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Palich R, Arias-Rodríguez A, Duracinsky M, Le Talec JY, Rousset Torrente O, Lascoux-Combe C, Lacombe K, Ghosn J, Viard JP, Pialoux G, Ohayon M, Duvivier C, Velter A, Ben Mechlia M, Beniguel L, Grabar S, Melchior M, Assoumou L, Supervie V. High proportion of post-migration HIV acquisition in migrant men who have sex with men receiving HIV care in the Paris region, and associations with social disadvantage and sexual behaviours: results of the ANRS-MIE GANYMEDE study, France, 2021 to 2022. Euro Surveill 2024; 29:2300445. [PMID: 38487889 PMCID: PMC10941311 DOI: 10.2807/1560-7917.es.2024.29.11.2300445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 01/03/2024] [Indexed: 03/17/2024] Open
Abstract
BackgroundSome migrant men who have sex with men (MSM) acquire HIV in France.AimsWe investigated, in migrant MSM receiving HIV care in France, the (i) rate of post-migration-HIV acquisition in France, (ii) delay between arrival and HIV acquisition and (iii) factors affecting HIV acquisition within 1 year after migration.MethodsThis cross-sectional study focused on ≥ 18-year-old MSM born outside France, receiving HIV care in the Paris region. Information on migration history, socioeconomic condition, sexual activity, and health was collected in May 2021-June 2022 through self-administered questionnaires and medical records. Post-migration-HIV-acquisition rate and delay between arrival in France and HIV acquisition were estimated from biographical data and CD4+ T-cell counts. Predictors of HIV acquisition within 1 year after migration were determined using logistic regression.ResultsOverall post-migration HIV-acquisition rate was 61.7% (715/1,159; 95%CI: 61.2-62.2), ranging from 40.5% (95%CI: 39.6-41.6) to 85.4% (95%CI: 83.9-86.0) in participants from Latin America and North Africa. Among post-migration-HIV acquisitions, those within 1 year after migration represented 13.1% overall (95%CI: 11.6-14.6), being highest in participants from sub-Saharan Africa (25%; 95%CI: 21.5-28.3). Participants ≥ 15-years old at migration, with post-migration-acquired HIV, had a 7.5-year median interval from arrival in France to HIV acquisition (interquartile range (IQR): 3.50-14.75). Older age at arrival, region of origin (sub-Saharan Africa and Asia), degree of social disadvantage and numbers of sexual partners were independently associated with acquiring HIV within 1 year in France.ConclusionOur findings may guide HIV prevention policies for most vulnerable migrants to Europe.
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Affiliation(s)
- Romain Palich
- Sorbonne University, Pitié-Salpêtrière hospital, AP-HP, Paris, France
- Sorbonne Université, Pierre Louis Epidemiology and Public Health institute (iPLESP), INSERM 1136, Paris, France
| | - Andrés Arias-Rodríguez
- Sorbonne Université, Pierre Louis Epidemiology and Public Health institute (iPLESP), INSERM 1136, Paris, France
| | - Martin Duracinsky
- Paris Cité University, Patient-Reported Outcomes Unit (PROQOL), INSERM 1123, Paris, France
| | - Jean-Yves Le Talec
- Toulouse Jean Jaurès University, CERTOP, CNRS UMR 5044, Toulouse, France
| | | | | | - Karine Lacombe
- Sorbonne University, Saint Antoine hospital, AP-HP, Paris, France
| | - Jade Ghosn
- Paris Cité University, Bichat hospital, AP-HP, Paris, France
| | - Jean-Paul Viard
- Paris Cité University, Hôtel-Dieu hospital, AP-HP, Paris, France
| | - Gilles Pialoux
- Sorbonne University, Tenon hospital, AP-HP, Paris, France
| | | | - Claudine Duvivier
- Paris Cité University, Necker hospital, AP-HP; INSERM U1016, CNRS UMR8104, Institut Cochin; IHU Imagine; Institut Pasteur Medical Center, Paris, France
| | | | - Mohamed Ben Mechlia
- French National Agency for Research on AIDS, Viral Hepatitis and Emerging Infectious Diseases (ANRS-MIE), Paris, France
| | - Lydie Beniguel
- Sorbonne Université, Pierre Louis Epidemiology and Public Health institute (iPLESP), INSERM 1136, Paris, France
| | - Sophie Grabar
- Sorbonne Université, Pierre Louis Epidemiology and Public Health institute (iPLESP), INSERM 1136, Paris, France
| | - Maria Melchior
- Sorbonne Université, Pierre Louis Epidemiology and Public Health institute (iPLESP), INSERM 1136, Paris, France
| | - Lambert Assoumou
- Sorbonne Université, Pierre Louis Epidemiology and Public Health institute (iPLESP), INSERM 1136, Paris, France
| | - Virginie Supervie
- Sorbonne Université, Pierre Louis Epidemiology and Public Health institute (iPLESP), INSERM 1136, Paris, France
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Di Ciaccio M, Villes V, Delabre RM, Alain T, Morel S, Michels D, Schmidt AJ, Velter A, Rojas Castro D. When awareness is not a barrier to PrEP uptake among men who have sex with men who are eligible for PrEP in France. AIDS Care 2024; 36:390-399. [PMID: 37931594 DOI: 10.1080/09540121.2023.2268887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 10/04/2023] [Indexed: 11/08/2023]
Abstract
Despite PrEP being available and free of charge in France, a gap remains between the estimated number of men who have sex with men (MSM) with high-risk exposure to HIV and the number of MSM PrEP users. The objective of this study is to identify factors associated with non-intention to use PrEP among PrEP-eligible and PrEP-aware MSM in France, "non-intenders".European MSM Internet Survey (EMIS)-2017 was a cross-sectional survey conducted among MSM concerning their HIV prevention needs. Logistic regression models were used to identify factors associated with "non-intenders".Compared to PrEP users, factors associated with non-intention to use PrEP were: age (aOR[95%CI] = 3.80[2.21;6.53]); not being vaccinated against hepatitis B (2.20[1.45;3.34]); self-efficacy (1.84[1.29;2.60]); lower knowledge about on-demand PrEP (11.48[7.37;17.87]) and daily PrEP (2.58[1.27;5.25]); not having a PrEP discussion at a hospital (12.39[8.90;17.27]) or at a community service/drop-in (4.93[3.48;6.97]); living in a department with few PrEP access points (1.70[1.10;2.63]).On-demand PrEP may meet the prevention needs of "non-intenders" who have lower HIV risk perception. Increasing communication from health providers and community health workers to all MSM is needed.
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Affiliation(s)
| | - Virginie Villes
- Coalition PLUS, Community-based Research Laboratory, Pantin, France
| | | | - Tristan Alain
- Coalition PLUS, Community-based Research Laboratory, Pantin, France
- AIDES, Pantin, France
| | - Stéphane Morel
- Coalition PLUS, Community-based Research Laboratory, Pantin, France
- AIDES, Pantin, France
| | - David Michels
- Coalition PLUS, Community-based Research Laboratory, Pantin, France
- AIDES, Pantin, France
| | - Axel Jeremias Schmidt
- Sigma Research, Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Daniela Rojas Castro
- Coalition PLUS, Community-based Research Laboratory, Pantin, France
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
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Delabre RM, Di Ciaccio M, Lorente N, Villes V, Castro Avila J, Yattassaye A, Bonifaz C, Ben Moussa A, Sikitu IZ, Khodabocus N, Freitas R, Spire B, Veras MA, Sagaon-Teyssier L, Girard G, Roux P, Velter A, Delpech V, Ghosn J, Riegel L, Rojas Castro D. Impact of the COVID-19 Health Crisis on Key Populations at Higher Risk for, or Living With, HIV or Hepatitis C Virus and People Working With These Populations: Multicountry Community-Based Research Study Protocol (EPIC Program). JMIR Res Protoc 2023; 12:e45204. [PMID: 38096016 PMCID: PMC10755648 DOI: 10.2196/45204] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 07/18/2023] [Accepted: 08/10/2023] [Indexed: 12/31/2023] Open
Abstract
BACKGROUND Information concerning the impact of the COVID-19 health crisis on populations most affected by HIV and hepatitis C virus (HCV; or key populations [KP]), and those working with these populations in community settings, is limited. Community-based organizations working in the field of HIV and viral hepatitis are well placed to identify and meet the new needs of KP owing to the health crisis. OBJECTIVE This study aims to describe the development and implementation of an exploratory and descriptive multicountry, community-based research program, EPIC (Enquêtes Pour évaluer l'Impact de la crise sanitaire covid en milieu Communautaire), within an international network of community-based organizations involved in the response to HIV and viral hepatitis. The EPIC program aimed to study the impact of the COVID-19 health crisis on KP or people living with HIV or HCV and people working with these populations at the community level (community health workers [CHWs]) and to identify the key innovations and adaptations in HIV and HCV services. METHODS A general protocol and study documents were developed and shared within the Coalition PLUS network. The protocol had a built-in flexibility that allowed participating organizations to adapt the study to local needs in terms of the target population and specific themes of interest. Data were collected using surveys or interviews. RESULTS From July 2020 to May 2022, a total of 79 organizations participated in the EPIC program. Across 32 countries, 118 studies were conducted: 66 quantitative (n=12,060 among KP or people living with HIV or people living with HCV and n=811 among CHWs) and 52 qualitative (n=766 among KP or people living with HIV or people living with HCV and n=136 among CHWs). CONCLUSIONS The results of the EPIC program will provide data to describe the impact of the health crisis on KP and CHWs and identify their emerging needs. Documentation of innovative solutions that were put into place in this context may help improve the provision of services after COVID-19 and for future health crises. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/45204.
