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HIV Risk Perception and Pre-Exposure Prophylaxis (PrEP) Awareness Among Transgender Women from Mexico. AIDS Behav 2023; 27:992-1002. [PMID: 36121550 DOI: 10.1007/s10461-022-03836-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2022] [Indexed: 11/01/2022]
Abstract
This study aimed to identify factors associated with HIV risk perception among Mexican transgender women (TGW). This cross-sectional survey was conducted online and at a public HIV clinic in Mexico City. Participants were ≥ 18 years old, self-identified as TGW, and reported not living with HIV. They answered questions on sexual behavior, HIV risk perception, and pre-exposure prophylaxis (PrEP) awareness. We performed a multivariate logistic regression to accomplish the study's objective. One hundred ninety-one TGW completed the survey. High HIV risk perception was associated with > 5 sexual partners, condomless receptive anal sex, sex with a male partner(s) of unknown HIV status, and PrEP awareness. Although most TGW reported low HIV risk perception, over half had risk sexual behavior, reflecting inaccurate risk assessment. Future interventions to improve accurate risk perception among TGW should promote HIV transmission and prevention knowledge and increase PrEP awareness and uptake.
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Hepatitis B, C and human immunodeficiency virus knowledge among the general greek population: results from the Hprolipsis nationwide survey. BMC Public Health 2022; 22:2026. [PMCID: PMC9637311 DOI: 10.1186/s12889-022-14353-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 09/09/2022] [Indexed: 11/08/2022] Open
Abstract
Abstract
Background
Although several studies on hepatitis B (HBV), C (HCV) and human immunodeficiency virus (HIV) infection have been conducted in Greece, little is known on the knowledge level of the Greek population towards these three infections. Our aim was to assess the knowledge level of the adult Greek general population about the HBV, HCV and HIV.
Methods
Data were derived from the first general population health survey, Hprolipsis. The sample was selected by multistage stratified random sampling. A standardized questionnaire was administered by trained interviewers during home visits. A knowledge score was constructed based on responses to 17 per infection selected items and categorized in three levels; high (12–17 correct replies) medium (6–11) and low (0–5). Among 8,341 eligible individuals, 6,006 were recruited (response rate: 72%) and 5,878 adults (≥ 18 years) were included in the analysis. The statistical analysis accounted for the study design.
Results
Only 30.4%, 21.6%, and 29.6% of the participants had a high overall knowledge level of HBV, HCV and HIV, respectively. These low percentages were mainly attributed to the high levels of misconception about transmission modes (65.9%, 67.2%, and 67.9%, respectively). Results showed that increasing age and living out of the big metropolitan cities were associated with decreased odds of having higher knowledge. Female gender, higher education level, higher monthly family income, higher medical risk score, history of testing and being born in Greece or Cyprus, were associated with increased odds of having higher knowledge.
Conclusions
There are significant knowledge gaps in the Greek general population regarding modes of transmission, preventive measures and treatment availability for HBV, HCV and HIV. There is an urgent need for large scale but also localized awareness activities targeted to less privileged populations, to fill the gaps in knowledge and increase population engagement in preventive measures.
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Le Fort M, Lefèvre C, Kieny P, Perrouin-Verbe B, Ravaud JF. Adherence to long-term medical follow-up: A qualitative, experience-focused study of people with spinal cord injury. Ann Phys Rehabil Med 2022; 65:101629. [PMID: 35031498 DOI: 10.1016/j.rehab.2022.101629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 11/07/2021] [Accepted: 12/21/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Scientific evidence indicates the presence of secondary conditions (such as pressure injuries) after spinal cord injury (SCI). Treatment methods focusing on the management of paraplegia and tetraplegia include systematic preventive follow-up. These advances have significantly improved the functional and vital prognosis of people with SCI, but some people may not have access to these specialized organizations or may not adhere closely to this medicalized vision. We used a narrative approach to explore the perceptions of people with SCI to better understand their adherence to follow-up. OBJECTIVES We aimed to determine the "common denominators" that lead to adherence or non-adherence to long-term follow-up after SCI. METHODS People with SCI who had completed their first rehabilitation period for > 1 year were included with regard to 2 variables: 1) an actual medical follow-up or not and 2) a history of pressure injury or not. A review of the literature was used as preparation for semi-directive interviews, which were prospectively analysed by using qualitative analysis software. Thematic saturation was reached at 28 interviews, and 32 interviews were ultimately completed. RESULT Three main areas concerning participants' perceptions emerged: people's readiness, appropriation and modulation of the systematic follow-up. We developed a broad conceptual framework representing follow-up and the promotion of the long-term health of people with SCI from their perspectives. CONCLUSIONS The medical environment should ensure that people with SCI are ready to actively consider the implementation of prevention strategies and should take into account their ability to establish their own truth, to integrate various life stages after SCI and to negotiate systematic follow-up. The implementation of data about functioning should be conducted using the concept of the Learning Health System.
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Affiliation(s)
- Marc Le Fort
- House of Social Sciences in Disability - School of Advanced Studies in Public Health (EHESP), 15 Avenue du Professeur Léon Bernard, 35043 Rennes, France; Neurological PMR department, University Hospital, 85, rue Saint-Jacques, 44093, Nantes cedex, France.
| | - Chloé Lefèvre
- House of Social Sciences in Disability - School of Advanced Studies in Public Health (EHESP), 15 Avenue du Professeur Léon Bernard, 35043 Rennes, France
| | - Pierre Kieny
- House of Social Sciences in Disability - School of Advanced Studies in Public Health (EHESP), 15 Avenue du Professeur Léon Bernard, 35043 Rennes, France
| | - Brigitte Perrouin-Verbe
- House of Social Sciences in Disability - School of Advanced Studies in Public Health (EHESP), 15 Avenue du Professeur Léon Bernard, 35043 Rennes, France
| | - Jean-François Ravaud
- Neurological PMR department, University Hospital, 85, rue Saint-Jacques, 44093, Nantes cedex, France; National Institute for Health and Medical research (INSERM), 101, rue de Tolbiac, 75654, cedex 13, France
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Duteil C, de La Rochebrochard E, Piron P, Segouin C, Troude P. What do patients consulting in a free sexual health center know about HIV transmission and post-exposure prophylaxis? BMC Public Health 2021; 21:494. [PMID: 33711979 PMCID: PMC7953800 DOI: 10.1186/s12889-021-10547-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 03/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Screening, condom use and post-exposure prophylaxis (PEP) are among existing HIV prevention strategies. However, efficient use of these strategies requires that patients have an adequate knowledge of HIV transmission routes and awareness of risk behaviors. This study aimed to assess knowledge about HIV transmission among patients who attended a free HIV and sexually transmitted infection (STI) screening center in Paris, France, and to explore the patient profiles associated with HIV-related knowledge. METHODS This observational cross-sectional study included 2002 patients who attended for STI testing from August 2017 through August 2018 and completed a self-administered electronic questionnaire. Based on incorrect answers regarding HIV transmission, two outcomes were assessed: lack of knowledge and false beliefs. Factors associated with these two outcomes were explored using univariate and multivariate logistic regressions. RESULTS Only 3.6% of patients did not know about HIV transmission through unprotected sexual intercourse and/or by sharing needles. More than one third of patients (36.4%) had at least one false belief, believing that HIV could be transmitted by sharing a drink (9.7%), kissing (17.6%) or using public toilets (27.5%). A low educational level and no previous HIV testing were associated in multivariate analyses with both lack of knowledge and false beliefs. Age and sexual orientation were also associated with false beliefs. Furthermore, 55.6% of patients did not know that post-exposure prophylaxis consists of taking emergency treatment as soon as possible after risky intercourse. CONCLUSIONS Although the main HIV transmission routes are well known, false beliefs persist and knowledge regarding PEP needs to be improved. Prevention campaigns must focus on these themes which appear as a complementary strategy to pre-exposure prophylaxis to reduce HIV infection.
