services combining sexual health and drug dependence could be an effective response.
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Affiliation(s)
- Philippe Trouiller
- Cermes 3 (Inserm U988/UMR CNRS 8211/EHESS/Paris Descartes University), 45 rue des Saint Pères, Paris, France; Santé publique france, French national public health agency, Saint-Maurice Cedex, France, 12 rue du Val d'Osne, 94415, Saint-Maurice, France
| | - Annie Velter
- Santé publique france, French national public health agency, Saint-Maurice Cedex, France, 12 rue du Val d'Osne, 94415, Saint-Maurice, France
| | - Leïla Saboni
- Santé publique france, French national public health agency, Saint-Maurice Cedex, France, 12 rue du Val d'Osne, 94415, Saint-Maurice, France
| | - Cécile Sommen
- Santé publique france, French national public health agency, Saint-Maurice Cedex, France, 12 rue du Val d'Osne, 94415, Saint-Maurice, France
| | - Claire Sauvage
- Santé publique france, French national public health agency, Saint-Maurice Cedex, France, 12 rue du Val d'Osne, 94415, Saint-Maurice, France
| | - Sophie Vaux
- Santé publique france, French national public health agency, Saint-Maurice Cedex, France, 12 rue du Val d'Osne, 94415, Saint-Maurice, France
| | - Francis Barin
- Centre National de référence du VIH, François Rabelais University, Tours, France
| | - Stéphane Chevaliez
- Centre National de Référence des hépatites B, C et Delta, Centre Hospitalier Henri Mondor, Créteil, France
| | - Florence Lot
- Santé publique france, French national public health agency, Saint-Maurice Cedex, France, 12 rue du Val d'Osne, 94415, Saint-Maurice, France
| | - Marie Jauffret-Roustide
- Cermes 3 (Inserm U988/UMR CNRS 8211/EHESS/Paris Descartes University), 45 rue des Saint Pères, Paris, France; Santé publique france, French national public health agency, Saint-Maurice Cedex, France, 12 rue du Val d'Osne, 94415, Saint-Maurice, France.
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6
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Duchesne L, Lydié N, Velter A. Increase in the overall level of protected anal sex in men who have sex with men in France: results from the repeated cross-sectional survey Rapport au Sexe, France, 2017-2019. AIDS Care 2020; 32:162-169. [PMID: 32160761 DOI: 10.1080/09540121.2020.1739208] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study measures the evolution in the overall level of protection against HIV by men who have sex with men (MSM) in France. Using data from the 2017 and 2019 editions of Rapport au Sexe - an online survey - we compared the use of HIV prevention tools by MSM during their most recent anal intercourse (MRAI) with a casual male partner. We developed a classification with five categories ordered according to the effectiveness of each tool method in reducing the risk of acquiring HIV: Treatment as prevention (TasP), Pre-exposure prophylaxis (PrEP), exclusive condom use, Post-exposure prophylaxis (PEP) or nothing (i.e., no tool used). The percentage of MSM who did not use any prevention tool decreased from 25.9% in 2017 to 23.5% in 2019 (aOR [95%CI] = 0.9 [0.8-0.9]). The proportion of MSM who took PrEP during the MRAI increased from 5.4% in 2017 to 14.0% in 2019 (aOR [95%CI] = 2.9[2.5-3.3]). The proportion of MSM who used condoms exclusively decreased from 67.5% in 2017 to 61.3% in 2019 (aOR [95%CI] = 0.8 [0.7-0.8]). We observed an increase in the rate of protected anal sex, and a decrease in the rate of condom use. The implementation of PrEP may be one of the main driving forces behind these changes.
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Affiliation(s)
- Lucie Duchesne
- Santé publique France, French National Public Health Agency, Saint-Maurice, France
| | - Nathalie Lydié
- Santé publique France, French National Public Health Agency, Saint-Maurice, France
| | - Annie Velter
- Santé publique France, French National Public Health Agency, Saint-Maurice, France
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Screening for Human Immunodeficiency Virus Infection by Use of a Fourth-Generation Antigen/Antibody Assay and Dried Blood Spots: In-Depth Analysis of Sensitivity and Performance Assessment in a Cross-Sectional Study. J Clin Microbiol 2019; 58:JCM.01645-19. [PMID: 31666365 DOI: 10.1128/jcm.01645-19] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 10/24/2019] [Indexed: 12/29/2022] Open
Abstract
We evaluated the performance of a fourth-generation antigen/antibody (Ag/Ab) assay for detecting HIV-1 infection on dried blood spots (DBS) both in a conventional laboratory environment and in an epidemiological survey corresponding to a real-life situation. Although a 2-log loss of sensitivity compared to that with plasma was observed when using DBS in an analytical analysis, the median delay of positivity between DBS and crude serum during the early phase postacute infection was 7 days. The performance of the fourth-generation assay on DBS was approximately similar to that of a third-generation (antibody only) assay using crude serum samples. Among 2,646 participants of a cross-sectional study in a population of men having sex with men, 428 DBS were found reactive, but negative results were obtained from 5 DBS collected from individuals who self-reported a positive HIV status, confirmed by detection of antiretroviral (ARV) drugs in their DBS. The data generated allowed us to estimate a sensitivity of 98.8% of the fourth-generation assay/DBS strategy in a high-risk population, even including a broad majority of individuals on ARV treatment among those HIV positive. Our study brings additional proofs that DBS testing using a fourth-generation immunoassay is a reliable strategy able to provide alternative approaches for both individual HIV testing and surveillance of various populations.
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8
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Mgbako O, Park SH, Mayer KH, Schneider JA, Goedel WC, Hambrick HR, Duncan DT. Transactional Sex and Preferences for Pre-Exposure Prophylaxis (PrEP) Administration Modalities Among Men Who Have Sex With Men (MSM). JOURNAL OF SEX RESEARCH 2019; 56:650-658. [PMID: 29634362 PMCID: PMC6179954 DOI: 10.1080/00224499.2018.1449190] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Pre-exposure prophylaxis (PrEP) is an important biomedical human immunodeficiency virus (HIV) prevention tool gaining more popularity among Parisian men who have sex with men (MSM) who engage in transactional sex. This study examines the knowledge of, and willingness to use, different modalities of PrEP among this subgroup. Broadcast advertisements were placed on a geosocial-networking smartphone application with a link to a Web-based survey during three 24-hour periods in October 2016. Modified Poisson regression models were used to assess the association between engagement in transactional sex and preferences for each of these PrEP modalities. A total of 444 respondents were included. About 14% reported engagement in transactional sex. In all, 90% of MSM who engaged in transactional sex were knowledgeable of daily oral PrEP, while 13.3% were knowledgeable about long-acting injectable PrEP or penile or rectal microbicides. They were more likely to be aware of long-acting injectable PrEP (aRR = 2.52, 95% CI = 1.16 to 5.47) and willing to use daily oral PrEP (aRR = 1.48; 95% CI = 1.11 to 1.98) or long-acting injectable PrEP (aRR = 1.40; 95% CI = 1.09 to 1.81) than MSM who had not engaged in transactional sex. Long-acting injectable PrEP may be an important HIV-prevention option for MSM who engage in transactional sex if this modality is proven effective.