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Affiliation(s)
| | | | - Nicolas Lorente
- Community-based Research Laboratory, Coalition PLUS, Pantin, France
- Centre Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya, Agència de Salut Pública de Catalunya, Badalona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - Virginie Villes
- Community-based Research Laboratory, Coalition PLUS, Pantin, France
| | | | - Adam Yattassaye
- Community-based Research Laboratory, Coalition PLUS, Pantin, France
- Association pour la Résilience des Communautés pour l'Accès au Développement et à la Santé PLUS, Bamako, Mali
| | - César Bonifaz
- Community-based Research Laboratory, Coalition PLUS, Pantin, France
- Corporación Kimirina, Quito, Ecuador
| | - Amal Ben Moussa
- Community-based Research Laboratory, Coalition PLUS, Pantin, France
- Association de Lutte Contre le Sida, Casablanca, Morocco
| | - Ingrid-Zaïre Sikitu
- Community-based Research Laboratory, Coalition PLUS, Pantin, France
- Association Nationale de Soutien aux Séropositifs et Malades du Sida, Bujumbura, Burundi
| | - Niloufer Khodabocus
- Community-based Research Laboratory, Coalition PLUS, Pantin, France
- Prévention Information Lutte contre le SIDA, Port Louis, Mauritius
| | - Rosa Freitas
- Community-based Research Laboratory, Coalition PLUS, Pantin, France
- Grupo de Ativistas em Tratamentos, Lisbon, Portugal
| | - Bruno Spire
- Community-based Research Laboratory, Coalition PLUS, Pantin, France
- Aix Marseille Université, Institut national de la santé et de la recherche médicale, Institut de Recherche pour le Développement, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l'Information Médicale, Institut des Sciences de la Santé Publique d'Aix-Marseille Université, Marseille, France
| | | | - Luis Sagaon-Teyssier
- Association pour la Résilience des Communautés pour l'Accès au Développement et à la Santé PLUS, Bamako, Mali
- Aix Marseille Université, Institut national de la santé et de la recherche médicale, Institut de Recherche pour le Développement, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l'Information Médicale, Institut des Sciences de la Santé Publique d'Aix-Marseille Université, Marseille, France
| | - Gabriel Girard
- Aix Marseille Université, Institut national de la santé et de la recherche médicale, Institut de Recherche pour le Développement, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l'Information Médicale, Institut des Sciences de la Santé Publique d'Aix-Marseille Université, Marseille, France
| | - Perrine Roux
- Aix Marseille Université, Institut national de la santé et de la recherche médicale, Institut de Recherche pour le Développement, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l'Information Médicale, Institut des Sciences de la Santé Publique d'Aix-Marseille Université, Marseille, France
| | - Annie Velter
- Aix Marseille Université, Institut national de la santé et de la recherche médicale, Institut de Recherche pour le Développement, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l'Information Médicale, Institut des Sciences de la Santé Publique d'Aix-Marseille Université, Marseille, France
- Santé Publique France, Saint-Maurice, France
| | - Valérie Delpech
- Director of Population and Public Health Directorate, North Coast North South Wales, Australia
| | - Jade Ghosn
- Assistance Publique - Hôpitaux de Paris Nord, Service des Maladies Infectieuses, Center Hospitalier Universitaire Bichât - Claude Bernard, Paris, France
- Infection, Antimicrobials, Modelling, Evolution, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1137, Université Paris Cité, Paris, France
| | - Lucas Riegel
- Community-based Research Laboratory, Coalition PLUS, Pantin, France
| | - Daniela Rojas Castro
- Community-based Research Laboratory, Coalition PLUS, Pantin, France
- Aix Marseille Université, Institut national de la santé et de la recherche médicale, Institut de Recherche pour le Développement, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l'Information Médicale, Institut des Sciences de la Santé Publique d'Aix-Marseille Université, Marseille, France
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Krug C, Tarantola A, Chazelle E, Fougère E, Velter A, Guinard A, Souares Y, Mercier A, François C, Hamdad K, Tan-Lhernould L, Balestier A, Lahbib H, Etien N, Bernillon P, De Lauzun V, Durand J, Fayad M, De Valk H, Beck F, Che D, Coignard B, Lot F, Mailles A. Mpox outbreak in France: epidemiological characteristics and sexual behaviour of cases aged 15 years or older, 2022. Euro Surveill 2023; 28:2200923. [PMID: 38099346 PMCID: PMC10831416 DOI: 10.2807/1560-7917.es.2023.28.50.2200923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 04/21/2023] [Indexed: 12/17/2023] Open
Abstract
BackgroundLocally-acquired mpox cases were rarely reported outside Africa until May 2022, when locally-acquired-mpox cases occurred in various European countries.AimWe describe the mpox epidemic in France, including demographic and behavioural changes among a subset of cases, during its course.MethodsData were retrieved from the enhanced national surveillance system until 30 September 2022. Laboratory-confirmed cases tested positive for monkeypox virus or orthopoxviruses by PCR; non-laboratory-confirmed cases had clinical symptoms and an epidemiological link to a laboratory-confirmed case. A subset of ≥ 15-year-old male cases, notified until 1 August, was interviewed for epidemiological, clinical and sexual behaviour information. Association of symptom-onset month with quantitative outcomes was evaluated by t- or Wilcoxon tests, and with binary outcomes, by Pearson's chi-squared or Fisher exact tests.ResultsA total of 4,856 mpox cases were notified, mostly in Île-de-France region (62%; 3,025/4,855). Cases aged ≥ 15 years were predominantly male (97%; 4,668/4,812), with 37 years (range: 15-81) as mean age. Between May and July, among the subset interviewed, mpox cases increased in regions other than Île-de-France, and mean age rose from 35 (range: 21-64) to 38 years (range: 16-75; p = 0.007). Proportions of cases attending men-who-have-sex-with-men (MSM) meeting venues declined from 60% (55/91) to 46% (164/359; p = 0.012); median number of sexual partners decreased from four (interquartile range (IQR): 1-10) to two (IQR: 1-4; p < 0.001).ConclusionChanges in cases' characteristics during the epidemic, could reflect virus spread from people who were more to less behaviourally vulnerable to mpox between May and July, or MSM reducing numbers of sexual partners as recommended.
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Affiliation(s)
- Catarina Krug
- Santé publique France, The French Public Health Agency, Saint-Maurice, France
- ECDC Fellowship Program, Field Epidemiology path (EPIET), European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
- These first authors contributed equally to this article
| | - Arnaud Tarantola
- Santé publique France, The French Public Health Agency, Saint-Maurice, France
- These first authors contributed equally to this article
| | - Emilie Chazelle
- Santé publique France, The French Public Health Agency, Saint-Maurice, France
- These first authors contributed equally to this article
| | - Erica Fougère
- Santé publique France, The French Public Health Agency, Saint-Maurice, France
| | - Annie Velter
- Santé publique France, The French Public Health Agency, Saint-Maurice, France
- Aix Marseille Univ, INSERM, IRD, Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM), Marseille, France
| | - Anne Guinard
- Santé publique France, The French Public Health Agency, Saint-Maurice, France
| | - Yvan Souares
- Santé publique France, The French Public Health Agency, Saint-Maurice, France
| | - Anna Mercier
- Santé publique France, The French Public Health Agency, Saint-Maurice, France
| | - Céline François
- Santé publique France, The French Public Health Agency, Saint-Maurice, France
| | - Katia Hamdad
- Santé publique France, The French Public Health Agency, Saint-Maurice, France
| | | | - Anita Balestier
- Santé publique France, The French Public Health Agency, Saint-Maurice, France
| | - Hana Lahbib
- Santé publique France, The French Public Health Agency, Saint-Maurice, France
| | - Nicolas Etien
- Santé publique France, The French Public Health Agency, Saint-Maurice, France
| | - Pascale Bernillon
- Santé publique France, The French Public Health Agency, Saint-Maurice, France
| | - Virginie De Lauzun
- Santé publique France, The French Public Health Agency, Saint-Maurice, France
| | - Julien Durand
- Santé publique France, The French Public Health Agency, Saint-Maurice, France
| | - Myriam Fayad
- Santé publique France, The French Public Health Agency, Saint-Maurice, France
| | - Henriette De Valk
- Santé publique France, The French Public Health Agency, Saint-Maurice, France
| | - François Beck
- Santé publique France, The French Public Health Agency, Saint-Maurice, France
- Centre de Recherche en Épidémiologie et Santé des Populations (CESP), Inserm U1018, Université Paris-Saclay, Université Paris-Sud, Université Versailles Saint-Quentin (UVSQ), Villejuif, France
| | - Didier Che
- Santé publique France, The French Public Health Agency, Saint-Maurice, France
| | - Bruno Coignard
- Santé publique France, The French Public Health Agency, Saint-Maurice, France
| | - Florence Lot
- Santé publique France, The French Public Health Agency, Saint-Maurice, France
- These authors contributed equally to this article
| | - Alexandra Mailles
- Santé publique France, The French Public Health Agency, Saint-Maurice, France
- These authors contributed equally to this article
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Ousseine YM, Allaire C, Ringa V, Lydie N, Velter A. Health Literacy as a Mediator of the Relationship Between Socioeconomic Position and Pre-Exposure Prophylaxis Uptake Among Men Who Have Sex with Men Living in France. Health Lit Res Pract 2023; 7:e61-e70. [PMID: 36888986 PMCID: PMC9991084 DOI: 10.3928/24748307-20230224-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND In recent decades, several research studies have mentioned a potential mediating effect of health literacy (HL) on the relationship between socioeconomic position and health prevention behaviors. However, no study to date has investigated this hypothesis on HIV prevention behaviors. OBJECTIVE The present study aimed to evaluate whether HL mediates the relationship between socioeconomic status (SES) and pre-exposure prophylaxis (PrEP) uptake in men who have sex with men (MSM). METHODS The study is based on data collected in the Enquête Rapport au Sexe [report to sex] 2019 survey, an anonymous, self-administered online cross-sectional survey in France conducted between February 16, 2019 and March 31, 2019. Data on education level and perceived financial situation were used as measures of SES, whereas HL was assessed from the Health Literacy Questionnaire's "ability to actively engage with health care providers" scale. Mediation analyses were performed with a model-based causal moderated mediation analysis package in R software. Analyses were adjusted for age, place of residence, marital status, and social support. KEY RESULTS The study sample included 13,629 MSM. Median age was 32 years. The majority had an education level higher than upper secondary school (78%) and an adequate HL level (73%). Almost two-thirds perceived their financial situation as comfortable (62%). Overall, PrEP uptake was low (9.5%). The analyses did not show a mediating effect of HL on the relationship between education and PrEP uptake. However, a total mediation effect of HL was observed on the relationship between perceived financial situation and uptake. CONCLUSIONS In the context of PrEP uptake, MSM ability to actively engage with health care providers may offset the effect of a difficult financial situation. In the current French context, where PrEP is now also available in general practitioner settings, this result could inform the development of training and support policies for health professionals and the way in which sexual health issues are addressed in consultations. [HLRP: Health Literacy Research and Practice. 2023;7(1):e61-e70.].