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Affiliation(s)
- Christelle Duteil
- Service de Santé Publique, Hôpitaux Lariboisière - Fernand-Widal, AP-HP Nord, F-75010, Paris, France.
| | - Elise de La Rochebrochard
- Institut National d'Etudes Démographiques (Ined), F-93322, Aubervilliers, France.,Université Paris-Saclay, UVSQ, Inserm, CESP, F94807, Villejuif, France
| | - Prescillia Piron
- Service de Santé Publique, Hôpitaux Lariboisière - Fernand-Widal, AP-HP Nord, F-75010, Paris, France.,CeGIDD, Hôpitaux Lariboisière - Fernand-Widal, AP-HP Nord, F-75010, Paris, France
| | - Christophe Segouin
- Service de Santé Publique, Hôpitaux Lariboisière - Fernand-Widal, AP-HP Nord, F-75010, Paris, France.,CeGIDD, Hôpitaux Lariboisière - Fernand-Widal, AP-HP Nord, F-75010, Paris, France
| | - Pénélope Troude
- Service de Santé Publique, Hôpitaux Lariboisière - Fernand-Widal, AP-HP Nord, F-75010, Paris, France.,Institut National d'Etudes Démographiques (Ined), F-93322, Aubervilliers, France
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Le Fort M, Lefèvre C, Kieny P, Perrouin-Verbe B, Ravaud JF. The functioning of social support in long-term prevention after spinal cord injury. A qualitative study. Ann Phys Rehabil Med 2020; 64:101454. [PMID: 33189942 DOI: 10.1016/j.rehab.2020.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 09/23/2020] [Accepted: 10/12/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND The impact of social support on the long-term condition after a spinal cord injury (SCI) varies across studies mainly involving self-report questionnaires. OBJECTIVE We aimed to establish the common factors associated with social support leading individuals with an SCI to the effective prevention of secondary complications, including via adherence to medical follow-up. METHODS Inclusion criteria were a history of acquired SCI of any etiology, wheelchair use, and age≥18 years at the time of the study. Participants should have completed their initial rehabilitation program in France≥1 year earlier and were also enrolled according to 2 related study variables: routine medical follow-up (patients were or were not followed up) and the medically supervised reporting of a pressure ulcer after the initial rehabilitation session (0 or≥1 pressure ulcers). We performed a preparatory quantitative and qualitative literature review to identify factors affecting long-term follow-up after SCI, then adopted a narrative design with semi-structured interviews, transcribed and analyzed progressively by using qualitative analysis software. RESULTS We included 32 participants. We categorized our results based on the knowledge, attitudes, beliefs and practices of participants with respect to pressure ulcer prevention and long-term medical follow-up. Our narrative approach allowed us to identify 3 main domains relevant to social support: reciprocity, self-management and timing related to social support. CONCLUSIONS Our study showed social support as a dynamic process, a reciprocal phenomenon evolving in variations over time. These findings should be central to short- and long-term therapeutic education programs for patients and for people providing social support. Effective changes should also be implemented through the concept of the Learning Health System.
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Affiliation(s)
- Marc Le Fort
- Neurological PMR department, university hospital, 85, rue Saint-Jacques, 44093 Nantes cedex, France; House of social sciences in disability, School of advanced studies in Public Health (EHESP), 15, avenue du Professeur Léon-Bernard, 35043 Rennes, France.
| | - Chloé Lefèvre
- Neurological PMR department, university hospital, 85, rue Saint-Jacques, 44093 Nantes cedex, France.
| | - Pierre Kieny
- Neurological PMR department, university hospital, 85, rue Saint-Jacques, 44093 Nantes cedex, France.
| | - Brigitte Perrouin-Verbe
- Neurological PMR department, university hospital, 85, rue Saint-Jacques, 44093 Nantes cedex, France.
| | - Jean-François Ravaud
- House of social sciences in disability, School of advanced studies in Public Health (EHESP), 15, avenue du Professeur Léon-Bernard, 35043 Rennes, France; National Institute for Health and Medical research (Inserm), 101, rue de Tolbiac, 75654 Paris cedex 13, France.
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Itodo OA, Viriot D, Velter A, Leon L, Dupin N, Bercot B, Goubard A, Lassau F, Fouere S, Martinet P, Tosini W, Florence S, Lot F, Ndeikoundam Ngangro N. Trends and determinants of condomless sex in gonorrhoea patients diagnosed in France through the sentinel surveillance network ResIST, 2005-2014. BMC Public Health 2020; 20:1620. [PMID: 33115464 PMCID: PMC7594409 DOI: 10.1186/s12889-020-09703-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 10/14/2020] [Indexed: 11/29/2022] Open
Abstract
Background Gonorrhoea is increasing in France since its resurgence in the late 1990’s. Understanding trends of condomless sex is a requirement to tailor prevention toward most exposed individuals. This study aims to analyse trends and determinants of condomless penetrative sex (PS) in MSM and heterosexuals diagnosed with gonorrhoea in France. Methods A standardized self-administered questionnaire filled by 3453 patients was used to monitor condomless sex through the sentinel surveillance network ResIST between 2005 and 2014. Trends were used to describe consistent condom use for penetrative sex (PS). A logistic regression model analysed patients’ characteristics associated with condomless PS. Results Between 2005 and 2014, condomless PS increased regardless of sexual orientation. Condomless PS was particularly common among HIV positive men who have sex with men (MSM (65%)). People living in metropolitan regions outside Paris area (adjusted odds-ratio (AOR) [95% CI] =1.33[1.12–1.58]) were more likely to engage in condomless PS. Conversely, MSM (AOR [95% CI] =0.21 [0.16–0.29]), HIV seronegative patients (AOR [95% CI] =0.68 [0.51–0.89]), patients diagnosed in hospital (AOR [95% CI] = 0.66 [0.45–0.97]) and multi-partners (≥ 10 partners, AOR [95% CI] = 0.54 [0.40–0.74]) were more likely to use condoms. Conclusions These findings highlight a decreasing use of condom in MSM and heterosexuals diagnosed with gonorrhoea. Prevention strategies should take in account drivers of condomless sex in a context of uncontrolled STI epidemics.