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Affiliation(s)
- Ofole Mgbako
- Department of Internal Medicine, School of Medicine, New York
University, New York, New York
- Spatial Epidemiology Lab, Department of Population Health, School of
Medicine, New York University, New York, New York
| | - Su Hyun Park
- Spatial Epidemiology Lab, Department of Population Health, School of
Medicine, New York University, New York, New York
| | - Kenneth H. Mayer
- Departments of Medicine and Global Health and Population, Harvard
Medical School and Harvard T.H. Chan School of Public Health, and Fenway Health,
Boston, Massachusetts
| | - John A. Schneider
- Departments of Medicine and Public Health Sciences, School of
Medicine, University of Chicago, Chicago, Illinois
- Chicago Center for HIV Elimination, University of Chicago, Chicago,
Illinois
| | - William C. Goedel
- Spatial Epidemiology Lab, Department of Population Health, School of
Medicine, New York University, New York, New York
| | - H. Rhodes Hambrick
- Spatial Epidemiology Lab, Department of Population Health, School of
Medicine, New York University, New York, New York
| | - Dustin T. Duncan
- Spatial Epidemiology Lab, Department of Population Health, School of
Medicine, New York University, New York, New York
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Prevalence of hepatitis C infection, screening and associated factors among men who have sex with men attending gay venues: a cross-sectional survey (PREVAGAY), France, 2015. BMC Infect Dis 2019; 19:315. [PMID: 30971207 PMCID: PMC6458747 DOI: 10.1186/s12879-019-3945-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 03/29/2019] [Indexed: 12/18/2022] Open
Abstract
Background Over the last 20 years, Hepatitis C virus (HCV) infection prevalence has dramatically increased among HIV-infected men who have sex with men (MSM) in many countries worldwide. It is suspected that this increase is primarily driven by sexual behaviours linked to blood exposure. Monitoring these behaviours is crucial to understand the drivers of the epidemic. This study assessed the prevalence of chronic HCV infection among MSM attending gay venues and associated chronic HCV risk factors. HCV screening and associated factors were described. Methods The cross-sectional survey PREVAGAY, based on time-location sampling, was conducted in 2015 among MSM attending gay venues in 5 French metropolitan cities. A self-administered questionnaire was completed and capillary whole blood on dried blood spots (DBS) collected. Possible factors associated with chronic HCV prevalence and with HCV screening in the previous year were investigated using Poisson regression. Results Chronic HCV infection prevalence from DBS analysis was 0.7% [IC95%: 0.3–1.5] in the study’s 2645 participants and was 3.0% [1.5–5.8] in HIV-positive MSM. It was significantly higher in those who reported the following: (lifetime) slamming (with or without the sharing of injection equipment); (during the previous year) fisting and chemsex, unprotected anal intercourse with casual partners, using gay websites and/or of mobile-based GPS applications, and having more than 10 sexual partners. Only 41.3% [38.2–44.5] of the participants reported HCV screening during the previous year. Screening was significantly more frequent in MSM under 30 years of age, those who were HIV-positive, those vaccinated against hepatitis B and meningococcus C, and those who reported the following (during the previous year): more than 10 sexual partners, at least one sexually transmitted infection and fisting. Conclusion Chronic HCV infection prevalence in MSM attending gay venues was significantly higher in HIV-positive MSM and in those with risky sexual behaviours. Reflecting current screening recommendations for specific populations, previous HCV screening was more frequent in HIV-positive individuals and those with risky sexual behaviours. Nevertheless, HCV screening coverage needs to be improved in these populations. Comprehensive medical management, which combines screening and linkage to care with prevention strategies, is essential to control HCV among MSM.
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10
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Frank K. Rethinking Risk, Culture, and Intervention in Collective Sex Environments. ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:3-30. [PMID: 29748787 DOI: 10.1007/s10508-018-1153-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 11/28/2017] [Accepted: 01/11/2018] [Indexed: 05/16/2023]
Abstract
This article provides a narrative overview of research on HIV/STI risk and collective sexual behavior based on an inclusive analysis of research on environments where people gather for sexual activity-sex clubs, swingers' clubs, bathhouses, parks, private sex parties, etc. The aim is to analyze how collective sex has been approached across disciplines to promote conversation across paradigms and suggest new lines of inquiry. Attention to context-such as the location of sex-was a necessary redress to universalizing models of sexual risk-taking behavior, leading to insights rooted in the particularities of each environment and its users. However, the identification of ever more precise risk groups or environmental idiosyncrasies eventually becomes theoretically restrictive, leading to an overestimation of the uniqueness of sexual enclaves, and of the difference between any given enclave and the broader social milieu. Using a theoretical framework of transgression to interpret the interdisciplinary literature, similarities in the spatial and social organization of collective sex environments are identified. Insights generated from this complementary perspective are then applied to understandings of collective sex: first, the example of male-female (MF) "swingers" is used to illustrate the need to establish, rather than assume, the distinctiveness of each non-normative sexual enclave, and to broaden the conceptualization of context; second, questions are raised about the practicality of interventions in collective sex environments. Finally, new lines of intellectual inquiry are suggested to shed light not just on collective sex but on sociosexual issues more generally, such as increasing protective sexual health behavior or negotiating consent in sexual encounters.
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Affiliation(s)
- Katherine Frank
- Department of Sociology, University of Nevada, Las Vegas, Las Vegas, NV, 89557, USA.
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11
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Dangerfield DT, Carmack CC, Gilreath TD, Duncan DT. Latent Classes of Sexual Positioning Practices and Sexual Risk Among Men Who Have Sex with Men in Paris, France. AIDS Behav 2018; 22:4001-4008. [PMID: 30173344 DOI: 10.1007/s10461-018-2267-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
HIV/STI risk varies by sexual positioning practices; however, limited data have characterized the behavioral profiles of men who have sex with men (MSM) in France. This study used latent class analysis (LCA) to explore sexual risk profiles among MSM in Paris, France. LCA was used to classify sexual positioning and serosorting profiles among MSM in Paris (n = 496). Age, HIV status, relationship status, substance use, group sex, and PrEP history were used in a multinomial regression model predicting class membership. Three latent classes were identified: majority top/serosorters, versatile/low partners, and majority bottom/some serosorters. Majority top/serosorters had the highest probability of condomless serosorting; majority bottom/some serosorters had the highest mean number of partners (~ 12 partners) for condomless receptive anal intercourse. HIV-positive MSM were more likely to be classified as majority bottom/some serosorters than versatile/low partners (AOR 7.61; 95% CI 2.28, 25.3). Findings support the need for tailored and targeted interventions for highest-risk individuals.
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Affiliation(s)
- Derek T Dangerfield
- The REACH Initiative, Johns Hopkins School of Nursing, 525 N. Wolfe St, SON House 104, Baltimore, MD, 21205, USA.
| | - Chakema C Carmack
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX, USA
| | - Tamika D Gilreath
- Department of Health and Kinesiology, Texas A & M University, College Station, TX, USA
| | - Dustin T Duncan
- Spatial Epidemiology Lab, Department of Population Health, New York University School of Medicine, New York, NY, USA
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Calendar trends in sexual behaviours in a cohort of HIV-infected MSM at the era of treatment as prevention of HIV infection. AIDS 2018; 32:1871-1879. [PMID: 29927787 DOI: 10.1097/qad.0000000000001916] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND With the advent of treatment as prevention of HIV infection (TasP), we assessed trends in sexual behaviours between 2000 and 2017 among HIV-infected MSM enrolled in the French ANRS PRIMO cohort. METHODS At each cohort visit, a clinical questionnaire including laboratory values was completed and a self-administered questionnaire was used to collect sexual behaviours, that is, the number, type (steady/casual) and HIV status (positive or negative/unknown) of partners, and condom use. The possible influence of viral load (undetectable/detectable) measured at the preceding visit on the evolution over time of sexual behaviour was assessed with logistic regression models fitted by generalized estimating equations (GEE), taking into account longitudinal data. RESULTS We analyzed data from 10657 follow-up visits by 1364 MSM. Overall, whatever the considered behavioural variable: at least one sexual partner, steady and/or casual, condomless sex with steady, casual partners, serodiscordant or not, we observed a calendar increase with a particularly more marked rise from 2010 (P < 0.0001). Inconsistent condom use did not differ according to the viral load status (detectable vs. undetectable). Trends in inconsistent condom use increased across different generations of MSM, as defined by the year they were diagnosed with HIV infection. CONCLUSIONS 'Having a sexual partner' and condomless sex, both increased in frequency between 2000 and 2017. Viral load status did not influence condom use as could have been expected from the 2008 Swiss Statement.
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Girard G, Doré V. Thirty Years of Research on Gay Men and HIV Prevention in France: A Narrative Review of the Literature. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:1341-1349. [PMID: 29417262 DOI: 10.1007/s10508-018-1163-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 02/16/2017] [Accepted: 01/25/2018] [Indexed: 06/08/2023]
Abstract
Research on homosexuality and HIV/AIDS in the social sciences has evolved into a vast and multiform field of study since the beginning of the epidemic in the Global North. Studies from France in this domain have remained relatively unknown at the international level. This article offers a narrative review of publications that resulted from research on homosexuality and HIV/AIDS, from 1985 to 2016. It offers an analysis of how the constitution of a field of research conditions the ways scientific questions are asked (and answered). This epistemological concern is addressed through a sociohistorical contextualization of the main issues surrounding prevention and how they have been addressed by researchers in France. A review of French publications on HIV prevention among gay men reveals certain specificities. In terms of the social science disciplines, psychology and psychoanalysis are much less present in this domain, whereas epidemiology, sociology, and anthropology are the most represented. The works analyzed in this article also reveal the circulation and local adaptations of risk categories imported from the English-speaking world, such as "relapse" and "bareback." Regardless, research on HIV prevention in France largely evolved contemporaneously in the same way that it did elsewhere.