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Affiliation(s)
- Youssoufa M. Ousseine
- Address correspondence to Youssoufa M. Ousseine, MPH, PhD, Department of Prevention and Health Promotion, Santé publique France, 12, rue du val d'Osne, 94415 Saint Maurice Cedex, France;
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Castry M, Cousien A, Champenois K, Supervie V, Velter A, Ghosn J, Yazdanpanah Y, Paltiel AD, Deuffic‐Burban S. Cost-effectiveness of hepatitis C virus test-and-treat and risk reduction strategies among men who have sex with men living with HIV in France. J Int AIDS Soc 2022; 25:e26035. [PMID: 36451286 PMCID: PMC9712801 DOI: 10.1002/jia2.26035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 10/31/2022] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Studies suggest that hepatitis C virus (HCV) micro-elimination is feasible among men who have sex with men (MSM) living with human immunodeficiency virus (HIV), through treatment-as-prevention and interventions aimed at reducing risk behaviours. However, their economic impact is poorly understood. The aim of this study was to assess the cost-effectiveness of HCV screening and risk reduction strategies in France. METHODS A compartmental deterministic mathematical model was developed to describe HCV disease transmission and progression among MSM living with HIV in France. We evaluated different combinations of HCV screening frequency (every 12, 6 or 3 months) and risk reduction strategies (targeting only high-risk or all MSM) from 2021 onwards. The model simulated the number of HCV infections, life-expectancy (LYs), quality-adjusted life-expectancy (QALYs), lifetime costs and incremental cost-effectiveness ratio (ICER) over a lifetime horizon (leading to an end of the simulation in 2065). RESULTS All strategies increased QALYs, compared with current practices, that is yearly HCV screening, with no risk reduction. A behavioural intervention resulting in a 20% risk reduction in the high-risk group, together with yearly screening, was the least expensive strategy, and, therefore, cost-saving compared to current practices. The ICER per QALY gained for the strategy combining risk reduction for the high-risk group with 6-month HCV screening, compared to risk reduction with yearly screening, was €61,389. It also prevented 398 new HCV infections between 2021 and 2065, with a cost per infection averted of €37,790. All other strategies were dominated (more expensive and less effective than some other available alternative) or not cost-effective (ICER per QALY gained > €100,000). CONCLUSIONS In the French context, current HCV screening practices without risk reduction among MSM living with HIV cannot be justified on economic grounds. Risk reduction interventions targeted to high-risk individuals-alongside screening either once or twice a year-could be cost-effective depending on the policymaker's willingness-to-pay.
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Affiliation(s)
| | | | | | - Virginie Supervie
- Sorbonne UniversitéInsermInstitut Pierre Louis d’Épidémiologie et de Santé PubliqueParisFrance
| | | | - Jade Ghosn
- Université de ParisIAMEINSERMParisFrance,Service de maladies Infectieuses et tropicalesHôpital Bichat Claude BernardParisFrance
| | - Yazdan Yazdanpanah
- Université de ParisIAMEINSERMParisFrance,Service de maladies Infectieuses et tropicalesHôpital Bichat Claude BernardParisFrance
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8
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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] [What about the content of this article? (0)] [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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9
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Ousseine YM, Vaux S, Vandentorren S, Bonmarin I, Champenois K, Lydié N, Velter A. Predictors of Uncertainty and Unwillingness to Receive the COVID-19 Vaccine in Men Who Have Sex with Men in France. Int J Environ Res Public Health 2022; 19:ijerph19095372. [PMID: 35564769 PMCID: PMC9101119 DOI: 10.3390/ijerph19095372] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/20/2022] [Accepted: 04/26/2022] [Indexed: 12/23/2022]
Abstract
The development of vaccines against COVID-19 has given hope to populations. Public acceptability of vaccination is a major driver in containing the disease. However, in marginalized and stigmatized populations, uncertainty and unwillingness may be a challenge. This study aimed to analyze the factors associated with uncertainty and unwillingness to vaccinate against COVID-19 in men who have sex with men (MSM) living in France. The data used came from Rapport au Sexe (ERAS) 2021, a voluntary, cross-sectional, anonymous, self-administered, online survey conducted from 26 February to 11 April 2021. Among the 15,426 respondents included in the analysis, 60.5% were willing to vaccinate (these included persons already vaccinated), 17.5% were not, and 22% were uncertain. Factors independently associated with uncertainty and unwillingness were lower education level, low health literacy level, financial hardship, being under 30 years of age, and living in a rural area. HIV-positive MSM were less likely to report vaccination uncertainty and unwillingness than HIV-negative MSM and those with unknown serostatus. Although more impacted by COVID-19, socioeconomically vulnerable MSM were the sub-group most unwilling to vaccinate. To improve acceptability of COVID-19 vaccination in MSM, policy makers and researchers must increase access to and understanding of medical information by considering the general public’s health literacy when developing information sources. Moreover, a dedicated global care approach, which ensures these populations can be reached, is necessary.
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Affiliation(s)
- Youssoufa M. Ousseine
- Santé Publique France, French National Public Health Agency, 94415 Saint-Maurice, France; (S.V.); (S.V.); (I.B.); (N.L.); (A.V.)
- Correspondence:
| | - Sophie Vaux
- Santé Publique France, French National Public Health Agency, 94415 Saint-Maurice, France; (S.V.); (S.V.); (I.B.); (N.L.); (A.V.)
| | - Stéphanie Vandentorren
- Santé Publique France, French National Public Health Agency, 94415 Saint-Maurice, France; (S.V.); (S.V.); (I.B.); (N.L.); (A.V.)
- Université de Bordeaux, INSERM UMR 1219, PHAreS Team, 33000 Bordeaux, France
| | - Isabelle Bonmarin
- Santé Publique France, French National Public Health Agency, 94415 Saint-Maurice, France; (S.V.); (S.V.); (I.B.); (N.L.); (A.V.)
| | | | - Nathalie Lydié
- Santé Publique France, French National Public Health Agency, 94415 Saint-Maurice, France; (S.V.); (S.V.); (I.B.); (N.L.); (A.V.)
| | - Annie Velter
- Santé Publique France, French National Public Health Agency, 94415 Saint-Maurice, France; (S.V.); (S.V.); (I.B.); (N.L.); (A.V.)
- Aix Marseille Univ., INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de L’Information Médicale, ISSPAM, 13005 Marseille, France
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10
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Riegel L, Di Ciaccio M, Ben Moussa A, Velter A, Acosta ME, Villes V, Castro Avila J, Lorente N, Cerveau T, Sikitu I, Yattassaye A, Khodabocus N, Michels D, Veras MA, Delpech V, Spire B, Delabre RM, Le groupe de travail EPIC, Rojas Castro D. [Community-based research during a pandemic: reflections from the multi-country EPIC project]. Sante Publique 2022; Vol. 33:1005-1009. [PMID: 35485002 DOI: 10.3917/spub.216.1005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
In 2020, the COVID-19 health crisis affected all regions of the world, not sparing people already vulnerable to other viral epidemics such as HIV or HCV and/or those in precarious or socially marginalized situations. This is particularly the case for drug users or sex workers.Coalition PLUS, a network of associations fighting against HIV and viral hepatitis which defends and promotes the community-based approach, and its partners, have set up a multi-country community-based research project aimed at documenting the impact of the health crisis on the fight against HIV and viral hepatitis (key populations and community workers/activists), as well as the community responses put in place (EPIC survey).The objective of this paper is to reflect on the implementation of this community-based research study during the COVID-19 health crisis, and in particular the unforeseen difficulties to which the community-based research process had to confront and adapt. The goal is to draw lessons on what worked (and what did not work) in order to capitalize on community-based research practices during this pandemic and subsequently, facilitate the implementation of new research projects in similar contexts.