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Affiliation(s)
- Oche Adam Itodo
- Santé Publique France (The French National Public Health Agency), Saint Maurice, France
| | - Delphine Viriot
- Santé Publique France (The French National Public Health Agency), Saint Maurice, France
| | - Annie Velter
- Santé Publique France (The French National Public Health Agency), Saint Maurice, France
| | - Lucie Leon
- Santé Publique France (The French National Public Health Agency), Saint Maurice, France
| | - Nicolas Dupin
- French National Reference Centre for Bacterial STI (Syphilis), APHP, Cochin University Hospital, Paris, France
| | - Beatrice Bercot
- French National Reference Centre for Bacterial STI (Gonorhoae), APHP, Saint Louis University Hospital, Paris, France
| | | | - François Lassau
- Dermatology Department, AP-HP, Saint-Louis Hospital, Paris, France.,Departmental Committee of Seine Saint Denis, Bobigny, France
| | - Sébastien Fouere
- Dermatology Department, AP-HP, Saint-Louis Hospital, Paris, France
| | | | - William Tosini
- STI Clinic (CeGIDD), Alfred Fournier Institute, Paris, France
| | | | | | - Florence Lot
- Santé Publique France (The French National Public Health Agency), Saint Maurice, France
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Rolland C, de La Rochebrochard E, Piron P, Shelly M, Segouin C, Troude P. Who fails to return within 30 days after being tested positive for HIV/STI in a free testing centre? BMC Infect Dis 2020; 20:795. [PMID: 33109139 PMCID: PMC7590592 DOI: 10.1186/s12879-020-05520-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 10/16/2020] [Indexed: 11/22/2022] Open
Abstract
Background Some patients who test positive for sexually transmitted infections (STIs) fail to return for results and treatment. To target improvement actions, we need to find out who these patients are. This study aimed to explore factors associated with failure to return within 30 days (FTR30) after testing among patients with positive results in a free STI testing centre in Paris. Methods All patients with at least one positive result between October 2016 and May 2017 and who completed a self-administered questionnaire were included in this cross-sectional study (n = 214). The questionnaire included sociodemographic factors, sexual behaviour and history of testing. Factors associated with FTR30 were assessed using logistic regression models. Results More than two-thirds of patients were men (72%), and the median age of patients was 27 years. Most patients were born in metropolitan France (56%) or in sub-Saharan Africa (22%). Men who had sex with men represented 36% of the study population. The FTR30 rate was 14% (95% CI [10–19%]). In multivariate analysis, previous HIV testing in younger persons (aOR: 3.36, 95% CI [1.27–8.84]), being accompanied by another person at the pretest consultation (aOR: 3.45, 95% CI [1.36–8.91]), and lower self-perceived risk of HIV infection (aOR: 2.79, 95% CI [1.07–7.30]) were associated with a higher FTR30. Testing for chlamydia/gonorrhoea without presumptive treatment was associated with a lower FTR30 (aOR: 0.21, 95% CI [0.07–0.59]). Conclusions These factors that affect failure to return are related to the patient’s representations and involvement in the STI screening process. Increasing health literacy and patient empowerment could help to decrease failure to return after being tested positive for HIV/STI. Trial registration Not applicable.
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Affiliation(s)
- Camille Rolland
- Department of Public Health, University Hospital Saint-Louis-Lariboisière-Fernand-Widal, AP-HP, 200 rue du Faubourg-Saint-Denis, F-75475, Paris Cedex 10, Paris, France. .,Free Sexual Health Centre, University Hospital Saint-Louis-Lariboisière-Fernand-Widal, AP-HP, Paris, France.
| | - Elise de La Rochebrochard
- Institut National d'Etudes Démographiques (Ined), Aubervilliers, France.,University Paris-Saclay, University Paris-Sud, UVSQ, CESP, INSERM, Paris, Villejuif, France
| | - Prescillia Piron
- Department of Public Health, University Hospital Saint-Louis-Lariboisière-Fernand-Widal, AP-HP, 200 rue du Faubourg-Saint-Denis, F-75475, Paris Cedex 10, Paris, France.,Free Sexual Health Centre, University Hospital Saint-Louis-Lariboisière-Fernand-Widal, AP-HP, Paris, France
| | - Marc Shelly
- Department of Public Health, University Hospital Saint-Louis-Lariboisière-Fernand-Widal, AP-HP, 200 rue du Faubourg-Saint-Denis, F-75475, Paris Cedex 10, Paris, France.,Free Sexual Health Centre, University Hospital Saint-Louis-Lariboisière-Fernand-Widal, AP-HP, Paris, France
| | - Christophe Segouin
- Department of Public Health, University Hospital Saint-Louis-Lariboisière-Fernand-Widal, AP-HP, 200 rue du Faubourg-Saint-Denis, F-75475, Paris Cedex 10, Paris, France.,Free Sexual Health Centre, University Hospital Saint-Louis-Lariboisière-Fernand-Widal, AP-HP, Paris, France
| | - Pénélope Troude
- Department of Public Health, University Hospital Saint-Louis-Lariboisière-Fernand-Widal, AP-HP, 200 rue du Faubourg-Saint-Denis, F-75475, Paris Cedex 10, Paris, France.,Institut National d'Etudes Démographiques (Ined), Aubervilliers, France
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Gantner P, Allavena C, Duvivier C, Cabie A, Reynes J, Makinson A, Ravaux I, Bregigeon S, Cotte L, Rey D. Post-exposure prophylaxis completion and condom use in the context of potential sexual exposure to HIV. HIV Med 2020; 21:463-469. [PMID: 32558205 DOI: 10.1111/hiv.12880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Post-exposure prophylaxis (PEP) care remains a challenge for individuals with potential sexual exposure to HIV in terms of PEP completion and ongoing risk behaviours. METHODS A retrospective analysis was carried out on data from the French Dat'AIDS prevention cohort (NCT03795376) for individuals evaluated for PEP between 2004 and 2017. A multivariable analysis was performed of predictors of both PEP completion and condom use [odds ratios (ORs)] and their associated probabilities (P, with P > 95% being clinically relevant). RESULTS Overall, 29 060 sexual exposures to HIV were evaluated for PEP [36% in men who have sex with men (MSM) and 64% in heterosexuals]. Overall, 12 different PEP regimens were offered in 19 240 cases (46%). Tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC) was the preferred backbone (n = 14 304; 74%). We observed a shift from boosted protease inhibitor-based regimens to nonnucleoside reverse transcriptase inhibitor- or integrase inhibitor-based regimens in recent years. Overall, 20% of PEP prescriptions were prematurely discontinued. Older age, MSM, intercourse with a sex worker, rape and intercourse with a known HIV-infected source patient were factors associated with increased rates of PEP completion (OR > 1; P > 98%). None of the 12 PEP regimens was associated with premature discontinuation. We also found 12 774 cases of unprotected sexual intercourse (48%). Condom use decreased (OR < 1; P > 99%) with the year of exposure, and was lower in MSM and rape victims. Condom use increased (OR > 1, P > 99%) with age, and was higher in those who had intercourse with a sex worker or with a female partner and in those with knowledge of the partner's HIV status. CONCLUSIONS We provide new insights into how rates of condom use and PEP completion might be improved in those receiving PEP by targeting certain groups of individuals for interventions. In particular, youth and MSM at risk should be linked in a prevention-to-care continuum.