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Affiliation(s)
- Gabriel Girard
- Institut de Recherche en Santé Publique de l, Université de Montréal, 7101 Avenue du Parc, Montreal, QC, H3N 1X9, Canada.
| | - Véronique Doré
- Agence Nationale de Recherche sur le Sida et les hépatites virales, Paris, France
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Time location sampling in men who have sex with men in the HIV context: the importance of taking into account sampling weights and frequency of venue attendance. Epidemiol Infect 2018; 146:913-919. [PMID: 29606158 DOI: 10.1017/s0950268818000675] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Sex between men is the most frequent mode of HIV transmission in industrialised countries. Monitoring risk behaviours among men who have sex with men (MSM) is crucial, especially to understand the drivers of the epidemic. A cross-sectional survey (PREVAGAY), based on time-location sampling, was conducted in 2015 among MSM attending gay venues in 5 metropolitan cities in France. We applied the generalised weight share method (GWSM) to estimate HIV seroprevalence for the first time in this population, taking into account the frequency of venue attendance (FVA). Our objectives were to describe the implementation of the sampling design and to demonstrate the importance of taking into account sampling weights, including FVA by comparing results obtained by GWSM and by other methods which use sample weights not including FVA or no weight. We found a global prevalence of 14.3% (95% CI (12.0-16.9)) using GWSM and an unweighted prevalence of 16.4% (95% CI (14.9-17.8)). Variance in HIV prevalence estimates in each city was lower when we did not take into account either the sampling weights or the FVA. We also highlighted an association of FVA and serological status in the most of investigated cities.
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Abstract
OBJECTIVES We undertook the economic evaluation of the double-blind randomized ANRS-IPERGAY trial, which showed the efficacy of on-demand preexposure prophylaxis (PrEP) with tenofovir disoproxil fumarate (TDF)-emtricitabine (FTC) in preventing HIV infection among high-risk MSM. DESIGN AND METHODS The economic evaluation was prospective. Counseling, drugs (TDF-FTC at &OV0556;500.88 for 30 tablets), tests, visits, and hospital admissions were valued based on in-trial use. The cost of on-demand PrEP/HIV infection averted was compared with the yearly and lifetime costs of HIV infection in France in a cost and benefits analysis. RESULTS The yearly number of participants needed to treat to prevent one HIV infection was 17.6 (95% confidence interval = 10.7-49.9). The annual cost of counseling was &OV0556;690/participant. The total 1-year costs of PrEP were &OV0556;4271/participant, of which &OV0556;3129 (73%) were drug costs corresponding to 15 tablets of TDF-FTC/month. The yearly cost of on-demand PrEP to avoid one infection was &OV0556;75 258. Using TDF-FTC generic (&OV0556;179.9/30 tablets) reduced the 1-year costs of on-demand PrEP to &OV0556;2271/participant and &OV0556;39 970/infection averted, respectively. Using TDF-FTC at international market discounted prices (&OV0556;60/30 tablets) reduced the costs to &OV0556;1517/participant and the cost to &OV0556;26 787/infection averted, comparable with the yearly treatment cost of HIV infection in France. On-demand PrEP was found to be cost saving in France if the duration of exposure was less than 7.5 years at current drug price and 13 years at generic price. CONCLUSION On-demand PrEP in high-risk MSM with TDF-FTC can be considered cost saving. Other benefits include the treatments of other diseases and reductions in secondary infections.
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Robineau O, Velter A, Barin F, Boelle PY. HIV transmission and pre-exposure prophylaxis in a high risk MSM population: A simulation study of location-based selection of sexual partners. PLoS One 2017; 12:e0189002. [PMID: 29190784 PMCID: PMC5708822 DOI: 10.1371/journal.pone.0189002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 11/16/2017] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE In France, indications for pre-exposure prophylaxis (PrEP) for HIV prevention are based on individual-level risk factors for HIV infection. However, the risk of HIV infection may also depend on characteristics of sexual partnerships. Here we study how place-based selection of partners change transmission and the overall efficiency of PrEP. METHODS We used the PREVAGAY survey of sexual behavior and HIV serostatus in men who have sex with men (MSM) in a Parisian district to look for associations between sexual network characteristics and HIV infection. We then simulated HIV transmission in a high-risk MSM population. We used information about venues visited to meet casual sexual partners (clubs, backrooms or saunas) to define sexual networks. We then simulated HIV transmission in these networks and assessed the impact of PrEP in this population. RESULTS In the PREVAGAY study, we found that HIV serostatus changed with the type of venues visited, in addition to other individual risk factors. In simulations, we found similar differences in HIV incidence when the choice of venues visited was not random. The use of PrEP allowed reducing incidence, irrespective of the venues visited by PrEP users. However, with the same amount of PrEP, the number of infections adverted could almost double depending on network structure and venues visited by PrEP users. CONCLUSION This study shows that characteristics of the sexual network structure can strongly impact the effectiveness of PrEP interventions. These should be considered further to refine individual risk assessment and maximize the effect of individual-based prevention policies.
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Affiliation(s)
- Olivier Robineau
- Sorbonne Universités - Univ Paris 06, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, INSERM U1136, Paris, France
- Service Universitaire des Maladies Infectieuses et du Voyageur, Centre Hospitalier Gustave Dron, Tourcoing, France
- Département des maladies infectieuses, Univ Lille 2, Lille, France
| | | | - Francis Barin
- Université François-Rabelais, INSERM UMR966, Tours, France
- Centre Hospitalier Régional Universitaire, Centre National de Référence du VIH, Tours, France
| | - Pierre-Yves Boelle
- Sorbonne Universités - Univ Paris 06, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, INSERM U1136, Paris, France
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Espinel M, Belza MJ, Cabeza-de-Vaca C, Arranz B, Guerras JM, Garcia-Soltero J, Hoyos J. Indicator condition based HIV testing: Missed opportunities for earlier diagnosis in men who have sex with men. Enferm Infecc Microbiol Clin 2017; 36:465-471. [PMID: 28993068 DOI: 10.1016/j.eimc.2017.07.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 07/24/2017] [Accepted: 07/25/2017] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Contact with the healthcare system by a sample of seropositive men who have sex with men (MSM) prior to their HIV diagnosis are analysed, and missed opportunities (MO) for an earlier HIV diagnosis are identified. METHODOLOGY Between 2012-2013, an online survey was conducted among HIV-positive MSM, mainly recruited from gay websites. Those who were diagnosed with HIV between 2010-2013 were analysed. MO were defined as episodes prior to the HIV diagnosis in which the healthcare system was contacted due to an indicator condition of HIV infection and the test was not suggested. The proportion of missed opportunities were compared according to the type of indicator condition, the department consulted and the healthcare professional's knowledge that the patient was MSM. RESULTS Overall, 639 participants (66% of 966) reported 1,145 episodes with some indicator condition, the majority of these being identified in primary care (n=527; 46%). The highest percentage of MOs is also observed in primary care (63%). Although the indicator condition with the highest number of MOs was STIs (n=124), the highest percentage of MOs was observed in consultations due to diarrhoea with no known cause (69.8%). The percentage of MOs when the doctor knew that the patient was MSM was 40 vs. 70% when the doctor did not know. CONCLUSION The majority of HIV-positive MSM analysed in this study went to healthcare services for HIV-infection indicator conditions prior to their HIV diagnosis. Primary care was the most-frequently-visited department and is also where the most opportunities were missed to perform an HIV test, even when it was known that the patient was a MSM.
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Affiliation(s)
| | - María José Belza
- Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Madrid, España; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, España.
| | | | - Beatriz Arranz
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, España
| | - Juan Miguel Guerras
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, España
| | | | - Juan Hoyos
- Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Madrid, España; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, España
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Le Roux E, Gottot S, Aupiais C, Girard T, Teixeira M, Alberti C. Professional's Perspectives on Care Management of Young People with Perinatally Acquired HIV during Transition: A Qualitative Study in Adult Care Setting. PLoS One 2017; 12:e0169782. [PMID: 28114376 PMCID: PMC5256933 DOI: 10.1371/journal.pone.0169782] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 12/21/2016] [Indexed: 12/30/2022] Open
Abstract
Background Increasing numbers of young people with perinatally acquired HIV are surviving to adulthood. When they come of age, they leave pediatric services in which they were followed and have to be transferred to the adult health care system. Difficulties in adaptation to adult care and the numbers of young people lost to follow up after transfer to adult care have been reported. This transition phase and their retention in adult care are crucial in maintaining the clinical status of these young with HIV in adulthood. Our study aimed to explore how HIV professionals working in adult care perceive and adapt their practices to young people in transition. Methods Qualitative interviews were conducted with 18 health and social services professionals in hospitals or patient associations in France. A thematic analysis was conducted. Results Adult care professionals were found to be making a distinction between these young people and their patients who were infected during adulthood. On the basis of the healthcare teams’ experience, a simplified categorization of these young people into four levels can be used: those “who have everything good”; those who have some deficiencies that must be addressed; those “who have everything bad”; and those lost to follow up. Professionals interviewed highlighted the difficulties they encountered with young people in transition. Three types of problematic situations were identified: problems of acceptance of the disease; communication problems; and problems of disorientation in the new care environment. Conclusions Despite the lack of specific training or national policy recommendations for the integration of young people with perinatally acquired HIV into adult services, all the adult healthcare teams interviewed tried to adapt their practice to this population. The results suggested that professional involvement during transition should depend on the characteristics of the patient, not be limited to a single transition model and that a dedicated structure for transition care is not appropriate for all young people.