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11
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Mendez-Lopez A, Hickson F, Jansen K, Lachowsky N, Burns F, Folch C, Velter A, Weatherburn P, Marcus U, von Rüden U, Mirandola M, Gios L, Frankis J, Brennan DJ, Schmidt AJ. What is the empirical basis for converting banded ordinal data on numbers of sex partners among MSM into a continuous scale level variable? A secondary analysis of 13 surveys across 17 countries. BMC Med Res Methodol 2022; 22:59. [PMID: 35249527 PMCID: PMC8898536 DOI: 10.1186/s12874-021-01483-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 10/05/2021] [Indexed: 11/10/2022] Open
Abstract
Background To provide empirically based guidance for substituting partner number categories in large MSM surveys with mean numbers of sexual and condomless anal intercourse (CAI) partners in a secondary analysis of survey data. Methods We collated data on numbers of sexual and CAI partners reported in a continuous scale (write-in number) in thirteen MSM surveys on sexual health and behaviour across 17 countries. Pooled descriptive statistics for the number of sexual and CAI partners during the last twelve (N = 55,180) and 6 months (N = 31,759) were calculated for two sets of categories commonly used in reporting numbers of sexual partners in sexual behaviour surveys. Results The pooled mean number of partners in the previous 12 months for the total sample was 15.8 partners (SD = 36.6), while the median number of partners was 5 (IQR = 2–15). Means for number of partners in the previous 12 months for the first set of categories were: 16.4 for 11–20 partners (SD = 3.3); 27.8 for 21–30 (SD = 2.8); 38.6 for 31–40 (SD = 2.4); 49.6 for 41–50 (SD = 1.5); and 128.2 for ‘more than 50’ (SD = 98.1). Alternative upper cut-offs: 43.4 for ‘more than 10’ (SD = 57.7); 65.3 for ‘more than 20’ (SD = 70.3). Self-reported partner numbers for both time frames consistently exceeded 200 or 300. While there was substantial variation of overall means across surveys, the means for all chosen categories were very similar. Partner numbers above nine mainly clustered at multiples of tens, regardless of the selected time frame. The overall means for CAI partners were lower than those for sexual partners; however, such difference was completely absent from all categories beyond ten sexual and CAI partners. Conclusions Clustering of reported partner numbers confirm common MSM sexual behaviour surveys’ questionnaire piloting feedback indicating that responses to numbers of sexual partners beyond 10 are best guesses rather than precise counts, but large partner numbers above typical upper cut-offs are common.
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12
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Roux P, Donadille C, Girard G, Spire B, Protière C, Velter A. Impact of COVID-19 Pandemic on Men Who Have Sex With Men That Practice Chemsex in France: Results From the National ERAS Web Survey. Am J Mens Health 2022; 16:15579883211073225. [PMID: 35156425 PMCID: PMC8848067 DOI: 10.1177/15579883211073225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Chemsex-the use of drugs in a sexual context-has been associated with more at-risk sexual practices and substance-related complications in men who have sex with men (MSM). To date, no study has focused on the impact of France's first coronavirus disease 2019 (COVID-19)-related lockdown on the mental health and drug/alcohol use of MSM who practice chemsex. We implemented a web-based survey of 9,488 MSM living in France in June 2020 (after the country's first COVID-19 lockdown). Specifically, we first compared the subpopulation of MSM who self-reported practicing chemsex during their most recent sexual intercourse (defined as "chemsexers") with other MSM, using five outcomes: increased 1/tobacco use, 2/alcohol use, and 3/other psychoactive drug use. 4/using psychotropic medication during the lockdown, and finally 5/psychological distress. We then analyzed the outcomes' associations with the main explanatory variable "chemsexer," after adjusting for all relevant variables. Among 7,195 MSM who had sexual intercourse with a man during the previous 6 months, 359 participants (5%) were identified as "chemsexers." Multivariable analyses showed that during the first lockdown period, chemsexers were significantly more likely than non-chemsexers to have increased their use of tobacco, alcohol, and other psychoactive substances. Chemsexers were also more likely to have used psychotropic medication and to have experienced psychological distress during the previous month. Given the ongoing COVID-19 pandemic in France and worldwide, this finding highlights the need to develop psychosocial interventions and harm reduction services for MSM chemsexers, potentially via mobile health.
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Affiliation(s)
- Perrine Roux
- Aix-Marseille University, INSERM, IRD, U1252 SESSTIM, Sciences économiques & sociales de la santé & traitement de l'information médicale, ISSPAM, Marseille, France
| | - Cécile Donadille
- Aix-Marseille University, INSERM, IRD, U1252 SESSTIM, Sciences économiques & sociales de la santé & traitement de l'information médicale, ISSPAM, Marseille, France
| | - Gabriel Girard
- Aix-Marseille University, INSERM, IRD, U1252 SESSTIM, Sciences économiques & sociales de la santé & traitement de l'information médicale, ISSPAM, Marseille, France
| | - Bruno Spire
- Aix-Marseille University, INSERM, IRD, U1252 SESSTIM, Sciences économiques & sociales de la santé & traitement de l'information médicale, ISSPAM, Marseille, France
| | - Christel Protière
- Aix-Marseille University, INSERM, IRD, U1252 SESSTIM, Sciences économiques & sociales de la santé & traitement de l'information médicale, ISSPAM, Marseille, France
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13
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Di Ciaccio M, Villes V, Michels D, Morel S, Delabre RM, Rojas Castro D, Velter A. Impact of the early 2020 COVID-19 crisis and lockdown on PrEP use among men who have sex with men (MSM) in France. Sex Transm Infect 2022; 98:510-517. [PMID: 35149580 DOI: 10.1136/sextrans-2021-055189] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 12/23/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To describe changes in pre-exposure prophylaxis (PrEP) use during and following the COVID-19 lockdown in France (March-May 2020) and identify the factors associated with PrEP discontinuation among men who have sex with men (MSM) after the lockdown. METHODS Data from the, an anonymous, cross-sectional internet survey among MSM in July 2020, were analysed. Among respondents who were using PrEP prior to the lockdown, a binary logistic regression model was used to compare participants who were still taking PrEP (current PrEP users) with those who were not taking PrEP at the time of the survey (former PrEP users). RESULTS Among 8345 respondents, 946 were PrEP users before the lockdown, of whom 58.8% (n=556) reported stopping PrEP during the lockdown and 15.4% (n=146) were not using PrEP at the time of the survey. Among the 556 who stopped PrEP during lockdown, 86.5% (n=481) reported no sexual activity; 76.8% (n=427) restarted PrEP after lockdown. Former PrEP users were more likely to be younger, not living with a stable male sexual partner, report moderate anxiety, report increased psychoactive drug use during the lockdown, and report not having tested for HIV or STI since the end of the lockdown because they did not know where to go, preferred to wait or for another reason. Reporting fewer male sexual partners in the last 6 months was also significantly associated with being a former PrEP user. CONCLUSIONS MSM adapted PrEP use to their sexual activity during and after the French lockdown. After the lockdown, discontinued PrEP occurred more often among MSM who had fewer sexual partners and had mental health vulnerabilities. These factors could also be predictive of PrEP discontinuation in a more general context. PrEP users should be informed on how to safely stop/start PrEP and on the use of other prevention tools to reduce potential risk exposure during PrEP discontinuation.
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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, Lyon, France
| | - Virginie Villes
- Community-based Research Laboratory, Coalition PLUS, Pantin, France
| | - David Michels
- Community-based Research Laboratory, Coalition PLUS, Pantin, France.,AIDES, Pantin, France
| | - Stéphane Morel
- Community-based Research Laboratory, Coalition PLUS, Pantin, France.,AIDES, Pantin, France
| | | | - Daniela Rojas Castro
- Community-based Research Laboratory, Coalition PLUS, Pantin, France.,Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
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14
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Ortu G, Barret AS, Danis K, Duchesne L, Levy-Bruhl D, Velter A. Low vaccination coverage for human papillomavirus disease among young men who have sex with men, France, 2019. Euro Surveill 2021; 26. [PMID: 34915971 PMCID: PMC8728497 DOI: 10.2807/1560-7917.es.2021.26.50.2001965] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background In France, human papillomavirus (HPV) vaccination has been recommended in 2016 for men who have sex with men (MSM) up to age 26 years. Aim We aimed to estimate HPV vaccine coverage in 18–28 year-old MSM and identify uptake determinants. Methods We collected data on socio-demographic characteristics, sexual behaviour, sexually transmitted diseases (STI) screening and vaccination uptake using a voluntary cross-sectional online survey conducted in 2019 targeting MSM. We calculated coverage of at least one dose of HPV vaccine and prevalence ratios (PR) of determinants with 95% confidence intervals (CI) using Poisson regression. Results Of 9,469 respondents (age range: 18–28 years), 15% (95% CI: 14–16) reported being vaccinated for HPV. Coverage was significantly higher among MSM < 24 years (PR: 1.25; 95% CI: 1.13–1.39), with education level below university degree (PR: 1.12; 95% CI: 1.08–1.32), living in rural areas (PR: 1.21; 95% CI: 1.08–1.36), attending sex parties (PR: 1.12; 95% CI: 1.03–1.33), using HIV-related biomedical prevention methods (PR: 1.31; 95% CI: 1.12–1.54), with STI diagnosis (PR: 1.22; 95% CI: 1.08–1.38) and with hepatitis A or B vaccination (PR: 4.56; 95% CI: 3.63–5.81 vs PR: 3.35; 95% CI: 2.53–4.44). Conclusions The HPV vaccination uptake among MSM in France was not satisfactory. It was higher among MSM benefitting from other vaccinations and biomedical preventive methods against HIV, suggesting a synergistic effect of the national preventive sexual health recommendations for MSM. Further efforts to improve HPV vaccination coverage targeting MSM are warranted.