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Affiliation(s)
- P Gantner
- Molecular Virology Department, Strasbourg University Hospital, Strasbourg, France.,INSERM, UMR-S U1109, Strasbourg University, Strasbourg, France
| | - C Allavena
- Infectious Diseases Department, Hôtel-Dieu Hospital, Nantes, France
| | - C Duvivier
- Infectious Diseases Department, Necker-Pasteur Infectiology Center, AP-HP-Necker Hospital, Paris, France.,Necker-Pasteur Infectiology Center, Medical Center of Pasteur Institute, Paris, France.,Paris Descartes University, EA7327, Sorbonne Paris Cité, Paris, France.,IHU Imagine, Paris, France
| | - A Cabie
- Infectious Diseases Department, Inserm CIC1424, Antilles University EA 4537, CHU de Martinique, Martinique, France
| | - J Reynes
- Infectious Diseases Department, Inserm U1175, CHU Montpellier, Montpellier, France
| | - A Makinson
- Infectious Diseases Department, Inserm U1175, CHU Montpellier, Montpellier, France
| | - I Ravaux
- AP-HM, IHU-Méditerranée Infection, Aix Marseille University, Marseille, France
| | - S Bregigeon
- AP-HM, Clinical Immuno-Hematology Department, CHU Sainte-Marguerite, Marseille, France
| | - L Cotte
- Infectious Diseases Department, Croix Rousse Hospital, Lyon, France
| | - D Rey
- Le Trait d'Union, HIV-Infection Care Center, Strasbourg University Hospital, Strasbourg, France
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Knowledge, Attitudes, and Prevention Practices of Drug Resistant Tuberculosis in the Eastern Cape Province, South Africa. Tuberc Res Treat 2019; 2019:8978021. [PMID: 31885917 PMCID: PMC6925671 DOI: 10.1155/2019/8978021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 07/24/2019] [Indexed: 11/18/2022] Open
Abstract
The aim of this study was to assess community members' knowledge and awareness levels, attitudes, and practices of Drug Resistant Tuberculosis. A quantitative descriptive cross sectional study was carried out in the Eastern Cape Province of South Africa. The sample size consisted of four hundred (400) respondents aged 18 years and above on their last birthday who were purposively and conveniently selected from Port Elizabeth area in the Nelson Mandela Municipality. Data were collected using close-ended questions, which were administered by the researcher and two research assistants to the selected respondents. Data were analysed using descriptive statistics. The results of this study show poor knowledge and awareness levels, unfavourable attitudes, but good prevention practices of Drug Resistant Tuberculosis among Port Elizabeth community members. This study also found a statistically significant association between knowledge and attitudes (p value = <0.001), and no statistically significant association between knowledge and practices and attitude and practices, respectively (p values = 0.120 and 0.136). The study also revealed low literacy levels, inadequate information, misconceptions and erroneous beliefs about causes, transmission, prevention, treatment, and management of Drug Resistant Tuberculosis among the respondents. This study also highlighted the use and existence of dual healthcare system (traditional spiritual and western).The study found that the main source of Drug Resistant TB information was radio and television among the majority of research respondents. It is recommended that in future health education interventions and awareness campaigns need to be intensified in the area so that misconceptions and erroneous beliefs that exist in society can be addressed. It is also recommended that training programs that are culturally sensitive should be developed and delivered taking into account different languages and literacy levels that exist in society. Such education interventions should be facilitated in collaboration with people living with Drug Resistant Tuberculosis. A multidisciplinary approach should be fostered and collaborations with spiritual healers and various congregational leaders, traditional health practitioners, community leaders, and government leaders in the health sector should be promoted in order to deal with Drug Resistant Tuberculosis. It is also recommended that a similar study be conducted using a qualitative research approach in urban and rural areas of the Eastern Cape. Lastly, assessment of knowledge, attitudes, and practices of spiritual and traditional healers with regard to Drug Resistant Tuberculosis should be conducted as they can influence health-seeking behaviour.
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Lefèvre T, Denis C, Marchand C, Vidal C, Gagnayre R, Chariot P. Multiple brief interventions in police custody: The MuBIC randomized controlled study for primary prevention in police custody. Protocol and preliminary results of a feasibility study in the Paris metropolitan area, France. J Forensic Leg Med 2018; 57:101-108. [PMID: 29801943 DOI: 10.1016/j.jflm.2016.05.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 05/09/2016] [Accepted: 05/10/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND The 15- to 35-year-old population has little contact with the health care system and is exposed to risk factors. Several studies demonstrated the feasibility of brief interventions (BIs) in different settings, e.g., in addiction medicine during police custody, where arrestees are entitled to a medical examination. Approximately 700,000 individuals are detained in police custody in France annually, and custody is an opportunity for young people to be medically examined. The characteristics of the detainees and previous experience with BIs suggest that custody is an opportunity to contribute to primary prevention. We propose to investigate the feasibility of such a contribution. OBJECTIVES The aim of this article is to present a study protocol and some preliminary results. The primary research objective is to assess the feasibility of performing brief interventions without a specific topic in police custody settings in arrestees aged 15-35 years. The secondary research objectives include i) testing four strategies for engaging in BIs that maximize the chances of success of the BI; ii) identifying the determinants that can orient the practitioner's choice to use a specific strategy over another one; and iii) analysing the differences between individuals who engage in BIs and those who do not and, in those who do engage, the determinants of success of the intervention. METHODS A two-step randomized and prospective study: i) randomization of eligible patients into 4 groups of 500 patients each; analysis of the response rates for each strategy; performance of the BI; and analyses of the associated factors and ii) a real-life, full-scale phase study evaluating the effectiveness of BIs performance of the BI; and analyses of the interventions. Analyses of the determinants of a positive response to BI, of success and of the topic of intervention will be conducted. EXPECTED RESULTS The rates of BI performed, rates of success, and characteristics associated with response and with success are the main expected results. Additionally, the development and assessment of filter questions and an improved BI dedicated to primary prevention for police custody settings will be attained.
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Affiliation(s)
- Thomas Lefèvre
- AP-HP, Hôpital Jean-Verdier, Department of Forensic Medicine, 93140 Bondy, France; IRIS - Institut de recherches interdisciplinaires sur les enjeux sociaux (INSERM, CNRS, EHESS, Université Paris 13, UMR 8156-723), 93 100 Bobigny, France.
| | - Céline Denis
- AP-HP, Hôpital Jean-Verdier, Department of Forensic Medicine, 93140 Bondy, France.
| | - Claire Marchand
- Paris 13 University, Sorbonne Paris Cite, Educations and Health Practices Laboratory (LEPS), (EA 3412), UFR SMBH, F-93017 Bobigny, France.
| | - Camille Vidal
- AP-HP, Hôpital Jean-Verdier, Department of Forensic Medicine, 93140 Bondy, France.
| | - Rémi Gagnayre
- Paris 13 University, Sorbonne Paris Cite, Educations and Health Practices Laboratory (LEPS), (EA 3412), UFR SMBH, F-93017 Bobigny, France.
| | - Patrick Chariot
- AP-HP, Hôpital Jean-Verdier, Department of Forensic Medicine, 93140 Bondy, France; IRIS - Institut de recherches interdisciplinaires sur les enjeux sociaux (INSERM, CNRS, EHESS, Université Paris 13, UMR 8156-723), 93 100 Bobigny, France.