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Affiliation(s)
- Enora Le Roux
- Université Paris Diderot, Sorbonne Paris Cité, ECEVE, UMRS 1123, Paris, France
- Inserm, ECEVE U1123 and CIC-EC, CIC 1426, Paris, France
- * E-mail:
| | - Serge Gottot
- Université Paris Diderot, Sorbonne Paris Cité, ECEVE, UMRS 1123, Paris, France
- Inserm, ECEVE U1123 and CIC-EC, CIC 1426, Paris, France
- Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Unité d’épidémiologie clinique, Paris, France
| | - Camille Aupiais
- Université Paris Diderot, Sorbonne Paris Cité, ECEVE, UMRS 1123, Paris, France
- Inserm, ECEVE U1123 and CIC-EC, CIC 1426, Paris, France
- Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Unité d’épidémiologie clinique, Paris, France
| | - Thomas Girard
- Assistance Publique-Hôpitaux de Paris, Hôpital de l'Hôtel-Dieu, Unité Guy Mocquet, Paris, France
| | - Maria Teixeira
- Université Paris Diderot, Sorbonne Paris Cité, ECEVE, UMRS 1123, Paris, France
- Inserm, ECEVE U1123 and CIC-EC, CIC 1426, Paris, France
- Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Unité d’épidémiologie clinique, Paris, France
| | - Corinne Alberti
- Université Paris Diderot, Sorbonne Paris Cité, ECEVE, UMRS 1123, Paris, France
- Inserm, ECEVE U1123 and CIC-EC, CIC 1426, Paris, France
- Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Unité d’épidémiologie clinique, Paris, France
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McCormack SM, Noseda V, Molina JM. PrEP in Europe - expectations, opportunities and barriers. J Int AIDS Soc 2016; 19:21103. [PMID: 27760681 PMCID: PMC5071751 DOI: 10.7448/ias.19.7.21103] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 06/28/2016] [Accepted: 07/12/2016] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION In contrast to the global trend showing a decline in new HIV infections, the number reported in the World Health Organization (WHO) region of Europe is increasing. Health systems are disparate, but even countries with free access to screening and treatment observe continuing high rates of new infections in key populations, notably men who have sex with men (MSM). Pre-exposure prophylaxis (PrEP) is only available in France. This commentary describes the European epidemics and healthcare settings where PrEP could be delivered, how need might be estimated for MSM and the residual barriers to access. DISCUSSION Health systems and government commitment to HIV prevention and care, both financial and political, differ considerably between the countries that make up Europe. A common feature is that funds for prevention are a small fraction of funds for care. Although care is generally good, access is limited in the middle-income countries of Eastern Europe and central Asia, and only 19% of people living with HIV received antiretroviral therapy in 2014. It is challenging to motivate governments or civil society to implement PrEP in the context of this unmet treatment need, which is driven by limited national health budgets and diminishing assistance from foreign aid. The high-income countries of Western Europe have hesitated to embrace PrEP for different reasons, initially due to key gaps in the evidence. Now that PrEP has been shown to be highly effective in European MSM in two randomized controlled trials, it is clear that the major barrier is the cost of the drug which is still on patent, although inadequate health systems and diminishing investment in civil society are also key challenges to overcome. CONCLUSIONS The momentum to implement PrEP in European countries is increasing and provides a welcome opportunity to expand and improve clinical services and civil society support focused on HIV and related infections including other sexually transmitted and blood-borne infections.
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Affiliation(s)
- Sheena Mary McCormack
- Medical Research Council Clinical Trials Unit, University College London, London, UK;
| | | | - Jean-Michel Molina
- Department of Infectious Diseases, Saint-Louis Hospital, and University of Paris Diderot, Sorbonne Paris Cité
- INSERM U941, Paris, France
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20
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Global implementation of PrEP as part of combination HIV prevention - Unsolved challenges. J Int AIDS Soc 2016. [DOI: 10.7448/ias.19.7.21479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Billings JD, Joseph Davey DL, Konda KA, Bristow CC, Chow J, Klausner JD, Cáceres CF. Factors associated with previously undiagnosed human immunodeficiency virus infection in a population of men who have sex with men and male-to-female transgender women in Lima, Peru. Medicine (Baltimore) 2016; 95:e5147. [PMID: 27759645 PMCID: PMC5079329 DOI: 10.1097/md.0000000000005147] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 09/06/2016] [Accepted: 09/26/2016] [Indexed: 11/25/2022] Open
Abstract
The aim of the study was to identify factors associated with undiagnosed human immunodeficiency virus (HIV) infection among men who have sex with men (MSM) and male-to-female transgender women in Lima, Peru.We analyzed characteristics of 378 MSM and transgender women recruited from 2 sexually transmitted infection (STI) clinics in Lima, Peru. Descriptive analyses compared: (A) HIV-uninfected, (B) previously undiagnosed HIV-infected, and (C) previously diagnosed HIV-infected participants. Multivariable logistic regression models identified: (1) correlates of previously undiagnosed HIV-infection among participants thought to be HIV-uninfected (B vs A); and (2) correlates of previously undiagnosed HIV-infection among HIV-infected participants (B vs C). Subanalysis identified correlates of frequent HIV testing among participants thought to be HIV-uninfected.Among participants, 31.0% were HIV-infected; of those, 35.0% were previously undiagnosed. Among participants thought to be HIV-uninfected (model 1), recent condomless receptive anal intercourse and last HIV test being over 1-year ago (compared to within the last 6-months) were associated with increased odds of being previously undiagnosed HIV-infected (adjusted odds ratio [aOR] = 2.43, 95% confidence interval [95%CI] = 1.10-5.36; aOR = 2.87, 95%CI = 1.10-7.53, respectively). Among HIV-infected participants (model 2), recent condomless receptive anal intercourse was again associated with previously undiagnosed HIV-infection (aOR = 2.54, 95%CI = 1.04-6.23). Achieving post-secondary education and prior syphilis infection were associated with lower odds of having previously undiagnosed HIV-infection (aOR = 0.35, 95%CI = 0.15-0.81; aOR = 0.32, 95%CI = 0.14-0.75, respectively).Reporting semiannual testing was associated with higher educational attainment, identifying as a transgender woman, or reporting a history of syphilis (aOR = 1.94, 95%CI = 1.11-3.37; aOR = 2.40, 95%CI = 1.23-4.70; aOR = 2.76, 95%CI = 1.62-4.71, respectively). Lower odds of semiannual testing were associated with recent condomless insertive anal intercourse or reporting a moderate or high self-perceived risk of acquiring HIV (aOR = 0.56, 95%CI = 0.33-0.96; aOR = 0.32, 95%CI = 0.18-0.59 and aOR = 0.43, 95%CI = 0.21-0.86, respectively).In our study, undiagnosed HIV-infection was associated with recent condomless receptive anal intercourse, infrequent HIV testing, lower education, and absence of prior syphilis diagnosis. Infrequent HIV testing was associated with lower education, not identifying as transgender, recent condomless insertive anal intercourse, absence of prior syphilis diagnosis, and higher self-perceived risk of HIV. Further efforts to decrease HIV transmission and increase HIV-serostatus awareness should be directed towards effectively promoting condom use and frequent HIV testing, integrated with STI management.