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Affiliation(s)
- Giuseppina Ortu
- Santé Publique France, Saint Maurice, France.,European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
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15
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Garros A, Bourrely M, Sagaon-Teyssier L, Sow A, Lydie N, Duchesne L, Higuero T, Damon H, Velter A, Abramowitz L. Risk of Fecal Incontinence Following Receptive Anal Intercourse: Survey of 21,762 Men Who Have Sex With Men. J Sex Med 2021; 18:1880-1890. [PMID: 37057489 DOI: 10.1016/j.jsxm.2021.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 05/28/2021] [Accepted: 07/27/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The prevalence of receptive anal intercourse (RAI) is increasing. A few studies, with heterogeneous designs, have investigated the associated risk of fecal incontinence (FI). AIM The primary objective of this study was to determine FI prevalence in a population of men who have sex with men (MSM) engaging in RAI. The secondary objective was to identify risk factors for severe FI. METHODS OUTCOMES An online survey of 24,308 MSM was performed in 2019. Demographic and socioeconomic data were collected, together with information about RAI sexual practices, and FI defined by: "During the last month, have you experienced any involuntary leakage of stools?" RESULTS CLINICAL IMPLICATIONS In total, 1,734 (8%) of the 21,762 participants reported FI. Mean age was 35.3 years. The prevalence of FI was correlated with RAI frequency: 12.7% (if RAI ≥ 1 /wk) versus 5.7% (if no RAI). In multivariate analysis, the factors associated with FI were age (OR: 1.01), low socioeconomic status (OR 1.32 to 1.40), HIV-seropositivity (OR: 1.78), high RAI frequency (OR: 1.64), chemsex (OR: 1.67) and fist-fucking (OR: 1.61). STRENGTHS AND LIMITATIONS Main strengths of our study are population size and assessment of detailed modalities of sexual practices. Main limitations are the use of a convenience non-random sample and the assessment of FI only during the past month. CONCLUSION This study of a large MSM population, highlights risk factors for FI among RAI practices: RAI ≥ 1 /wk, chemsex, fist-fucking, low socioeconomic status. Garros A, Bourrely M, Sagaon-Teyssier L, et al. Risk of Fecal Incontinence Following Receptive Anal Intercourse: Survey of 21,762 Men Who Have Sex With Men. J Sex Med 2021;18:1880-1890.
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Affiliation(s)
- Aurélien Garros
- CH ST Joseph ST LUC - Gastroenterologie, Lyon, Auvergne-Rhône-Alpes, France.
| | - Michel Bourrely
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - Luis Sagaon-Teyssier
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - Abdourahmane Sow
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - Nathalie Lydie
- Public Health France (SPF), Paris, France, Paris, France
| | - Lucie Duchesne
- Public Health France (SPF), Paris, France, Paris, France
| | - Thierry Higuero
- Hepato-Gastroenterology Department, Beausoleil, Beausoleil, France
| | - Henri Damon
- Gastroenterology department, Infirmerie Prostante, Caluire, Caluire, France
| | - Annie Velter
- Public Health France (SPF), Paris, France, Paris, France
| | - Laurent Abramowitz
- Hepato-Gastroenterology and Proctology Department, Bichat University Hospital, Paris, France
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16
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Castry M, Cousien A, Supervie V, Velter A, Ghosn J, Paltiel AD, Yazdanpanah Y, Deuffic-Burban S. Impact of test-and-treat and risk reduction strategies on HCV transmission among MSM living with HIV in France: a modelling approach. Gut 2021; 70:1561-1569. [PMID: 33109688 DOI: 10.1136/gutjnl-2020-321744] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 09/24/2020] [Accepted: 10/02/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Since the early 2000s, there has been an epidemic of HCV occurring among men who have sex with men (MSM) living with HIV, mainly associated with high-risk sexual and drug-related behaviours. Early HCV diagnosis and treatment, and behavioural risk-reduction, may be effective to eliminate HCV among MSM living with HIV. DESIGN We developed a deterministic dynamic compartmental model to simulate the impact of test-and-treat and risk-reduction strategies on HCV epidemic (particularly on incidence and prevalence) among MSM living with HIV in France. We accounted for HIV and HCV cascades of care, HCV natural history and heterogeneity in HCV risk behaviours. The model was calibrated to primary HCV incidence observed between 2014 and 2017 among MSM living with HIV in care (ANRS CO4-French hospital database on HIV (FHDH)). RESULTS With current French practices (annual HCV screening and immediate treatment), total HCV incidence would fall by 70%, from 0.82/100 person-years in 2015 to 0.24/100 person-years in 2030. It would decrease to 0.19/100 person-years in 2030 with more frequent screening and to 0.19 (0.12)/100 person-years in 2030 with a 20% (50%) risk-reduction. When combining screening every 3 months with a 50% risk-reduction, HCV incidence would be 0.11/100 person-years in 2030, allowing to get close to the WHO target (90% reduction from 2015 to 2030). Similarly, HCV prevalence would decrease from 2.79% in 2015 to 0.48% in 2030 (vs 0.71% with current practices). CONCLUSION Combining test-and-treat and risk-reduction strategies could have a marked impact on the HCV epidemic, paving the way to HCV elimination among MSM living with HIV.
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Affiliation(s)
- Mathieu Castry
- Université de Paris, Inserm, IAME, F-75006 Paris, France
| | | | - Virginie Supervie
- Sorbonne Université, Inserm, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Paris, France
| | - Annie Velter
- Department of Infectious Diseases, Santé Publique France, French national public health agency, Saint-Maurice, France
| | - Jade Ghosn
- Université de Paris, Inserm, IAME, F-75006 Paris, France.,Service de Maladies Infectieuses et Tropicales, Hôpital Bichat Claude-Bernard, F-75018 Paris, France
| | - A David Paltiel
- Department of Health Policy and Management, Yale University School of Public Health, New Haven, Connecticut, USA
| | - Yazdan Yazdanpanah
- Université de Paris, Inserm, IAME, F-75006 Paris, France.,Service de Maladies Infectieuses et Tropicales, Hôpital Bichat Claude-Bernard, F-75018 Paris, France
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17
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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El-Khoury F, Puget M, Leon C, du Roscoat E, Velter A, Lydié N, Sitbon A. Increased risk of suicidal ideation among French women: the mediating effect of lifetime sexual victimisation. Results from the nationally representative 2017 Health Barometer survey. Arch Womens Ment Health 2020; 23:635-641. [PMID: 32016550 DOI: 10.1007/s00737-020-01021-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 01/16/2020] [Indexed: 12/01/2022]
Abstract
Sexual victimisation has been associated with suicidal ideation, especially among women; however data on this association from a large sample of general population is surprisingly limited. Also, no study quantifies sex differences in the effect of sexual victimisation on suicide risk. We used data from the French Health Barometer, a general population phone survey, which recruited 25,319 adults aged 18 to 75 years in 2017. Data were weighted to be representative of the French adult population. Three outcomes were examined: (a) suicidal ideation in the preceding year, (b) suicidal imagery (having thought about how to commit suicide), and (c) suicide attempt in the preceding year. We conducted adjusted mediation analyses, using the counterfactual approach, to evaluate the contribution that lifetime sexual victimisation has in the association between sex and suicide risk. Women were around five times more likely to report lifetime sexual violence (9.1% vs 1.9%) and were more at risk of any suicidal ideation (Ora = 1.20 (95%CI: 1.07-1.36)) and suicidal imagery (Ora = 1.39 (95%CI: 1.20-1.61)), but not suicide attempt compared to men in adjusted analysis. In mediation analysis, sexual victimisation explained 49 and 40% of the increased risk women have compared to men in suicidal ideation and suicidal imagery, respectively. Sexual violence is more prevalent among women and explains a substantial share of sex difference in suicide risk. Our findings reiterate the importance of the prevention of sexual violence and an adequate care for victims, especially women, in public health and mental health policies and initiatives.