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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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Denison HJ, Bromhead C, Grainger R, Dennison EM, Jutel A. Barriers to sexually transmitted infection testing in New Zealand: a qualitative study. Aust N Z J Public Health 2017; 41:432-437. [PMID: 28664644 PMCID: PMC5564490 DOI: 10.1111/1753-6405.12680] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 02/01/2017] [Accepted: 03/01/2017] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE To investigate the barriers that prevent or delay people seeking a sexually transmitted infection (STI) test. METHODS Qualitative in-depth interviews were conducted with 24 university students, who are a group prone to behaviours putting them at risk of STIs, to understand the factors that had prevented or delayed them from going for an STI test in the past. Resulting data were thematically analysed employing a qualitative content analysis method, and a final set of themes identified. RESULTS There were three main types of barrier to STI testing. These were: personal (underestimating risk, perceiving STIs as not serious, fear of invasive procedure, self-consciousness in genital examination and being too busy); structural (financial cost of test and clinician attributes and attitude); and social (concern of being stigmatised). Conclusions and implications for public health: These data will help health providers and policy-makers provide services that minimise barriers and develop effective strategies for improving STI testing rates. The results of this study suggest a holistic approach to encouraging testing is required, which includes addressing personal beliefs, working with healthcare providers to minimise structural barriers and developing initiatives to change social views about STIs.
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Affiliation(s)
- Hayley J Denison
- School of Biological Sciences, Victoria University of Wellington, New Zealand
| | | | - Rebecca Grainger
- Department of Medicine, University of Otago Wellington, New Zealand
| | - Elaine M Dennison
- School of Biological Sciences, Victoria University of Wellington, New Zealand.,MRC Lifecourse Epidemiology Unit, University of Southampton, United Kingdom
| | - Annemarie Jutel
- Graduate School of Nursing, Midwifery and Health, Victoria University of Wellington, New Zealand
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Parker RD, Rüütel K. Sexually Transmitted Infections - Prevalence, Knowledge and Behaviours among Professional Defence Forces in Estonia: a Pilot Study. Cent Eur J Public Health 2017; 25:11-14. [PMID: 28399349 DOI: 10.21101/cejph.a4498] [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: 07/15/2015] [Accepted: 01/26/2017] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Our study assessed sexually transmitted infections (STI) occurrence and risk behaviours from a sample of the defence forces of Estonia. Previous research on military personnel yields various results on the prevalence of STIs and high risk behaviours. The increasing recognition of high risk behaviours among military personnel is evident given increased programmes that focus on education of drug use and risky sexual behaviours. Many militaries conduct routine, periodic screening for diseases such as HIV and viral hepatitis at entry and pre-foreign deployment. Protecting deployed forces from secondary infections is important as persons with chronic viral infections are living longer, healthier lives and are more frequently serving in military forces. METHODS A cross sectional study used convenient sampling among professional defence forces. Participation was both voluntary and anonymous. RESULTS Of 186 participants accounting for 7.3% of all forces (86.6% male, mean age 30 years) at selected bases, there were four cases of chlamydia. No cases of gonorrhea, trichomoniasis, hepatitis C, hepatitis B, or HIV were found. One person reported ever injecting drugs. CONCLUSIONS These findings indicate a lower STI occurrence among professional defence forces in Estonia compared with the non-military population. While these rates were lower than expected, as a voluntary study, people suspicious of having an STI might opt not to participate, limiting generalizability to the remainder of the military. Militaries without regular screening programmes could consider regular scheduled testing for STIs, HIV and blood borne pathogens, even if voluntary, especially prior to foreign deployment. Consistent testing would align across many militaries who deploy international peace keepers.
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Affiliation(s)
- R. David Parker
- School of Public Health, West Virginia University, Morgantown, WV, USA
| | - Kristi Rüütel
- Infectious Diseases and Drug Abuse Prevention Department, Estonian National Institute for Health Development, Tallinn, Estonia
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Lydié N, de Barbeyrac B, Bluzat L, Le Roy C, Kersaudy-Rahib D. Chlamyweb Study I: rationale, design and acceptability of an internet-based chlamydia testing intervention. Sex Transm Infect 2017; 93:179-187. [PMID: 28258251 DOI: 10.1136/sextrans-2015-052511] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 08/08/2016] [Accepted: 09/03/2016] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES In recent years, the internet has widely facilitated Chlamydia trachomatis home-sampling. In France (2012), the Chlamyweb Study evaluated an intervention (Chlamyweb) involving home-based self-sampling via the internet. One element of the study consisted of a randomised controlled trial (RCT), which is reported in detail elsewhere. The focus of this paper, however, is on describing the Chlamyweb Intervention and reporting on the non-RCT element of the evaluation of that intervention by the Chlamyweb Study. This involves (1) describing the design and roll-out of the Chlamyweb Intervention, (2) comparing the socio-behavioural profiles of the participants in the intervention with a nationally representative general population sample and (3) examining the factors that influence the acceptance and return of a self-sampling kit supplied to participants in the course of the intervention. METHODS Self-sampling kits were offered to sexually active people aged 18-24 years living on the mainland French. Participants' characteristics were compared with the general population to describe recruited and participant populations. Multivariate analyses by conditional logistic regression were performed to determine factors that were predictors of kit acceptation and use. RESULTS 7215 people aged 18-24 years were included. Compared with the general population, Chlamyweb reached larger proportions of women, younger people and people with several partners in the previous year. 3372 (46.7%) agreed to receive a self-sampling kit and 2084 (61.8%) returned it, with more women doing so than men. The participation rate was associated with age, place of birth, occupational status, number of partners and condom use, differently for men and women. CONCLUSION The offer of easy-to-use, self-sampling kits free of charge appeared to be a logistically feasible strategy for testing in France and reached a large and diverse population including individuals who have limited access to the traditional healthcare system. TRIAL REGISTRATION NUMBER AFFSAPS n° IDRCB 0211-A01000-41; pre-results.