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Affiliation(s)
| | - Dvora L. Joseph Davey
- David Geffen School of Medicine at University of California Los Angeles
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA
| | - Kelika A. Konda
- David Geffen School of Medicine at University of California Los Angeles
- Center for Interdisciplinary Studies in Sexuality, AIDS and Society, and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Claire C. Bristow
- Division of Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA
| | - Jeremy Chow
- David Geffen School of Medicine at University of California Los Angeles
| | - Jeffrey D. Klausner
- David Geffen School of Medicine at University of California Los Angeles
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA
| | - Carlos F. Cáceres
- Center for Interdisciplinary Studies in Sexuality, AIDS and Society, and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
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Duwal S, Sunkara V, von Kleist M. Multiscale Systems-Pharmacology Pipeline to Assess the Prophylactic Efficacy of NRTIs Against HIV-1. CPT Pharmacometrics Syst Pharmacol 2016; 5:377-87. [PMID: 27439573 PMCID: PMC4961081 DOI: 10.1002/psp4.12095] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 06/20/2016] [Accepted: 06/20/2016] [Indexed: 12/14/2022] Open
Abstract
While HIV-1 continues to spread, the use of antivirals in preexposure prophylaxis (PrEP) has recently been suggested. Here we present a modular systems pharmacology modeling pipeline, predicting PrEP efficacy of nucleotide reverse transcriptase inhibitors (NRTIs) at the scale of reverse transcription, target-cell, and systemic infection and after repeated viral exposures, akin to clinical trials. We use this pipeline to benchmark the prophylactic efficacy of all currently approved NRTIs in wildtype and mutant viruses. By integrating pharmacokinetic models, we find that intracellular tenofovir-diphosphate builds up too slowly to halt infection when taken "on demand" and that lamivudine may substitute emtricitabine in PrEP combinations. Lastly, we delineate factors confounding clinical PrEP efficacy estimates and provide a method to overcome these. The presented framework is useful to screen and optimize PrEP candidates and strategies and to understand their clinical efficacy by integrating the diverse scales which determine PrEP efficacy.
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Affiliation(s)
- S Duwal
- Department of Mathematics & Computer ScienceFreie Universität BerlinBerlinGermany
| | - V Sunkara
- Department of Mathematics & Computer ScienceFreie Universität BerlinBerlinGermany
- Konrad‐Zuse‐Institut für InformationstechnikBerlinGermany
| | - M von Kleist
- Department of Mathematics & Computer ScienceFreie Universität BerlinBerlinGermany
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Leblanc J, Rousseau A, Hejblum G, Durand-Zaleski I, de Truchis P, Lert F, Costagliola D, Simon T, Crémieux AC. The impact of nurse-driven targeted HIV screening in 8 emergency departments: study protocol for the DICI-VIH cluster-randomized two-period crossover trial. BMC Infect Dis 2016; 16:51. [PMID: 26831332 PMCID: PMC4736610 DOI: 10.1186/s12879-016-1377-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 01/25/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In 2010, to reduce late HIV diagnosis, the French national health agency endorsed non-targeted HIV screening in health care settings. Despite these recommendations, non-targeted screening has not been implemented and only physician-directed diagnostic testing is currently performed. A survey conducted in 2010 in 29 French Emergency Departments (EDs) showed that non-targeted nurse-driven screening was feasible though only a few new HIV diagnoses were identified, predominantly among high-risk groups. A strategy targeting high-risk groups combined with current practice could be shown to be feasible, more efficient and cost-effective than current practice alone. METHODS/DESIGN DICI-VIH (acronym for nurse-driven targeted HIV screening) is a multicentre, cluster-randomized, two-period crossover trial. The primary objective is to compare the effectiveness of 2 strategies for diagnosing HIV among adult patients visiting EDs: nurse-driven targeted HIV screening combined with current practice (physician-directed diagnostic testing) versus current practice alone. Main secondary objectives are to compare access to specialist consultation and how early HIV diagnosis occurs in the course of the disease between the 2 groups, and to evaluate the implementation, acceptability and cost-effectiveness of nurse-driven targeted screening. The 2 strategies take place during 2 randomly assigned periods in 8 EDs of metropolitan Paris, where 42 % of France's new HIV patients are diagnosed every year. All patients aged 18 to 64, not presenting secondary to HIV exposure are included. During the intervention period, patients are invited to fill a 7-item questionnaire (country of birth, sexual partners and injection drug use) in order to select individuals who are offered a rapid test. If the rapid test is reactive, a follow-up visit with an infectious disease specialist is scheduled within 72 h. Assuming an 80 % statistical power and a 5 % type 1 error, with 1.04 and 3.38 new diagnoses per 10,000 patients in the control and targeted groups respectively, a sample size of 140,000 patients was estimated corresponding to 8,750 patients per ED and per period. Inclusions started in June 2014. Results are expected by mid-2016. DISCUSSION The DICI-VIH study is the first large randomized controlled trial designed to assess nurse-driven targeted HIV screening. This study can provide valuable information on HIV screening in health care settings. TRIAL REGISTRATION ClinicalTrials.gov: NCT02127424 (29 April 2014).
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Affiliation(s)
- Judith Leblanc
- Assistance Publique - Hôpitaux de Paris (AP-HP), Groupe Hospitalier des Hôpitaux Universitaires Est Parisien, Clinical Research Center of East of Paris (CRC-Est), F75012, Paris, France. .,Université Paris Saclay - Université Versailles Saint-Quentin, Doctoral School of Public Health (EDSP), UMR 1173, F92380, Garches, France.
| | - Alexandra Rousseau
- AP-HP, Groupe Hospitalier des Hôpitaux Universitaires Est Parisien, Clinical Research Unit of East of Paris (URC-Est), F75012, Paris, France.
| | - Gilles Hejblum
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP UMRS 1136), F75012, Paris, France.
| | - Isabelle Durand-Zaleski
- AP-HP, Hôpital Hôtel-Dieu, URC Eco Île-de-France, F75004, Paris, France. .,Université Paris Diderot, Univ Paris 07, INSERM, ECEVE, UMR 1123, F75019, Paris, France. .,AP-HP, Hôpital Henri-Mondor, Santé publique, F94010, Créteil, France.
| | - Pierre de Truchis
- AP-HP, Hôpital Raymond-Poincaré, Infectious Disease Department, F92380, Garches, France.
| | - France Lert
- Université Paris Sud, Univ Paris 11, INSERM, Centre for research in Epidemiology and population health, U 1018, F94800, Villejuif, France.
| | - Dominique Costagliola
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP UMRS 1136), F75012, Paris, France.
| | - Tabassome Simon
- AP-HP, Groupe Hospitalier des Hôpitaux Universitaires Est Parisien, Department of clinical pharmacology and Clinical Research Center of East of Paris (CRC-Est), F75012, Paris, France. .,Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR 1148, F75018, Paris, France.
| | - Anne-Claude Crémieux
- AP-HP, Hôpital Raymond-Poincaré, Infectious Disease Department, F92380, Garches, France. .,Université Versailles Saint-Quentin, UMR 1173, F92380, Garches, France.
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Fraisse T, Fourcade C, Brazes-Sanz J, Koumar Y, Lavigne JP, Sotto A, Laureillard D. A cross sectional survey of the barriers for implementing rapid HIV testing among French general practitioners. Int J STD AIDS 2015; 27:1005-12. [PMID: 26429893 DOI: 10.1177/0956462415605413] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 08/18/2015] [Indexed: 11/17/2022]
Abstract
In France, almost 30,000 people are unaware of their HIV-positive status. Innovative screening strategies are essential to reach this population. The aim of this study was to describe the acceptability of rapid HIV testing (RHT) among French general practitioners (GPs) working in the south of France and barriers for implementing this strategy. We analysed an anonymous questionnaire sent by mail to GPs about demographic data, routine practice, knowledge of RHT and barriers to its use. Between 1 April and 30 September 2013, out of the 165 GPs contacted, 78 returned the questionnaires. The GPs' mean age was 52 years; 49 were men. Fifty-one GPs reported that their registered patients included at least one HIV-infected person and 70 GPs reported taking care of high-risk patients. Sixty-three percent of GPs reported being interested in using RHT in their daily practice. The main reasons reported by uninterested GPs were: greater confidence in standard HIV testing, difficulties including RHT during the routine consultation, difficulties to screen for other sexually transmitted infections simultaneously, and difficulties to deliver a positive result. French National Authorities for Health propose to screen the population at least once in their lifetime and high-risk people at least once a year. In order to achieve this aim, RHT should be included in the GPs' arsenal for HIV testing. We showed a high acceptability of RHT by GPs. If specific and adapted training is developed, and if solutions to barriers reported by GPs are found, RHT could be implemented in to their routine activity.