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Affiliation(s)
- Fabienne El-Khoury
- Sorbonne Université, INSERM UMRS_1136, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Paris, France.
| | | | - Christophe Leon
- French National Public Health Agency, Santé Publique France, Saint-Maurice, France
| | | | - Annie Velter
- French National Public Health Agency, Santé Publique France, Saint-Maurice, France
| | - Nathalie Lydié
- French National Public Health Agency, Santé Publique France, Saint-Maurice, France
| | - Audrey Sitbon
- French National Public Health Agency, Santé Publique France, Saint-Maurice, France
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Ngangro NN, Velter A, Lydie N, Lot F. Authors' response: Prevention of bacterial sexually transmitted infections (STI) in France: a comprehensive approach. ACTA ACUST UNITED AC 2020; 24. [PMID: 30914074 PMCID: PMC6440583 DOI: 10.2807/1560-7917.es.2019.24.12.1900187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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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. Int J 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Annequin M, Villes V, Delabre RM, Alain T, Morel S, Michels D, Schmidt AJ, Velter A, Rojas Castro D. Are PrEP services in France reaching all those exposed to HIV who want to take PrEP? MSM respondents who are eligible but not using PrEP (EMIS 2017). AIDS Care 2020; 32:47-56. [PMID: 32189518 DOI: 10.1080/09540121.2020.1739219] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Pre-exposure prophylaxis (PrEP) is fully reimbursed by the French health insurance system since 2016. However, uptake of PrEP is slower than expected and little is known about men who have sex with men (MSM) who are eligible for PrEP according to French guidelines, but not using it. This study aims to (1) assess and describe MSM that are eligible to PrEP but not using it, and (2) identify potential individual and structural barriers of PrEP uptake among eligible MSM who are aware and intend to take PrEP. Data from EMIS-2017, a cross-sectional internet survey among gay, bisexual, and other MSM, were used. Among 7965 respondents without diagnosed HIV, 9.2% were PrEP users. Among 7231 non-PrEP users, 35.2% were eligible to PrEP and 15.2% were eligible, aware and intended to take PrEP. Eligible MSM who are not using PrEP are mostly younger, students, less "out", living in small cities, using condoms more frequently but still with low self-efficacy regarding safe sex and more distant from preventive health care and information than PrEP users. Despite free PrEP availability in France, results suggest that PrEP is not fully accessible and that there is a need to increase PrEP demand and decentralize PrEP delivery.
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Affiliation(s)
- Margot Annequin
- Community-based Research Laboratory, Coalition PLUS, Pantin, France
| | - Virginie Villes
- Community-based Research Laboratory, Coalition PLUS, Pantin, France
| | | | - Tristan Alain
- Community-based Research Laboratory, Coalition PLUS, Pantin, France.,AIDES, Pantin, France
| | - Stéphane Morel
- Community-based Research Laboratory, Coalition PLUS, Pantin, France.,AIDES, Pantin, France
| | - David Michels
- Community-based Research Laboratory, Coalition PLUS, Pantin, France.,AIDES, Pantin, France
| | | | | | - Daniela Rojas Castro
- Community-based Research Laboratory, Coalition PLUS, Pantin, France.,Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Gaissad L, Velter A. Drogue et sexualité gay sous influence : « Quand on prend ça, c’est fait pour ». Sexologies 2019. [DOI: 10.1016/j.sexol.2019.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Chapin-Bardales J, Schmidt AJ, Guy RJ, Kaldor JM, McGregor S, Sasse A, Archibald C, Rank C, Casabona Barbarà J, Folch C, Vives N, Cowan SA, Cazein F, Velter A, An der Heiden M, Gunsenheimer-Bartmeyer B, Marcus U, Op de Coul ELM, van Sighem A, Aldir I, Cortes Martins H, Berglund T, Velicko I, Gebhardt M, Delpech V, Hughes G, Nardone A, Hall HI, Johnson AS, Sullivan PS. Trends in human immunodeficiency virus diagnoses among men who have sex with men in North America, Western Europe, and Australia, 2000-2014. Ann Epidemiol 2018; 28:874-880. [PMID: 30389234 DOI: 10.1016/j.annepidem.2018.09.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 09/17/2018] [Accepted: 09/24/2018] [Indexed: 11/15/2022]
Abstract
PURPOSE The aim of the article was to investigate recent trends in human immunodeficiency virus (HIV) diagnosis rates among men who have sex with men (MSM) in high-income countries in North America, Western Europe, and Australia. METHODS Data on annual rates of HIV diagnoses among MSM aged 15 to 65 years from 2000 to 2014 were collected from 13 high-income countries. Joinpoint regression software was used to empirically determine country-specific trend periods. Trends in HIV diagnosis rates and in the proportion of diagnoses occurring in young MSM aged 15 to 24 years were analyzed using Poisson regression and log-binomial regression, respectively. RESULTS Six countries experienced an increasing trend from 2000 to 2007-08 followed by either a stable or declining trend through 2014. Five countries had recently increasing trends, and two countries had one stable trend from 2000 to 2014. All 13 countries experienced increases in the proportion of diagnoses occurring in young MSM. CONCLUSIONS Since 2008, half of the 13 high-income countries examined experienced stable or decreasing trends. Still, some countries continue to experience increasing HIV trends, and young MSM are increasingly represented among new diagnoses. Efforts to support early sexual health promotion, reduce barriers to pre-exposure prophylaxis, and improve care engagement for young MSM are critical to addressing current HIV trends.
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Affiliation(s)
| | - Axel J Schmidt
- Swiss Federal Office of Public Health, Bern, Switzerland
| | - Rebecca J Guy
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - John M Kaldor
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Skye McGregor
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - André Sasse
- Institut Scientifique de Santé Publique, Brussels, Belgium
| | | | - Claudia Rank
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Jordi Casabona Barbarà
- Centre d'Estudis Epidemiològics sobre les ITS i Sida de Catalunya (CEEISCAT), Dept Salut, Generalitat de Catalunya, Barcelona, Spain; CIBER Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain
| | - Cinta Folch
- Centre d'Estudis Epidemiològics sobre les ITS i Sida de Catalunya (CEEISCAT), Dept Salut, Generalitat de Catalunya, Barcelona, Spain; CIBER Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain
| | - Núria Vives
- Centre d'Estudis Epidemiològics sobre les ITS i Sida de Catalunya (CEEISCAT), Dept Salut, Generalitat de Catalunya, Barcelona, Spain; CIBER Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain
| | | | | | - Annie Velter
- The French Public Health Agency, Saint-Maurice, France
| | | | | | - Ulrich Marcus
- Robert Koch Institute, Department of Infectious Disease Epidemiology, Berlin, Germany
| | - Eline L M Op de Coul
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | | | | | | | | | - Inga Velicko
- Public Health Agency of Sweden, Stockholm, Sweden
| | | | | | | | | | - H Irene Hall
- US Centers for Disease Control and Prevention, Atlanta, GA
| | - Anna S Johnson
- US Centers for Disease Control and Prevention, Atlanta, GA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Velter A, Sauvage C, Meyer L, Bajos N. Première pénétration anale et usage du préservatif chez les hommes ayant des relations sexuelles avec des hommes : évolution des constructions sociales de l’homosexualité et des normes préventives. Rev Epidemiol Sante Publique 2016. [DOI: 10.1016/j.respe.2016.06.329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Paget LM, Chan Chee C, Sauvage C, Saboni L, Beltzer N, Velter A. Facteurs associés aux tentatives de suicide chez les minorités sexuelles : résultats de l’enquête presse gays et lesbiennes 2011. Rev Epidemiol Sante Publique 2016; 64:153-63. [DOI: 10.1016/j.respe.2016.01.098] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 11/26/2015] [Accepted: 01/04/2016] [Indexed: 11/28/2022] Open
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Méthy N, Velter A, Semaille C, Bajos N. Sexual behaviours of homosexual and bisexual men in France: a generational approach. PLoS One 2015; 10:e0123151. [PMID: 25816322 PMCID: PMC4376702 DOI: 10.1371/journal.pone.0123151] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 02/24/2015] [Indexed: 11/19/2022] Open
Abstract
Objective In high-income countries, the social and epidemiological contexts surrounding homosexuality and AIDS have changed profoundly in recent decades. This work sought to examine key indicators of the long-term sexual trajectories of successive generations of men who have sex with men (MSM) in France. Methods We performed a longitudinal analysis of the French Gay Press surveys, which were self-administered socio-behavioural questionnaires, repeated from 1985 to 2011 in the gay press, and on the internet in 2004 and 2011. An age-cohort analysis using graphical representations and multivariate logistic regressions was conducted among participants aged 18-59 (N=38 821). Results First sexual intercourse occurred more often with a male partner in younger generations than in older ones: 76.0% in MSM who turned 18 in 1956-1959, 75.6% in 1980-1983, 83.7% in 2008-2011, poverall=0.0002). Every generation showed the same pattern of sexual trajectory between 1985 and 2011: globally, the frequency of masturbation increased from the 1985 survey to the early 1990s and then decreased from the late 1990s to the end of the study period. Inversely, the frequency of oral and anal sex decreased in the mid-1980s and increased from 1990 to 2011. The frequency of both oral sex and anal intercourse is currently quite high, regardless of generation (>95% and around 80%, respectively). Compared to their predecessors, recent generations of young MSM reported more frequent oral and anal sex, but fewer male partners in the previous 12 months. Discussion While the increased frequency of first intercourse with a man over successive generations since the 1970s may be related to reduced social pressure for heterosexuality, there is evidence that sexual norms among MSM are widespread, with practices spreading across age groups and generations. Although AIDS profoundly affected sexual practices in the 1980s, further AIDS-related events (discovery of HIV antiretroviral drugs and their use in prevention) do not appear to have accentuated ongoing trends in sexual practices.