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Affiliation(s)
- Nathalie Lydié
- Sexual Health Unit, Santé publique France, Saint-Maurice, France
| | - Bertille de Barbeyrac
- Univ. Bordeaux & INRA, USC EA 3671 Mycoplasmal and Chlamydial Infections in Humans, French National Reference Centre (NRC) for Chlamydial Infections, Bordeaux, France
| | - Lucile Bluzat
- Sexual Health Unit, Santé publique France, Saint-Maurice, France
| | - Chloé Le Roy
- Univ. Bordeaux & INRA, USC EA 3671 Mycoplasmal and Chlamydial Infections in Humans, French National Reference Centre (NRC) for Chlamydial Infections, Bordeaux, France
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Méthy N, Meyer L, Bajos N, Velter A. Generational analysis of trends in unprotected sex in France among men who have sex with men: The major role of context-driven evolving patterns. PLoS One 2017; 12:e0171493. [PMID: 28170424 PMCID: PMC5295686 DOI: 10.1371/journal.pone.0171493] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 01/20/2017] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE Using a generational approach, this study analyses how unprotected anal intercourse has evolved since 1991 in France across different generations of men who have sex with men (MSM) whose sexual lives began at different periods in the history of the HIV epidemic. DESIGN Data were collected from 18-59 year-old respondents to the French Gay Press surveys Enquêtes Presse Gay, conducted repeatedly between 1991 and 2011 (N = 32,196) using self-administered questionnaires distributed in gay magazines and over the internet. METHODS Trends in unprotected anal intercourse (i.e. condomless anal sex) with casual partners of unknown or different HIV serostatus (hereafter "UAId" in this manuscript) were studied. Responses were analysed according to year and then reorganised for age-cohort analyses by generation, based on the year respondents turned 18. RESULTS UAId rates fell from 1991 to 1997, and then rose from 13.4% in 1997 to 25.5% in 2011 among seronegative respondents, and from 24.8% to 63.3%, respectively, among seropositive respondents. Both in seropositive and seronegative respondents, UAId increased over time for all generations, indicative of a strong period effect. CONCLUSION Analyses of data from several generations of MSM who started their sexual lives at different time points in the HIV epidemic, revealed very similar trends in UAId between generations, among both seropositive and seronegative respondents. This strong period effect suggests that sexual behaviours in MSM are influenced more by contextual than generational factors. The fact that prevention practices are simultaneously observed in different generations and that there are most likely underlying prevention norms among MSM, suggests that PrEP could become widely accepted by all generations of MSM exposed to the risk of HIV.
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Affiliation(s)
- Nicolas Méthy
- CESP, Univ. Paris-Sud, UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
| | - Laurence Meyer
- CESP, Univ. Paris-Sud, UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
| | - Nathalie Bajos
- CESP, Univ. Paris-Sud, UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
| | - Annie Velter
- CESP, Univ. Paris-Sud, UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
- Santé Publique France, Saint Maurice, France
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Johnson MA. Asking Numbers to Speak: Verbal Markers and Stages of Change. QUALITATIVE HEALTH RESEARCH 2016; 26:1761-1773. [PMID: 27557926 DOI: 10.1177/1049732316665349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Through routine screenings for sexually transmitted infections (STIs) and HIV, medical providers are able to motivate behavior change. Although established models rely on quantitative measures, doing so requires time and ability to score each. Listening for verbal cues, however, could simplify the process of suggesting HIV screenings. Using mixed methods to identify verbal indicators for readiness to change, this article conducted two phases of study. First using quantitative means of identifying participant's knowledge of HIV, perceptions of safer sex, and readiness to change safer sex behaviors ( N = 487). Interviews were then conducted exploring the possibility of verbal markers for one's readiness to change ( n = 25). Results confirmed the use of verbal markers when discussing perceptions of risk. Identification of verbal markers, at three stages of change, provides new possibilities for medical providers' such as providing time saving and effective tools when seeking to motivate HIV and STI testing, and other safer sex behaviors.
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Gantner P, Treger M, De Miscault C, Batard ML, Bernard-Henry C, Cheneau C, De Mautort E, Partisani M, Priester M, Rey D. Predictors of Standard Follow-Up Completion after Sexual Exposure to HIV: Five-Year Retrospective Analysis in a French HIV-Infection Care Center. PLoS One 2015; 10:e0145440. [PMID: 26696009 PMCID: PMC4687908 DOI: 10.1371/journal.pone.0145440] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Accepted: 12/03/2015] [Indexed: 11/18/2022] Open
Abstract
Objectives The care of exposed individuals to HIV remains a challenge regarding follow-up completion and HIV-testing of the partner. Identifying patients with risk of not fulfilling HIV-testing follow-up completion (FC), among patients demanding non-occupational post-exposure prophylaxis (nPEP), may improve clinical practice. Methods A retrospective chart review was conducted in a single French HIV-infection care center. FC predictors were assessed in a multivariate logistic regression model (Likelihood ratios test). Results Between 2009 and 2013, 646 sexual exposures to HIV were evaluated for nPEP, of which 507 effectively received nPEP (78%). FC rate was 30% (194/646). In the multivariate analysis, FC rates rose with age of exposed individuals (OR, 1.04 [0.25–4.28]; p<0.001) and decreased with the year of sexual exposure (OR, 0.74 [0.65–0.85]; p<0.001). FC was associated with sexual encounter with a sex worker (OR, 4.07 [0.98–16.82]; p<0.001) and nPEP use (OR, 2.69 [2.37–3.06]; p<0.001). nPEP early discontinuation was associated with decreased FC rates (OR, 0.18 [0.08–0.39]; p<0.001). No documented nPEP failure was identified. However, five Men who have Sex with Men (MSM) nPEP recipients for unprotected anal receptive intercourse subsequently seroconverted to HIV more than 6 months after nPEP. Seroconversion to HIV was associated with the lack of FC (p = 0.04) and multiple presentations for nPEP over the study period (p = 0.002). Conclusions We identified significant predictors of not fulfilling sequential HIV-testing. They appear to be linked with a self-perceived HIV risk, especially in young adults recently exposed. Enhanced counseling in targeted individuals with high risk behaviors and using smartphone and internet-based strategies may be interesting retention in care options.
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Affiliation(s)
- Pierre Gantner
- Le Trait d’Union, HIV-infection care center, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- * E-mail:
| | - Michele Treger
- Biostatistics Laboratory, Faculté de Médecine, Université de Strasbourg, Strasbourg, France
| | - Constance De Miscault
- Le Trait d’Union, HIV-infection care center, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Marie-Laure Batard
- Le Trait d’Union, HIV-infection care center, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Claudine Bernard-Henry
- Le Trait d’Union, HIV-infection care center, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Christine Cheneau
- Le Trait d’Union, HIV-infection care center, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Erik De Mautort
- Le Trait d’Union, HIV-infection care center, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Marialuisa Partisani
- Le Trait d’Union, HIV-infection care center, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Michele Priester
- Le Trait d’Union, HIV-infection care center, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - David Rey
- Le Trait d’Union, HIV-infection care center, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
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Massari V, Lapostolle A, Grupposo MC, Dray-Spira R, Costagliola D, Chauvin P. Which adults in the Paris metropolitan area have never been tested for HIV? A 2010 multilevel, cross-sectional, population-based study. BMC Infect Dis 2015. [PMID: 26198690 PMCID: PMC4509770 DOI: 10.1186/s12879-015-1006-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Despite the widespread offer of free HIV testing in France, the proportion of people who have never been tested remains high. The objective of this study was to identify, in men and women separately, the various factors independently associated with no lifetime HIV testing. METHODS We used multilevel logistic regression models on data from the SIRS cohort, which included 3006 French-speaking adults as a representative sample of the adult population in the Paris metropolitan area in 2010. The lifetime absence of any HIV testing was studied in relation to individual demographic and socioeconomic factors, psychosocial characteristics, sexual biographies, HIV prevention behaviors, attitudes towards people living with HIV/AIDS (PLWHA), and certain neighborhood characteristics. RESULTS In 2010, in the Paris area, men were less likely to have been tested for HIV at least once during their lifetime than women. In multivariate analysis, in both sexes, never having been tested was significantly associated with an age younger or older than the middle-age group (30-44 years), a low education level, a low self-perception of HIV risk, not knowing any PLWHA, a low lifetime number of couple relationships, and the absence of any history of STIs. In women, other associated factors were not having a child < 20 years of age, not having additional health insurance, having had no or only one sexual partner in the previous 5 years, living in a cohabiting couple or having no relationship at the time of the survey, and a feeling of belonging to a community. Men with specific health insurance for low-income individuals were less likely to have never been tested, and those with a high stigma score towards PLWHA were more likely to be never-testers. Our study also found neighborhood differences in the likelihood of men never having been tested, which was, at least partially, explained by the neighborhood proportion of immigrants. In contrast, in women, no contextual variable was significantly associated with never-testing for HIV after adjustment for individual characteristics. CONCLUSIONS Studies such as this one can help target people who have never been tested in the context of recommendations for universal HIV screening in primary care.