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Affiliation(s)
- Thibaut Fraisse
- Department of Geriatric Medicine, General Hospital, Alès, France
| | - Camille Fourcade
- Department of Infectious and Tropical Diseases, University Hospital, Nîmes, France
| | | | - Yatrika Koumar
- Department of Infectious and Tropical Diseases, University Hospital, Nîmes, France
| | | | - Albert Sotto
- Department of Infectious and Tropical Diseases, University Hospital, Nîmes, France
| | - Didier Laureillard
- Department of Infectious and Tropical Diseases, University Hospital, Nîmes, France
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Self-sampling and quantitative analysis of DBS: can it shift the balance in over-burdened healthcare systems? Bioanalysis 2015; 7:1963-6. [DOI: 10.4155/bio.15.110] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Robineau O, Frange P, Barin F, Cazein F, Girard PM, Chaix ML, Kreplak G, Boelle PY, Morand-Joubert L. Combining the Estimated Date of HIV Infection with a Phylogenetic Cluster Study to Better Understand HIV Spread: Application in a Paris Neighbourhood. PLoS One 2015; 10:e0135367. [PMID: 26267615 PMCID: PMC4534393 DOI: 10.1371/journal.pone.0135367] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Accepted: 07/21/2015] [Indexed: 11/19/2022] Open
Abstract
Objectives To relate socio-demographic and virological information to phylogenetic clustering in HIV infected patients in a limited geographical area and to evaluate the role of recently infected individuals in the spread of HIV. Methods HIV-1 pol sequences from newly diagnosed and treatment-naive patients receiving follow-up between 2008 and 2011 by physicians belonging to a health network in Paris were used to build a phylogenetic tree using neighbour-joining analysis. Time since infection was estimated by immunoassay to define recently infected patients (very early infected presenters, VEP). Data on socio-demographic, clinical and biological features in clustered and non-clustered patients were compared. Chains of infection structure was also analysed. Results 547 patients were included, 49 chains of infection containing 108 (20%) patients were identified by phylogenetic analysis. analysis. Eighty individuals formed pairs and 28 individuals were belonging to larger clusters. The median time between two successive HIV diagnoses in the same chain of infection was 248 days [CI = 176–320]. 34.7% of individuals were considered as VEP, and 27% of them were included in chains of infection. Multivariable analysis showed that belonging to a cluster was more frequent in VEP and those under 30 years old (OR: 3.65, 95 CI 1.49–8.95, p = 0.005 and OR: 2.42, 95% CI 1.05–5.85, p = 0.04 respectively). The prevalence of drug resistance was not associated with belonging to a pair or a cluster. Within chains, VEP were not grouped together more than chance predicted (p = 0.97). Conclusions Most newly diagnosed patients did not belong to a chain of infection, confirming the importance of undiagnosed or untreated HIV infected individuals in transmission. Furthermore, clusters involving both recently infected individuals and longstanding infected individuals support a substantial role in transmission of the latter before diagnosis.
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Affiliation(s)
- Olivier Robineau
- Service Universitaire Régional de Maladies Infectieuses et Tropicales, Centre Hospitalier de Tourcoing, Tourcoing, France
- INSERM, UMR_S 1136, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris, France
- * E-mail: (OR); (LMJ)
| | - Pierre Frange
- EA 3620, Université Paris Descartes, Sorbonne Paris-Cité, Paris, France
- Laboratoire de Microbiologie & Unité d’Immunologie, Hématologie et Rhumatologie Pédiatriques, AP-HP, Hôpital Necker, Enfants Malades, Paris, France
| | - Francis Barin
- Centre National de Référence du VIH & INSERM U966, CHU Bretonneau & Université Francois Rabelais, Tours, France
| | | | - Pierre-Marie Girard
- INSERM, UMR_S 1136, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris, France
- Service des Maladies Infectieuses et Tropicales, Hôpital Saint Antoine, APHP, Paris, France
| | - Marie-Laure Chaix
- EA 3620, Université Paris Descartes, Sorbonne Paris-Cité, Paris, France
- Laboratoire de Virologie, AP-HP, Hôpital Saint-Louis, Paris, France
| | | | - Pierre-Yves Boelle
- INSERM, UMR_S 1136, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris, France
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 943, Paris, France
- Service de Santé Publique, AP-HP, Hôpital Saint-Antoine, Paris, France
| | - Laurence Morand-Joubert
- INSERM, UMR_S 943, Paris, France
- Laboratoire de Virologie, Hôpital Saint-Antoine, AP-HP, Paris, France
- * E-mail: (OR); (LMJ)
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Zea MC, Reisen CA, del Río-González AM, Bianchi FT, Ramirez-Valles J, Poppen PJ. HIV Prevalence and Awareness of Positive Serostatus Among Men Who Have Sex With Men and Transgender Women in Bogotá, Colombia. Am J Public Health 2015; 105:1588-95. [PMID: 25602899 PMCID: PMC4504275 DOI: 10.2105/ajph.2014.302307] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2014] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We estimated HIV prevalence among men who have sex with men (MSM) and transgender women in Bogotá, Colombia, and explored differences between HIV-positive individuals who are aware and unaware of their serostatus. METHODS In this cross-sectional 2011 study, we used respondent-driven sampling (RDS) to recruit 1000 MSM and transgender women, who completed a computerized questionnaire and received an HIV test. RESULTS The RDS-adjusted prevalence was 12.1% (95% confidence interval [CI] = 8.7, 15.8), comparable to a previous RDS-derived estimate. Among HIV-positive participants, 39.7% (95% CI = 25.0, 54.8) were aware of their serostatus and 60.3% (95% CI = 45.2, 75.5) were unaware before this study. HIV-positive-unaware individuals were more likely to report inadequate insurance coverage, exchange sex (i.e., sexual intercourse in exchange for money, goods, or services), and substance use than other participants. HIV-positive-aware participants were least likely to have had condomless anal intercourse in the previous 3 months. Regardless of awareness, HIV-positive participants reported more violence and forced relocation experiences than HIV-negative participants. CONCLUSIONS There is an urgent need to increase HIV detection among MSM and transgender women in Bogotá. HIV-positive-unaware group characteristics suggest an important role for structural, social, and individual interventions.
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Affiliation(s)
- Maria Cecilia Zea
- Maria Cecilia Zea, Carol A. Reisen, Ana María del Río-González, Fernanda T. Biachi, and Paul J. Poppen are with George Washington University, Washington, DC. Jesus Ramirez-Valles is with the University of Illinois, Chicago
| | - Carol A Reisen
- Maria Cecilia Zea, Carol A. Reisen, Ana María del Río-González, Fernanda T. Biachi, and Paul J. Poppen are with George Washington University, Washington, DC. Jesus Ramirez-Valles is with the University of Illinois, Chicago
| | - Ana María del Río-González
- Maria Cecilia Zea, Carol A. Reisen, Ana María del Río-González, Fernanda T. Biachi, and Paul J. Poppen are with George Washington University, Washington, DC. Jesus Ramirez-Valles is with the University of Illinois, Chicago
| | - Fernanda T Bianchi
- Maria Cecilia Zea, Carol A. Reisen, Ana María del Río-González, Fernanda T. Biachi, and Paul J. Poppen are with George Washington University, Washington, DC. Jesus Ramirez-Valles is with the University of Illinois, Chicago
| | - Jesus Ramirez-Valles
- Maria Cecilia Zea, Carol A. Reisen, Ana María del Río-González, Fernanda T. Biachi, and Paul J. Poppen are with George Washington University, Washington, DC. Jesus Ramirez-Valles is with the University of Illinois, Chicago
| | - Paul J Poppen
- Maria Cecilia Zea, Carol A. Reisen, Ana María del Río-González, Fernanda T. Biachi, and Paul J. Poppen are with George Washington University, Washington, DC. Jesus Ramirez-Valles is with the University of Illinois, Chicago
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Family practitioners screening for HIV infection. Med Mal Infect 2015; 45:157-64. [PMID: 25866373 DOI: 10.1016/j.medmal.2015.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 02/16/2015] [Accepted: 03/13/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND We assessed how family physicians screened for HIV infection in Paris, in 2013 and whether their practice had changed after publication of the HAS (French National Authority for Health) recommendation for systematic screening. METHOD Family practitioners (FPs) in Paris answered a questionnaire by e-mail or regular mail from January to April 2013. The statistical analysis was performed with the Chi(2) test. RESULTS Four hundred and seven FPs answered (77.8% response rate). FPs did not always identify risk cases: 78% in case of sexually transmitted infection, but 32% for partner change, 39% for patients from a highly HIV endemic country, and 21% for sexually active teenagers or adults. Practices differed according to districts. FPs in the 1st and in the Northeastern Paris districts detected risk cases for HIV more often than their colleagues, and they used screening more often, with, consequently, more frequently positive results. The screening strategies also differed according to the FPs' demographic characteristics and their type of practice: young (P = 0.0002) female (P = 0.02) FPs working in "sector 1 (patients fully reimbursed)" (P = 8.10(-5)) prescribed more HIV blood tests. Surprisingly, only 45% of FPs was aware of the recent recommendation for systematic screening of HIV. CONCLUSION The Paris FP screening practices differ according to demographic characteristics, place, and type of practice. Screening practices have not changed since the publication of the new screening strategy.