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Affiliation(s)
- Nicolas Méthy
- CESP-Inserm U1018, Le Kremlin-Bicêtre, France
- * E-mail:
| | - Annie Velter
- Institut de veille sanitaire, Saint-Maurice, France
| | - Caroline Semaille
- Agence nationale de sécurité du médicament et des produits de santé, Saint-Denis, France
| | - Nathalie Bajos
- CESP-Inserm U1018, Le Kremlin-Bicêtre, France
- Institut national d’études démographiques, Paris, France
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Methy N, Velter A, Semaille C, Bajos N. Analyse générationnelle des trajectoires sexuelles des homo/bisexuels masculins en France depuis 1985. Rev Epidemiol Sante Publique 2013. [DOI: 10.1016/j.respe.2013.07.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Le Vu S, Velter A, Meyer L, Peytavin G, Guinard J, Pillonel J, Barin F, Semaille C. Biomarker-based HIV incidence in a community sample of men who have sex with men in Paris, France. PLoS One 2012; 7:e39872. [PMID: 22768150 PMCID: PMC3387238 DOI: 10.1371/journal.pone.0039872] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Accepted: 05/28/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Population-based estimates of HIV incidence in France have revealed that men who have sex with men (MSM) are the most affected population and contribute to nearly half of new infections each year. We sought to estimate HIV incidence among sexually active MSM in Paris gay community social venues. METHODOLOGY/ PRINCIPAL FINDINGS A cross-sectional survey was conducted in 2009 in a sample of commercial venues such as bars, saunas and backrooms. We collected a behavioural questionnaire and blood sample. Specimens were tested for HIV infection and positive specimens then tested for recent infection by the enzyme immunoassay for recent HIV-1 infection (EIA-RI). We assessed the presence of antiretroviral therapy among infected individuals to rule out treated patients in the algorithm that determined recent infection. Biomarker-based cross-sectional incidence estimates were calculated. We enrolled 886 MSM participants among which 157 (18%) tested HIV positive. In positive individuals who knew they were infected, 75% of EIA-RI positive results were due to ART. Of 157 HIV positive specimens, 15 were deemed to be recently infected. The overall HIV incidence was estimated at 3.8% person-years (py) [95%CI: 1.5-6.2]. Although differences were not significant, incidence was estimated to be 3.5% py [0.1-6.1] in men having had a negative HIV test in previous year and 4.8% py [0.1-10.6] in men having had their last HIV test more than one year before the survey, or never tested. Incidence was estimated at 4.1% py [0-8.3] in men under 35 years and 2.5% py [0-5.4] in older men. CONCLUSIONS/ SIGNIFICANCE This is the first community-based survey to estimate HIV incidence among MSM in France. It includes ART detection and reveals a high level of HIV transmission in sexually active individuals, despite a high uptake of HIV testing. These data call for effective prevention programs targeting MSM engaged in high-risk behaviours.
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Champenois K, Cousien A, Ndiaye B, Soukouna Y, Baclet V, Alcaraz I, Choisy P, Chaud P, Velter A, Gallay A, Yazdanpanah Y. Risk factors for syphilis infection in men who have sex with men: results of a case-control study in Lille, France. Sex Transm Infect 2012; 89:128-32. [PMID: 22679099 DOI: 10.1136/sextrans-2012-050523] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Substantial increases in syphilis have been reported since the early 2000s in northern countries, particularly among men who have sex with men (MSM). The authors aimed to identify risk factors for early syphilis in MSM in Lille, a large urban area of northern France. METHODS A matched case-control study was conducted in MSM aged ≥ 18 years. Cases were diagnosed with primary, secondary or early latent syphilis between April 2008 and June 2010. Controls sought care in STIs clinics or were followed in an HIV clinic. Controls had no history of and no current syphilis. They were matched to cases for age and HIV status. Multivariate conditional logistic regression models were used to identify risk factors for early syphilis. RESULTS 53 patients with early syphilis were enrolled. Average age was 37 years, and 47% were HIV-infected. For analysis, they were matched to 90 controls. Factors associated with syphilis were: low educational attainment (OR=5.38, 95% CI 1.94 to 14.94; p=0.001), receptive oral sex with casual male partners without a condom (OR=4.86, 95% CI 1.63 to 14.48; p=0.005) and anal sex toy use with casual male partners (OR=2.72, 95% CI 1.01 to 7.32; p=0.05). Seeking of sex partners online (OR=5.17, 95% CI 1.33 to 20.11), use of poppers (OR=2.2, 95% CI 1.1 to 4.3) and erectile dysfunction drugs (OR=1.9, 95% CI 1.0 to 13.2) were associated with syphilis only in the univariate analysis. CONCLUSIONS Receptive oral sex without a condom and use of anal sex toys were identified as presenting a major risk of syphilis infection. Although these practices have been shown to present low risk of HIV transmission, the general public is unaware of their impact on transmission of other STIs.
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Affiliation(s)
- Karen Champenois
- ATIP-Avenir Inserm: Modélisation, Aide à la Décision, et Coût-Efficacité en Maladies Infectieuses, Lille, France.
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Chetcuti N, Beltzer N, Methy N, Laborde C, Velter A, Bajos N. Preventive care's forgotten women: life course, sexuality, and sexual health among homosexually and bisexually active women in France. J Sex Res 2012; 50:587-597. [PMID: 22497621 DOI: 10.1080/00224499.2012.657264] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Although studies show that women who have sex with women (WSW) have poorer sexual health and more limited access to health care for gynecological problems than other women, the social processes giving rise to such health differences have not, so far, been explored. These processes may be formed in response to a dominant social norm, which assigns women to a heterosexual and monogamous sexuality. Based on data from a national random survey of sexuality (N = 6,824), enriched by qualitative interviews with WSW (n = 40), this analysis shows that bisexually active women had similar socio-demographic profiles to heterosexually active women, whereas homosexually active women appeared to be more highly educated than other women and less likely to live as couples than bisexually active women. Bisexually active women had more diversified sexual trajectories and sexual networks than other women. Chlamydia prevalence was found to be higher among bisexually active women, and homosexually active women reported fewer medical consultations for gynecological reasons. These analyses highlight the need to deconstruct the binary classification of homosexual versus heterosexual women. Because of constraint by the monogamous heterosexual norm, bisexually active women were less likely to be tested for sexually transmitted infections, and homosexually active women were less likely to have had gynecological follow-ups.
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Affiliation(s)
- Natacha Chetcuti
- Centre for Research in Epidemiology and Population Health, National Institute for Health and Medical Research, Paris, France
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Larsen C, Chaix ML, Le Strat Y, Velter A, Gervais A, Aupérin I, Alric L, Duval X, Miailhes P, Pioche C, Pol S, Piroth L, Delarocque-Astagneau E. Gaining greater insight into HCV emergence in HIV-infected men who have sex with men: the HEPAIG Study. PLoS One 2011; 6:e29322. [PMID: 22216248 PMCID: PMC3245268 DOI: 10.1371/journal.pone.0029322] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Accepted: 11/24/2011] [Indexed: 12/19/2022] Open
Abstract
Objectives The HEPAIG study was conducted to better understand Hepatitis C virus (HCV) transmission among human immuno-deficiency (HIV)-infected men who have sex with men (MSM) and assess incidence of HCV infection among this population in France. Methods and Results Acute HCV infection defined by anti-HCV or HCV ribonucleic acid (RNA) positivity within one year of documented anti-HCV negativity was notified among HIV-infected MSM followed up in HIV/AIDS clinics from a nationwide sampling frame. HIV and HCV infection characteristics, HCV potential exposures and sexual behaviour were collected by the physicians and via self-administered questionnaires. Phylogenetic analysis of the HCV-NS5B region was conducted. HCV incidence was 48/10 000 [95% Confidence Interval (CI):43–54] and 36/10 000 [95% CI: 30–42] in 2006 and 2007, respectively. Among the 80 men enrolled (median age: 40 years), 55% were HIV-diagnosed before 2000, 56% had at least one sexually transmitted infection in the year before HCV diagnosis; 55% were HCV-infected with genotype 4 (15 men in one 4d-cluster), 32.5% with genotype 1 (three 1a-clusters); five men were HCV re-infected; in the six-month preceding HCV diagnosis, 92% reported having casual sexual partners sought online (75.5%) and at sex venues (79%), unprotected anal sex (90%) and fisting (65%); using recreational drugs (62%) and bleeding during sex (55%). Conclusions This study emphasizes the role of multiple unprotected sexual practices and recreational drugs use during sex in the HCV emergence in HIV-infected MSM. It becomes essential to adapt prevention strategies and inform HIV-infected MSM with recent acute HCV infection on risk of re-infection and on risk-reduction strategies.
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Affiliation(s)
- Christine Larsen
- National Institute for Public Health Surveillance (InVS), Saint-Maurice, France.
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Pillonel J, Heraud-Bousquet V, Pelletier B, Semaille C, Velter A, Saura C, Desenclos JC, Danic B. Deferral from donating blood of men who have sex with men: impact on the risk of HIV transmission by transfusion in France. Vox Sang 2011; 102:13-21. [DOI: 10.1111/j.1423-0410.2011.01509.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Leobon A, Velter A, Engler K, Drouin MC, Otis J. A relative profile of HIV-negative users of French websites for men seeking men and predictors of their regular risk taking: a comparison with HIV-positive users. AIDS Care 2011; 23:25-34. [PMID: 21218274 DOI: 10.1080/09540121.2010.498866] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The Net Gay Barometre is a biennial survey among users of France's most popular websites for men who have sex with men (MSM). Given the recent increases in HIV infection and sexual risk practices among French MSM, this study aims to: (1) create a socio-sexual profile of HIV-negative men (HIV-); (2) identify predictors of regular unprotected anal intercourse (RUAI) in this group, and responding to a call for stratifying analyses of online samples of MSM by HIV status; and (3) perform the former two aims by comparing HIV- men with HIV-positive men (HIV+). Statistical analyses were conducted with 11,771 HIV- men and 2130 HIV+ men who completed the online survey between December 2008 and March 2009. Regarding the first aim, fewer HIV- men, relative to HIV+ men, were exposed to factors conducive to sexually transmitted infection; in the previous 12 months, smaller proportions of this group had gone to venues where sexual encounters were possible, engaged in an esoteric sexual activity, had a high number of casual partners, and practiced unprotected anal sex, RUAI or barebacking. However, multivariate regression analyses identifying predictors of RUAI in each group revealed common predictors: sensation-seeking, esoteric activities, oral contact with sperm, and barebacking (in a couple), although odds were generally higher in HIV+ men. Our findings raise the possibility of a sexual culture accentuating pleasure and adventurism that may gain in amplitude once seroconversion takes place.