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Affiliation(s)
- Véronique Massari
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis Institute d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Department of Social Epidemiology, F-75012, Paris, France.
| | - Annabelle Lapostolle
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis Institute d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Department of Social Epidemiology, F-75012, Paris, France.
| | - Marie-Catherine Grupposo
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis Institute d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Department of Social Epidemiology, F-75012, Paris, France.
| | - Rosemary Dray-Spira
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis Institute d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Department of Social Epidemiology, F-75012, Paris, France.
| | - Dominique Costagliola
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis Institute d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Department of HIV Clinical Research, F-75013, Paris, France.
| | - Pierre Chauvin
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis Institute d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Department of Social Epidemiology, F-75012, Paris, France.
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Brawner BM, Alexander KA, Fannin EF, Baker JL, Davis ZM. The Role of Sexual Health Professionals in Developing a Shared Concept of Risky Sexual Behavior as it Relates to HIV Transmission. Public Health Nurs 2015; 33:139-50. [PMID: 26184496 DOI: 10.1111/phn.12216] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
"Risky sexual behavior" accounts for the majority of new HIV infections regardless of gender, age, geographic location, or ethnicity. The phrase, however, refers to a relatively nebulous concept that hampers development of effective sexual health communication strategies. The purpose of this paper was to propose development of a shared conceptual understanding of "risky sexual behavior." We reviewed multidisciplinary HIV/AIDS literature to identify definitions of risky sexual behavior. Both the linguistic components and the social mechanisms that contribute to the concept of risky sexual behaviors were noted. Risky sexual behavior was often defined in a subjective manner in the literature, even in the scientific research. We urge a paradigm shift to focus on explicit behaviors and the social context of those behaviors in determining HIV risk. We also propose a new definition that reduces individual biases and promotes a broader discussion of the degree of sexual risk across a diversity of behavioral contexts. Sexual health professionals can strengthen practice and research initiatives by operating from a concise working definition of risky sexual behavior that is broadly transferable and expands beyond a traditional focus on identity-based groups.
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Affiliation(s)
- Bridgette M Brawner
- Department of Nursing, Center for Health Equity Research and Center for Global Women's Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
| | - Kamila A Alexander
- Johns Hopkins School of Nursing, Department of Community Public Health, Baltimore, Maryland
| | - Ehriel F Fannin
- Center for Health Equity Research and Center for Global Women's Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
| | - Jillian L Baker
- Department of Urban Public Health & Nutrition, School of Nursing & Health Sciences, La Salle University, Philadelphia, Pennsylvania
| | - Zupenda M Davis
- Department of Urban Public Health & Nutrition, School of Nursing & Health Sciences, La Salle University, Philadelphia, Pennsylvania
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Burke HM, Fleming PJ, Guest G. Assessment of the psychometric properties of HIV knowledge items across five countries. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2014; 26:577-87. [PMID: 25490737 PMCID: PMC6626987 DOI: 10.1521/aeap.2014.26.6.577] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
HIV knowledge is commonly measured in HIV prevention research and program evaluations, but rigorous measurement standards are not always applied. Using item response theory methods, we examined the psychometric functioning of five commonly used HIV knowledge questions in five countries with varying HIV prevalence. We evaluated the internal consistency and measurement invariance of the items. The items performed poorly in all samples and the scale as a whole did not perform equally across samples. We conclude that current ways of measuring HIV knowledge are not adequate and recommend new items be developed, tested, and validated using psychometric methods.
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La Ruche G, Pedrono G, Semaille C, Warszawski J, Beltzer N. Self-report of sexually transmitted infections from 1994 to 2010 by adults living in France. Rev Epidemiol Sante Publique 2014; 62:283-90. [PMID: 25444835 DOI: 10.1016/j.respe.2014.06.274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 04/08/2014] [Accepted: 06/10/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Since 1994, French population-based knowledge, attitudes, beliefs and practices surveys have enabled researchers to estimate trends in sexual behavioural indicators. METHODS We estimated trends and prevalence of self-reported sexually transmitted infections during the previous 5 years among 16,095 sexually active adults aged 18-54 through five cross-sectional telephone surveys between 1994 and 2010. We then studied the factors associated with participants' most recent sexually transmitted infections other than genital candidiasis. RESULTS Overall, 2.5% (95% confidence interval: 2.2%-2.9%) of women reported sexually transmitted infections within the previous 5 years, increases being continuously reported between 1998 and 2010. In contrast, men reported lower prevalence of sexually transmitted infections (1.4%; 95% confidence interval: 1.1%-1.7%), which remained stable over time. General practitioners and gynaecologists managed most sexually transmitted infections. Men notified their stable partners about infection less often than women (66% vs. 84%). Self-reported sexually transmitted infections were associated with younger age, multiple sexual partnerships and fear of sexually transmitted infections in both genders, with exclusively homosexual practices in men, and with a high educational level and recent HIV testing in women. CONCLUSION Self-reported sexually transmitted infections clearly reflect risky sexual behaviours. The lower prevalence of self-reported sexually transmitted infections among men than among women may reflect less access to screening activities for sexually transmitted infections in men.