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Velter A, Saboni L, Sommen C, Bernillon P, Bajos N, Semaille C. Sexual and prevention practices in men who have sex with men in the era of combination HIV prevention: results from the Presse Gays et Lesbiennes survey, France, 2011. ACTA ACUST UNITED AC 2015; 20. [PMID: 25884150 DOI: 10.2807/1560-7917.es2015.20.14.21090] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
To better understand the diversity of practices and behaviours to prevent HIV with casual partners, data from a large convenience sample of men who have sex with men (MSM) in France were categorised into different prevention profiles: no anal intercourse, consistent condom use during anal intercourse, risk-reduction practices (serosorting, seropositioning) and no discernible prevention practice (NDPP). Categories were applied to HIV-positive respondents with controlled (CI; n=672) and uncontrolled infection (UI; n=596), HIV-negative (n=4,734) and untested respondents (n=663). Consistent condom use was reported by 22% (n=148) of HIV-positive-CI respondents, 13% (n=79) of HIV-positives UI, 55% (2,603) of HIV-negatives, and 50% (n=329) of untested (p<0.001). Corresponding figures for NDPP were 45% (n=304), 55% (n=327), 21% (n=984) and 34% (n=227) (p<0.001). Logistic regressions showed that, regardless of respondents' serostatus, NDPP was associated with regularly frequenting dating websites, drug use, exposure to sperm during oral sex, and with HIV diagnosis after 2000 for HIV-positive respondents (CI and UI), with age <30 years for HIV-positive-CI, and with low education for HIV-negatives. Risk-taking remains high, despite implementation of risk-reduction practices. A global health approach should be central to prevention programmes for MSM, to include target behavioural intervention, promotion of condom use, and encouragement of regular HIV testing and early initiation of ART.
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Affiliation(s)
- A Velter
- Institut de Veille Sanitaire, Saint Maurice, France
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Ferrer L, Furegato M, Foschia JP, Folch C, González V, Ramarli D, Casabona J, Mirandola M. Undiagnosed HIV infection in a population of MSM from six European cities: results from the Sialon project. Eur J Public Health 2014; 25:494-500. [PMID: 25161202 DOI: 10.1093/eurpub/cku139] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The purpose of this article is to assess the distribution of undiagnosed HIV infection in men who have sex with men (MSM) in Southern and Eastern European countries, to describe the differences in epidemiology and behaviour between undiagnosed, diagnosed HIV-positive and HIV-negative MSM and to identify factors associated with undiagnosed HIV infection in the study population. METHODS A multi-centre biological and behavioural cross-sectional study was conducted in 2008. Time-location sampling was used to recruit men attending different venues. A self-administered questionnaire was completed and oral fluid samples were collected to estimate HIV prevalence. RESULTS HIV prevalence was 17% in Barcelona, 12% in Verona, 6% in Bratislava, 5% in Ljubljana, 5% in Bucharest and 3% in Prague while undiagnosed HIV infection was 47, 62, 67, 83, 85 and 57%, respectively. Diagnosed HIV-positive men reported more casual partners than HIV-negative MSM (mean: 19 and 9, respectively) (P < 0.001), and they were more likely to self-reported condyloma in the last year than undiagnosed HIV-positive and HIV-negative men (15, 1 and 3%, respectively) (P < 0.001). Factors associated with undiagnosed HIV infection included attending sex-focused venues (OR = 2.49), reporting syphilis in the previous 12 months (OR = 2.56), using poppers at last sexual intercourse (OR = 3.36) and having had an HIV test in the previous year (OR = 2.00). CONCLUSIONS Many HIV infections remain undiagnosed, and there is evidence of the persistence of frequent risk behaviours and sexually transmitted infections (STI) despite knowledge of HIV-positive status, emphasising the need for a multidimensional approach to HIV/STI prevention. Access to HIV testing should be considered a priority in prevention programs targeted at MSM, especially in Eastern Europe.
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Affiliation(s)
- Laia Ferrer
- 1 Center for Epidemiological Studies on STI and AIDS of Catalonia (CEEISCAT), Agència Salut Pública de Catalunya (ASPC), Generalitat de Catalunya, Badalona, Spain 2 Institut d'Investigació Germans Trias i Pujol (IGTP), Badalona, Spain 3 CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Martina Furegato
- 4 Regional Center for Health Promotion, Veneto Region, Verona, Italy
| | | | - Cinta Folch
- 1 Center for Epidemiological Studies on STI and AIDS of Catalonia (CEEISCAT), Agència Salut Pública de Catalunya (ASPC), Generalitat de Catalunya, Badalona, Spain 2 Institut d'Investigació Germans Trias i Pujol (IGTP), Badalona, Spain 3 CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain 5 Departament de Pediatria, d'Obstetrícia i Ginecologia i de Medicina Preventiva i de Salut Pública, Facultat de Medicina, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Victoria González
- 1 Center for Epidemiological Studies on STI and AIDS of Catalonia (CEEISCAT), Agència Salut Pública de Catalunya (ASPC), Generalitat de Catalunya, Badalona, Spain 2 Institut d'Investigació Germans Trias i Pujol (IGTP), Badalona, Spain 3 CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain 6 Microbiology Service, Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Dunia Ramarli
- 7 Immunology Section, Verona University Hospital, Verona, Italy
| | - Jordi Casabona
- 1 Center for Epidemiological Studies on STI and AIDS of Catalonia (CEEISCAT), Agència Salut Pública de Catalunya (ASPC), Generalitat de Catalunya, Badalona, Spain 2 Institut d'Investigació Germans Trias i Pujol (IGTP), Badalona, Spain 3 CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain 5 Departament de Pediatria, d'Obstetrícia i Ginecologia i de Medicina Preventiva i de Salut Pública, Facultat de Medicina, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Massimo Mirandola
- 8 Infectious Diseases Section, Department of Pathology, Verona University Hospital, Verona, Italy
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Yang Z, Zhang S, Dong Z, Jin M, Han J. Prevalence of unprotected anal intercourse in men who have sex with men recruited online versus offline: a meta-analysis. BMC Public Health 2014; 14:508. [PMID: 24885058 PMCID: PMC4070357 DOI: 10.1186/1471-2458-14-508] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 05/21/2014] [Indexed: 11/13/2022] Open
Abstract
Background Men who have sex with men (MSM) are a high risk population for human immunodeficiency virus (HIV) infection. Our study aims to find whether MSM who were recruited online had a higher prevalence of self-reported unprotected anal intercourse (UAI) than those who were recruited offline. Methods A meta-analysis was conducted from the results of published studies. The analysis was stratified by the participants’ geographic location, the sample size and the date of the last reported UAI. Results Based on fourteen studies, MSM who were recruited online (online-based group) reported that 33.9% (5,961/17,580) of them had UAI versus 24.9% (2,700/10,853) of MSM who were recruited offline (offline-based group). The results showed that it is more likely for an online-based MSM group to have UAI with male partners than an offline-based MSM group [odds ratio (OR) = 1.35, 95% CI = 1.13-1.62, P < 0.01]. The subgroup analysis results also showed that the prevalence of UAI was higher in the European subsample (OR = 1.38, 95% CI = 1.17-1.63, P < 0.01) and in sample sizes of more than 500 individuals (OR = 1.32, 95% CI = 1.09-1.61, P < 0.01) in the online group compared to the offline group. The prevalence of UAI was also significantly higher when the time of the last UAI was during the last 3 or more months (OR = 1.40, 95% CI = 1.13-1.74, P < 0.05) in the online group compared to the offline group. A sensitivity analysis was used to test the reliability of the results, and it reported that the results remained unchanged and had the same estimates after deleting any one of the included studies. Conclusions A substantial percentage of MSM were recruited online, and they were more inclined to engage in UAI than MSM who were recruited offline. Targeted interventions of HIV prevention programs or services are recommended when designing preventive interventions to be delivered via the Internet.
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Affiliation(s)
| | | | | | - Meihua Jin
- Huzhou Center for Disease Control and Prevention, Huzhou 313000, Zhejiang Province, China.
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Vagenas P, Ludford KT, Gonzales P, Peinado J, Cabezas C, Gonzales F, Lama JR, Sanchez J, Altice FL. Being unaware of being HIV-infected is associated with alcohol use disorders and high-risk sexual behaviors among men who have sex with men in Peru. AIDS Behav 2014; 18:120-7. [PMID: 23670711 PMCID: PMC3796203 DOI: 10.1007/s10461-013-0504-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This study compared the correlates of HIV risk among men who have sex with men (MSM) with newly diagnosed versus previously known HIV infection among 5,148 MSM recruited using modified snowball sampling in 5 Peruvian cities. Participants, if age ≥18 years and reporting sex with a male in the previous 12 months, underwent standardized computer-assisted risk assessments and HIV and syphilis testing. Overall, 420 (8.2 %) participants tested HIV seropositive, most of whom (89.8 %) were unaware of their HIV status. Compared to those who knew themselves to be HIV-infected, multivariate logistic regression demonstrated that unprotected anal intercourse at last encounter [AOR = 2.84 (95 % CI 1.09-7.40)] and having an alcohol use disorder (AUD) [AOR = 2.14 (95 % CI 1.01-5.54)] were independently associated with a newly diagnosed HIV infection. Being unaware of being HIV-infected was associated with high-risk sexual behaviors and AUDs, both of which are amenable to behavioral and medication-assisted therapy interventions.