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Affiliation(s)
- Alain Leobon
- Laboratoire CARTA - UMR Espaces et Societe, Centre National de la Recherche Scientifique, Angers, France.
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Semaille C, Cazein F, Lot F, Pillonel J, Le Vu S, Le Strat Y, Bousquet V, Velter A, Barin F. Recently acquired HIV infection in men who have sex with men (MSM) in France, 2003-2008. Euro Surveill 2009; 14. [DOI: 10.2807/ese.14.48.19425-en] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
An increase in the number of new HIV diagnoses among men who have sex with men (MSM) was observed in several countries in the early 2000s. In this article, we explore the trends among MSM in France between 2003 and 2008. To estimate the number of MSM newly diagnosed with HIV, we take into account the reporting delay, underreporting and missing data for HIV case notification. To identify recent infections (RI) (acquired an average of six months before diagnosis), we used an enzyme immunoassay for recent HIV-1 infections (EIA-RI) which has been performed routinely for new HIV diagnoses since 2003. Multivariate analysis was used to identify factors associated with RI. We estimate that between 1,900 and 2,400 MSM have been newly diagnosed with HIV every year: the proportion of MSM among all newly diagnosed with HIV cases has increased from 25.2% (95% confidence interval (CI): 23.3-27.1) in 2003 to 37.0% (95% CI: 35.2-38.7) in 2008 and was stable during the period 2006-2008. In 2008, the rate of newly diagnosed HIV cases per 10,000 MSM living in France was 72.5. The proportion of non-B subtypes of HIV-1 among cases diagnosed in MSM was 11.7% (2003-2008). The assessment of RI was performed for 4,819 MSM newly diagnosed with HIV in 2003-2008. Of these, 47.6% (95%CI = 46.2-49.0) (2,295 cases) were shown to have been recently infected. The risk of RI was greater for those of French nationality (adjusted odds ratio (aOR) =1.6 [95% CI: 1.4-1.9]), those with high economic status (aOR =1.4 [95% CI: 1.2-1.8]), those tested after a risk exposure (aOR =1.6[95% CI: 1.3-1.8]) or after presenting with clinical symptoms or abnormal biological markers (aOR =1.8 [95% CI: 1.5-2.0]), those who had tested for HIV three or more times during their life-time (aOR =4.2 [95% CI: 3.4-5.2]) and those living in the Paris area (aOR =1.2 [95% CI: 1.0-1.3]). The risk of RI decreased with age. The HIV situation among MSM living in France is a cause of concern, despite the prevention campaigns dedicated to this highly educated sub-population.
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Affiliation(s)
- C Semaille
- Institut de Veille Sanitaire (InVS, French Institute for Public Health Surveillance), Saint Maurice, France
| | - F Cazein
- Institut de Veille Sanitaire (InVS, French Institute for Public Health Surveillance), Saint Maurice, France
| | - F Lot
- Institut de Veille Sanitaire (InVS, French Institute for Public Health Surveillance), Saint Maurice, France
| | - J Pillonel
- Institut de Veille Sanitaire (InVS, French Institute for Public Health Surveillance), Saint Maurice, France
| | - S Le Vu
- Institut de Veille Sanitaire (InVS, French Institute for Public Health Surveillance), Saint Maurice, France
| | - Y Le Strat
- Institut de Veille Sanitaire (InVS, French Institute for Public Health Surveillance), Saint Maurice, France
| | - V Bousquet
- Institut de Veille Sanitaire (InVS, French Institute for Public Health Surveillance), Saint Maurice, France
| | - A Velter
- Institut de Veille Sanitaire (InVS, French Institute for Public Health Surveillance), Saint Maurice, France
| | - F Barin
- Université François Rabelais, Inserm ERI 19, Centre National de Référence du VIH, Tours, France
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Velter A, Bouyssou-Michel A, Arnaud A, Semaille C. Do men who have sex with men use serosorting with casual partners in France? Results of a nationwide survey (ANRS-EN17-Presse Gay 2004). ACTA ACUST UNITED AC 2009; 14. [PMID: 19941805 DOI: 10.2807/ese.14.47.19416-en] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We examined whether men who have sex with men (MSM) in France have adopted serosorting with their casual partners, serosorting being one strategy to reduce the risk of HIV transmission. We expected to see the same predictors of this practice with casual partners in France as in other similar MSM communities (HIV-seropositive, Internet dating). Data from a cross-sectional survey was used, based on a self-administered questionnaire conducted among readers of the gay press and users of gay websites in 2004. The study population consisted of MSM who reported their HIV status, as well as the practice of unprotected anal intercourse (UAI) with a casual partner at least once during the previous 12 months. Among 881 respondents included in the analysis, 195 (22%) had practiced serosorting: 14% among HIV-seropositive men and 26% among HIV-seronegative men. Serosorting was independently associated with the use of cruising venues (AOR 0.28, p=0.001) and Internet dating (AOR 2.16, p=0.051) among HIV-seropositive men, whereas it was independently associated with the use of cruising venues (AOR 0.59, p=0.013) and the fact of having less partners (AOR 1.50, p=0.046) among HIV-seronegative men. Serosorting requires an up-to-date knowledge of HIV serostatus for MSM and their UAI casual partners, and does not prevent from acquiring other sexually transmitted infections. Prevention campaigns are needed to underline the risks associated with serosorting.
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Affiliation(s)
- A Velter
- Unite VIH/sida-IST-VHC-VHB chronique, Department of infectious diseases, French Institute for Public Health Surveillance, Saint-Maurice, France.
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Gambotti L, Batisse D, Colin-de-Verdiere N, Delaroque-Astagneau E, Desenclos JC, Dominguez S, Dupont C, Duval X, Gervais A, Ghosn J, Larsen C, Pol S, Serpaggi J, Simon A, Valantin MA, Velter A. Acute hepatitis C infection in HIV positive men who have sex with men in Paris, France, 2001-2004. Euro Surveill 2005; 10:115-7. [PMID: 16077209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
Abstract
In mid-2004, three Parisian hospital wards informed the Institut de veille sanitaire of recent acute hepatitis C in HIV-infected (HIV+) men who had sex with men (MSM). These cases for whom none of the usual bloodborne routes for hepatitis C (HCV) transmission was found, reported having had unprotected sex. In October 2004, we conducted a retrospective investigation in Parisian hospital wards to explore HCV modes of transmission in recent acute hepatitis C in HIV+ MSM. Patient demographics, clinical and biological status of HIV infection, reasons for HCV testing, sexual behaviour and risk factors for HCV transmission within the 6 months before hepatitis onset were collected from medical records. An anonymous self-administered questionnaire on sexual behaviour within the six months before hepatitis onset was also offered to all cases. We identified 29 cases of acute hepatitis C in HIV+ MSM with onset from April 2001 to October 2004. HIV infection was asymptomatic for 76%. Median age at hepatitis C onset was 40 (28-54) years. In all records, were noted unprotected anal sex, fisting in 21% and a concomitant sexually transmitted infection (STI) in 41%. Median time between HIV diagnosis and HCV infection was 6.5 years (0-22). From the 11 self-administered questionnaires completed, 10 reported an STI, 8 'hard' sexual practices, 6 bleeding during sex and 5 fisting. HCV transmission probably occurred through bleeding during unprotected traumatic anal sex among HIV+ MSM and may be facilitated by STI mucosal lesions. This report stresses the continuous need to strongly advocate safer sex to MSM.
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Affiliation(s)
- L Gambotti
- Institut de veille sanitaire, Saint-Maurice, France
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Josseran L, King G, Velter A, Dressen C, Grizeau D. Smoking behavior and opinions of French general practitioners. J Natl Med Assoc 2000; 92:382-90. [PMID: 10992683 PMCID: PMC2608614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
This report examines smoking prevalence, sociodemographic factors, and the opinions of French general practitioners (GPs) about tobacco control policies. Data from the CFES (Comité Français d'Education pour la Santé) national survey on general practitioners included 1013 respondents. The questionnaire was administered by telephone and a response rate of 65% was attained. Instrumentation included variables related to medical practice, sociodemographic characteristics, and opinions about health behavior. Thirty-four percent of physicians were current smokers. A higher proportion of males smoked compared to women (36.1% vs. 24.9%, p < 0.01), and they consumed on average more cigarettes per day (11.2 vs. 8 cigarettes/day, p < 0.05). Slightly more than 52% of physicians regarded their role in reducing nicotine addiction to be important. Doctors who believed that the physician's role was limited were less likely to advise pregnant women to stop smoking (odds ratio = 0.39, p < 0.001), and nonsmokers were more supportive of bans on smoking in public places. Despite the high prevalence of smoking among French physicians, they can still play an important role in reducing smoking among their patients. Medical school curriculum and continuing medical education programs focusing on prevention and cessation in France should be strengthened to help reduce smoking rates among physicians and the general population.
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Affiliation(s)
- L Josseran
- Service de Santé Publique, University of Paris Nord VI, France
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