[Transitions, reinventing the genre]

Our consultations are saturated by an influx of requests from young people - and very often from their parents - for whom the binarity of the boy/girl classification has been shattered, and whose only watchword is: "I choose my gender, my sexuality, my body, my way of being, of moving and representing myself, I want to become what I am". For them, anatomy is no longer a fatality: hormones, mutilating and restorative surgeries, increasingly sophisticated aesthetic techniques make it possible to adapt their body and their gender to their intimate aspirations. Psychological support must help these patients to explore their gender identity, and allow them to live it as well as possible in their social and family environment.

[Families and transitions]

Today, more and more young people are questioning the fixations of identity. They claim the right to invent themselves and invite adults to deconstruct the boundaries between masculine and feminine, between heterosexuality and homosexuality. Parents are often disconcerted by this, especially when they are confronted with transgender issues in their child or adolescent. They react in different ways, from guilt to rejection, from resignation to support. The work of professionals, especially psychiatrists, does not consist so much in identifying the sources of gender issues as in creating a space for listening and supporting young people who are at particular risk of suicide.

Do Radicalized Minors Have Different Social and Psychological Profiles From Radicalized Adults?

Introduction: Radicalization is a major issue in Western societies. Supposedly, there is no predefined pathway leading to radicalization. However, youth appears to be at risk for radicalization. The aim of this study was to compare the social and psychological profiles of radicalized minors and radicalized adults. Methods: This cross-sectional study is based on the first large prospective sample of young French individuals (N = 150) who aimed to join the Islamic State (IS) between 2014 and 2016. This sample included 70 adolescents (mean age 15.82 years old, SD 1.14) and 80 young adults (mean age 23.32 years, SD 4.99). We compared the two groups on their sociodemographic and psychological characteristics. Results: Radicalized minors and radicalized adults have different profiles and follow different paths in the radicalization process. Among the group of minors, there are significantly more female subjects (81.4% versus 55.0%, adj. p = 0.007) and more self-harm history before radicalization (44.3% versus 16.2%, p <0.001). In addition, there are significantly less attempts to radicalize the entourage (24.3% versus 50.0%, adj. p = 0.007), and a tendency to show less cases of radicalization among the entourage (32.9% versus 52.5%, adj. p = 0.075) and less radicalization through physical encounter (45.7% versus 65%, adj. p = 0.082). Discussion: Overall, radicalized minors appear to be more psychologically vulnerable individuals than radicalized adults. These differences highlight the importance of tailored interventions in order to prevent radicalization among vulnerable adolescents.

Internet-using men who have sex with men would be interested in accessing authorised HIV self-tests available for purchase online

Men who have sex with men (MSM) recruited in sex venues have been shown to be interested in accessing HIV home-tests if reliable and authorised tests were available. To what extent is this true for MSM recruited online? In an online survey in French on the use of unauthorised HIV home-tests purchased online, MSM previously unaware of the existence of these tests were asked if they would be interested in accessing them if these tests were authorised. Among 5908 non-HIV positive respondents, 86.5% expressed interest. Independent variables associated with interest included: being younger, living in smaller towns, having a job but not tertiary education and living in a conventional family with one's parents or a wife and family. Interested men were also more likely to have never done the standard HIV test or not in the last year, to have casual sex partners but on average not more than once a week, to take sexual risks with these partners, to live their sex-lives with men in absolute secrecy and yet often to try to make a date to see their sex partners again. Of the 5109 respondents interested in accessing self-tests purchasable online, 4362 (85.4%) answered an open question on their reasons for being interested. Using thematic analysis, principle themes identified proved to be similar to those found in earlier studies with MSM recruited in sex venues: convenience, rapidity accessing results and privacy. In answer to a closed question, men not interested chose as reasons: satisfaction with current method, doubts about reliability, not wanting to be alone when discovering results and fear of incorrect use. In conclusion, although the online questionnaire may have introduced selection bias over-representing men already interested, many Internet-using MSM are interested in accessing self-tests available for purchase online.

Access to and use of unauthorised online HIV self-tests by internet-using French-speaking men who have sex with men

OBJECTIVES

Although not authorised in France, HIV self-tests are easily available online. The authors questioned French-speaking internet-using men who have sex with men (MSM) concerning their access to and use of such tests.

METHODS

Online questionnaire on sex websites and gay and HIV community websites. A multivariate logistic regression for rare events was used to identify factors associated with accessing self-tests.

RESULTS

9169 MSM completed the questionnaire. 2748 (30%) were aware of online self-tests, but only 82 of those aware and not already HIV positive (3.5%) declared having accessed one and only 69 using it. In the multivariate model, living one's sex-life with men in absolute secrecy (odds ratio (OR)=3.90, 95% CI 1.73 to 8.76), knowing of the tests via a sex partner (OR=3.42, CI 1.39 to 8.41) or an internet search engine (OR=2.18, CI 1.26 to 3.74) but not through the general (OR=0.21, CI 0.11 to 0.42) or the gay press (OR=0.34, CI 0.16 to 0.73), having unprotected anal intercourse with a casual partner in the preceding year (OR=1.90, CI 1.17 to 3.06), using self-tests for other diseases (OR=2.66, CI 1.43 to 4.90), using poppers (OR=2.23, CI 1.35 to 3.67) and doping products (OR=3.53, CI 1.55 to 8) in the preceding year, having done a traditional HIV test but not in the preceding year (OR=1.93, CI 1.14 to 3.32), never having had suicidal thoughts (OR=0.54, CI 0.32 to 0.90) and living in the provinces (OR=1.80, CI 1.01 to 3.25) were all independently associated with accessing self-tests.

CONCLUSIONS

Although readiness to admit use of unauthorised medical products may have influenced results, few MSM aware of the existence of self-tests actually declared having accessed one. Accessing the self-test was independently associated with both living one's sex-life with men in total secrecy and having had unprotected anal intercourse in the last 12 months, indicating that autonomous self-testing may reduce barriers to testing for this vulnerable population.

Evaluation of a peer support group therapy for HIV-infected adolescents

OBJECTIVE

To assess the effects of a peer support group therapy on HIV-infected adolescents.

DESIGN

A prospective study of a cohort of HIV-infected adolescents participating or not participating in a psychodynamic oriented, emotional support group.

METHODS

From a group of 30 perinatally HIV-infected adolescents who attended an outpatient clinic, 10 agreed to participate in the peer support group (group 1), 10 declined (group 2) and 10 others who lived too far from the clinic were not invited to participate (group 3). The three groups were compared at baseline and 2 years later using the outcome measures: perceived illness experience scale, perceived treatment inventory, self-esteem inventory.

RESULTS

At baseline, the three groups had similar characteristics overall. The adolescents' self-esteem was in the normal range. After 2 years, worries about illness had decreased in group 1, whereas the scores had increased or remained the same for the other adolescents (P = 0.026). The adolescents in group 1 had less negative perception of treatment at 2 years than those in groups 2 and 3 (P = 0.030). After intervention, the percentage of adolescents with an undetectable viral load had increased in group 1 from 30 to 80% (P = 0.063) but was unchanged in groups 2 and 3. Considering the three groups altogether, the decrease in the viral load correlated with improvement of the perceived treatment inventory (Spearman R = 0.482 P = 0.015).

CONCLUSIONS

: This pilot study suggests that a peer support group intervention is associated with an improvement in adolescents' emotional well being, and that this can have a positive influence on medical outcomes.