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Affiliation(s)
- Panagiotis Vagenas
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, Yale University AIDS Program, 135 College Street, Suite 323, New Haven, CT, 06510, USA,
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Characterization of CRF56_cpx, a new circulating B/CRF02/G recombinant form identified in MSM in France. AIDS 2013; 27:2309-12. [PMID: 24157908 DOI: 10.1097/qad.0b013e3283632e0c] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Several B/CRF02_AG Unique Recombinant Forms (URFs) have previously been identified in France. Here we show that one of them (URF5_B/02/G) is emerging in MSM, a high-risk population where HIV incidence and number of superinfections are increasing. We describe this new Circulating Recombinant Form, CRF56_cpx, estimate the time to its most recent common ancestor, investigate its origins and show that it probably shares common ancestors with strains from the East Mediterranean.
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Bozicevic I, Handanagic S, Lepej SZ, Begovac J. The emerging and re-emerging human immunodeficiency virus epidemics in Europe. Clin Microbiol Infect 2013; 19:917-29. [PMID: 24205884 DOI: 10.1111/1469-0691.12313] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We provide a summary of the current status of the human immunodeficiency virus (HIV) epidemic, including data on the transmission of drug-resistant virus in the European Region of the WHO. The review was conducted by searching the reports of the European Centre for Disease Prevention and Control and the United Nations General Assembly Special Session country reports to identify the number of HIV cases reported in 2002-2011, the number of HIV tests performed, and the results of the most recent HIV surveys in at-risk groups. In the West, a 5-year linear trend analysis suggests an increase in the number of reported HIV cases in Belgium, Greece, and Iceland, and a decline in The Netherlands, Ireland, Portugal, Switzerland, and the UK. In the Centre, the number of reported cases increased in Bulgaria and Turkey, and in the East, the number of reported cases increased in Armenia, Georgia, and Ukraine. Estonia and Latvia reported a significant downward trend. HIV transmission in men who have sex with men (MSM) and heterosexual transmission accounted for, respectively, 40% and 38% of newly reported HIV cases in the West in 2011, whereas the epidemic in the Centre is predominantly concentrated in MSM. Although injection drug use remains the key driving force of the epidemic in the East, there is increasing evidence of sexual transmission from the core groups of injection drug users, and increasing spread within MSM. The pattern of transmitted drug resistance (TDR) is heterogeneous accross Europe; a significant number of clusters of TDR have been recently observed in several European countries.
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Affiliation(s)
- I Bozicevic
- WHO Collaborating Centre for HIV Surveillance, University of Zagreb School of Medicine, Zagreb, Croatia
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Investigating Recent Testing among MSM: Results from Community-Based HIV Rapid Testing Attendees in France. JOURNAL OF SEXUALLY TRANSMITTED DISEASES 2013; 2013:648791. [PMID: 26316962 PMCID: PMC4437427 DOI: 10.1155/2013/648791] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Accepted: 06/24/2013] [Indexed: 11/25/2022]
Abstract
Background. We aimed to identify factors associated with recent HIV testing in MSM who attended two experimental community-based and nonmedicalized voluntary counselling and testing programmes (CB-VCT) targeting MSM in France. Methods. This analysis was based on data collected in 2009–2011 through a self-administered pretesting questionnaire. An index measuring the level of participants' sexual orientation disclosure was built: the higher the index, the greater the disclosure. Factors associated with recent HIV testing (last test ≤ 1 year) were identified using a multivariate logistic regression model adjusted for the CB-VCT programme of enrolment. Results. 716 MSM provided data on testing history. Overall, 49% were recently tested for HIV and 51% were not. Recently tested MSM had a higher homosexuality disclosure index (adjusted OR [95% confidence interval]: aOR = 1.2 [1.1–1.4]), reported more inconsistent condom use during anal sex with men (aOR = 1.6 [1.2–2.1]), and were less likely to have sex under the influence of club drugs (aOR = 0.6 [0.4–1.0]). Conclusion. New testing strategies should focus on those who live their homosexuality relatively secretly and those who use club drugs before sex. Governments should develop policies which encourage improved social acceptance of homosexuality as concealment of sexual orientation represents a major barrier to testing.
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Drabkin AS, Sikkema KJ, Wilson PA, Meade CS, Hansen NB, DeLorenzo A, Kochman A, MacFarlane JC, Watt MH, Aunon FM, Ranby KW, Mayer G. Risk patterns preceding diagnosis among newly HIV-diagnosed men who have sex with men in New York City. AIDS Patient Care STDS 2013; 27:333-41. [PMID: 23730703 PMCID: PMC3701313 DOI: 10.1089/apc.2012.0313] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Men who have sex with men (MSM) are at high risk for contracting and transmitting HIV. They are increasingly encouraged to get tested, but understanding of the interplay between HIV testing and risk behavior is limited. One hundred fifty newly HIV-diagnosed (within past 3 months) MSM were recruited from a community clinic in New York City. Participants completed an interview assessing sexual behavior and substance use during the 3 months pre-diagnosis, current depressive symptoms, and prior HIV testing. HIV-related health characteristics at diagnosis were abstracted from medical records. Analyses examined factors associated with unprotected anal intercourse (UAI) in the 3 months pre-diagnosis, and with a negative HIV test in the 12 months pre-diagnosis. The sample was young (mean age=32.5, SD=8.8), ethnically diverse (62% racial/ethnic minority), low-income (71%≤$30,000/year), and educated (48% college/advanced degree). Most (95%) had a prior negative HIV test, 55% within the last 12 months. Significant risk behavior was reported, with 79% reporting UAI. UAI was associated with recent testing and use of substances during sexual behavior. Recent testing was associated with being employed/a student, having had UAI, and higher CD4 count. Implications for future research addressing perceived HIV risk, HIV testing utilization, and risk behavior are discussed.
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Affiliation(s)
- Anya S Drabkin
- Department of Psychology and Neuroscience, Duke University, Durham, NC 27708, USA.
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Lorente N, Preau M, Vernay-Vaisse C, Mora M, Blanche J, Otis J, Passeron A, Le Gall JM, Dhotte P, Carrieri MP, Suzan-Monti M, Spire B. Expanding access to non-medicalized community-based rapid testing to men who have sex with men: an urgent HIV prevention intervention (the ANRS-DRAG study). PLoS One 2013; 8:e61225. [PMID: 23613817 PMCID: PMC3628708 DOI: 10.1371/journal.pone.0061225] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 03/08/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Little is known about the public health benefits of community-based, non-medicalized rapid HIV testing offers (CBOffer) specifically targeting men who have sex with men (MSM), compared with the standard medicalized HIV testing offer (SMOffer) in France. This study aimed to verify whether such a CBOffer, implemented in voluntary counselling and testing centres, could improve access to less recently HIV-tested MSM who present a risk behaviour profile similar to or higher than MSM tested with the SMOffer. METHOD This multisite study enrolled MSM attending voluntary counselling and testing centres' during opening hours in the SMOffer. CBOffer enrolees voluntarily came to the centres outside of opening hours, following a communication campaign in gay venues. A self-administered questionnaire was used to investigate HIV testing history and sexual behaviours including inconsistent condom use and risk reduction behaviours (in particular, a score of "intentional avoidance" for various at-risk situations was calculated). A mixed logistic regression identified factors associated with access to the CBOffer. RESULTS Among the 330 participants, 64% attended the CBOffer. Percentages of inconsistent condom use in both offers were similar (51% CBOffer, 50% SMOffer). In multivariate analyses, those attending the CBOffer had only one or no test in the previous two years, had a lower intentional avoidance score, and met more casual partners in saunas and backrooms than SMOffer enrolees. CONCLUSION This specific rapid CBOffer attracted MSM less recently HIV-tested, who presented similar inconsistent condom use rates to SMOffer enrolees but who exposed themselves more to HIV-associated risks. Increasing entry points for HIV testing using community and non-medicalized tests is a priority to reach MSM who are still excluded.
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Affiliation(s)
- Nicolas Lorente
- Institut National de la Santé et de la Recherche Médicale U912 (SESSTIM), Marseille, France.
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