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Affiliation(s)
- G La Ruche
- Département des maladies infectieuses, institut de veille sanitaire, 12, rue du Val-d'Osne, 94415 Saint-Maurice cedex, France.
| | - G Pedrono
- Département des maladies infectieuses, institut de veille sanitaire, 12, rue du Val-d'Osne, 94415 Saint-Maurice cedex, France; Observatoire régional de santé d'Île-de-France, 75003 Paris, France
| | - C Semaille
- Département des maladies infectieuses, institut de veille sanitaire, 12, rue du Val-d'Osne, 94415 Saint-Maurice cedex, France
| | - J Warszawski
- Inserm U1018, université Paris-Sud 11, AP-HP hôpital de Bicêtre, département d'épidémiologie, 94276 Le Kremlin-Bicêtre, France
| | - N Beltzer
- Observatoire régional de santé d'Île-de-France, 75003 Paris, France
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Hlavinkova L, Mentel A, Kollarova J, Kristufkova Z. Effectiveness of a prevention campaign on HIV/AIDS knowledge among adolescents in Eastern Slovakia. Int J Public Health 2014; 59:905-11. [PMID: 25312012 DOI: 10.1007/s00038-014-0607-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 09/09/2014] [Accepted: 09/12/2014] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES The aim of this manuscript was to evaluate results of the questionnaire given to young people before and after the prevention campaign to determine whether the prevention campaign improved HIV/AIDS-related knowledge of young people. METHODS A total of 533 students completed the pre-test and 496 students completed the post-test. Questionnaire was used as pre/post testing tool. Construct validity and measurement scale were assessed using the factor analysis. Rasch scaling was used to establish common scale for pre/post test and to transform raw score into the interval scale. A non-parametric Mann-Whitney U test was used to compare knowledge in pre-test and post-test. RESULTS Students increased their knowledge of HIV/AIDS (Pearson's measure of effect size r = 0.74) and the risk of acquiring HIV infection (r = 0.68) statistically significantly (p = 0.001). Girls (risk estimation: r = 0.78, knowledge: r = 0.81) improved much more than boys (risk estimation: r = 0.57, knowledge: r = 0.62). CONCLUSIONS This study suggests that, for the selected sample, the prevention campaign was an effective tool to increase young people's knowledge of HIV/AIDS. The authors recommend dividing and tailoring interventions by gender to achieve even more efficient preventive future interventions.
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Affiliation(s)
- Lucia Hlavinkova
- Department of Epidemiology, Faculty of Public Health, Slovak Medical University, Bratislava, Slovakia,
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Trends in condom use and risk behaviours after sexual exposure to HIV: a seven-year observational study. PLoS One 2014; 9:e104350. [PMID: 25157477 PMCID: PMC4144812 DOI: 10.1371/journal.pone.0104350] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Accepted: 07/13/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE We aimed to determine the trends in numbers and percentages of sexually exposed persons to HIV (SE) consulting an ED for post-exposure prophylaxis (PEP), as well as predictors of condom use. STUDY DESIGN We conducted a prospective-observational study. METHODS We included all SE attendances in our Emergency Department (ED) during a seven-year study-period (2006-2012). Trends were analyzed using time-series analysis. Logistic Regression was used to define indicators of condom use. RESULTS We enrolled 1851 SE: 45.7% reported intercourse without condom-use and 12.2% with an HIV-infected partner. Significant (p<0.01) rising trends were observed in the overall number of SE visits (+75%), notably among men having sex with men (MSM) (+126%). There were rising trends in the number and percentage of those reporting intercourse without condom-use in the entire population +91% (p<0.001) and +1% (p>0.05), in MSM +228% (p<0.001) and +49% (p<0.001), in Heterosexuals +68% (p<0.001) and +10% (p = 0.08). Among MSM, significant rising trends were found in those reporting high-risk behaviours: anal receptive (+450% and +76%) and anal insertive (+l33% and +70%) intercourses. In a multivariate logistic regression analysis, heterosexuals, vaginal intercourse, visit during the night-shift and short time delay between SE and ED visit, were significantly associated with condom-use. CONCLUSION We report an increasing trend in the number of SE, mainly among MSM, and rising trends in high-risk behaviours and unprotected sexual intercourses among MSM. Our results indicate that SE should be considered as a high-risk population for HIV and sexually transmitted diseases.
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Zakher B, Blazina I, Chou R. Association between knowledge of HIV-positive status or use of antiretroviral therapy and high-risk transmission behaviors: systematic review. AIDS Care 2013; 26:514-21. [PMID: 24007512 DOI: 10.1080/09540121.2013.832723] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
To systematically review the evidence on the association between knowledge of HIV-positive status or use of antiretroviral therapy (ART) and high-risk transmission behaviors, we searched Ovid MEDLINE from 2004 to February 2012 and the Cochrane Library Database through the first quarter of 2012. Four observational studies meeting inclusion criteria addressed HIV-positive status and seven addressed the use of ART and effects on behavior. Studies including both average and high-risk populations were conducted in developed countries and were rated at least fair quality. Overall, knowledge of HIV-positive status was associated with less engagement in high-risk transmission behaviors, and the use of ART was not found to increase participation in high-risk transmission behaviors by HIV-positive individuals.
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Affiliation(s)
- Bernadette Zakher
- a Department of Medical Informatics and Clinical Epidemiology , Oregon Health and Science University , Portland , OR , USA
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Brouard C, Gautier A, Saboni L, Jestin C, Semaille C, Beltzer N. Hepatitis B knowledge, perceptions and practices in the French general population: the room for improvement. BMC Public Health 2013; 13:576. [PMID: 23764171 PMCID: PMC3849746 DOI: 10.1186/1471-2458-13-576] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 06/06/2013] [Indexed: 12/18/2022] Open
Abstract
Background Little is known about the knowledge, perceptions and prevention practices of the French general population with respect to Hepatitis B virus (HBV) infection. This article describes this population’s knowledge of HBV, their perceptions of the disease, and associated screening and vaccination practices. It compares these indicators with those observed in the same population for HIV, an infection with a chronic course and transmission modes resembling those of HBV. Methods A module on hepatitis B was added into the HIV KABP (Knowledge, Attitudes, Beliefs and Practices) survey which was carried out telephonically in 2010 among a random sample of 9,014 individuals aged between 18–69 and living in metropolitan France. Results Compared with HIV, the general population was less aware that needle exchange during intravenous drug use and sexual relationships are HBV transmission modes (HBV: 89.9% and 69.7%; HIV: 99.1% and 99.4%). The fear of both illnesses was similar at 20.3%. The individual perceived risk of infection was higher for HBV than for HIV with, respectively, 60.8% and 40.3% of respondents believing they had an equal or greater risk of being infected than the average person. However, the percentage of those reporting HBV screening during their lifetime (27.4%) was half that for HIV screening (61.4%). In multivariate analysis, HBV screening was reported more often by individuals born in areas with high HBV endemicity (OR = 2.1 [95% CI: 1.5-2.9]) than by those born in low HBV endemicity areas, and more often by those who reported they had taken drugs intravenously during their lifetime (OR = 2.2 [95% CI: 1.2-4.2]) than those who did not report such behavior. Almost one in two respondents (47%) reported HBV vaccination. The intermediate or high endemicity groups did not report vaccination more often than those born in low endemicity areas nor did those reporting intravenously drug use compared with those who did not. Conclusions This study highlights very contrasting levels of knowledge, perceptions and practices regarding HBV and HIV in the French general population. Our results demonstrate the need to improve the general and high-risk populations’ knowledge of HBV, in particular concerning sexual transmission, in order to improve screening and vaccination practices.
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Affiliation(s)
- Cécile Brouard
- Department for infectious diseases, French Institute for Public Health Surveillance (InVS), 12, rue du Val d'Osne, Saint-Maurice Cedex, 94415, France.
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