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Purpose: The MAKASI intervention aimed to empower Sub-Saharan African immigrants living in precarious situations in the Paris metropolitan area. Because there are factors specifically related to immigration that may increase the risk for common mental disorders, the present study aimed to examine participants' levels of depression and loneliness and analyze the effect of the intervention on depression and loneliness. Methods: The MAKASI study was designed as a stepped wedge cluster randomized trial. Study participants were recruited through an outreach program led by a nongovernmental organization and randomly assigned to two clusters, with an intervention delay of 3 months between them. Participants were assessed for 6 months after inclusion and the effect of the intervention on depression and loneliness was assessed using generalized linear mixed models. The study was conducted from 2018 to 2021 and took in consideration whether being interviewed during one of the Covid-19 confinement had an effect on the results. Results: Between 2018 and 2021 a total of 821 subjects participated in the Makasi study. High levels of depression and loneliness were found in the study population. We found no effect of the intervention on depression [95% CI 0.77 to 2.40]. Similarly, no effect of the intervention was found on loneliness [95% CI 0.87 to 2.54]. Conclusions: The intervention tested did not appear to improve the level of depression and loneliness among participants. However, the high prevalence of mental and emotional problems in the study population suggests a public health crisis among immigrants in the greater Paris area. Clinical Trial Registration Number: Trial registration Clinicaltrials.gov, NCT04468724 (July 13, 2020). [ABSTRACT FROM AUTHOR]

Background: A pilot HIV testing programme, Au Labo sans Ordo (ALSO; "to the laboratory without prescription") was implemented in two French Fast-Track Cities Initiative areas from 07/2019 to 12/2020. ALSO aimed to remove barriers to HIV testing by providing free testing with widespread access through all laboratories, extended opening hours, and no prescription requirements. Objectives: Assessing the ALSO programme in terms of testing activity, user characteristics, and costs, compared to other HIV testing offers. Methods: Laboratories and STI clinics reported the monthly numbers of tests performed and positive tests. Two short surveys were carried out 12 months apart in people who sought HIV testing. In each offer, the mean costs of HIV testing have been estimated according to negative or positive results using a microcosting approach. Results: During the study period, 214/264 laboratories reported performing 38,941 ALSO tests that accounted for 7.2% of laboratory HIV testing activity. Positivity rates of ALSO and prescribed tests were similar (2.2/1000) but lower than that in STI clinics (6.0/1000). Heterosexual men, and individuals with multiple sexual partners, poor health insurance and few visits to GPs were more likely to use the ALSO offer than tests upon prescription. Compared to ALSO, STI clinic users were younger, more exposed to HIV and with a less favourable socio-economic situation. ALSO had low costs: €13 for a negative test, €163 for a positive test and €5,388 to identify an HIV-positive person (versus €9,068 in STI clinics and €20,126 with prescribed tests). Conclusion: ALSO has attracted users less likely to visit STI clinics or to seek a prescribed test, particularly heterosexual men. Activities, user profiles and costs suggested the complementarity of the HIV testing offers and the relevance of making them coexist. French health authorities have decided to maintain and expand this programme to complement existing HIV testing offers. [ABSTRACT FROM AUTHOR]

Background Aspirational targets to end AIDS by 2030 include having 95% of people with human immunodeficiency virus (HIV; PWH) diagnosed, 95% treated, and 95% with controlled viral load (VL). Our objective was to describe, using a large French prospective cohort, the median transition times through the cascade of care between 2009 and 2019. Methods We analyzed patients whose first HIV diagnosis was made between 1 January 2009 and 31 December 2019. Using the Kaplan–Meier method, we estimated the time to linkage to care (from HIV diagnosis to first biological assessment), to treatment (date of first antiretroviral therapy [ART] prescription), and to controlled VL (first value <200 copies/mL). Analyses were disaggregated by time periods and patients' characteristics. Censoring date was 31 December 2021. Results Among the 16 864 patients linked to care since 2009, the median [Q1; Q3] time from HIV diagnosis to controlled VL decreased from 254 [127–745] to 73 [48–132] days in 2009–2011 and 2018–2019, respectively. Transition times from linkage to care to first ART decreased from 67 [17; 414] in 2009–2011 to 13 [5; 26] days in 2018–2019, and from ART to controlled VL from 83 [35; 130] in 2009–2011 to 38 [28; 90] days in 2018–2019. Differences were observed depending on patients' characteristics. Conclusions We describe drastic reductions in transition time through the cascade of care, allowing reduction in the transmission period following each new infection. Delayed diagnosis remains the main obstacle to ending AIDS in the next decade. [ABSTRACT FROM AUTHOR]

Objectives: Few studies have addressed the long-term consequences of adverse childhood experiences among women in Oceania, in particular among indigenous women. This paper aims to report prevalences of childhood sexual abuse (CSA) and to asses the negative sexual health consequences in adulthood by comparing indigenous Kanak to non-Kanak women in New Caledonia. Methods: Data come from a population survey on violence against women and health. Face-to-face interviews were conducted in 2002-2003 with adult women randomly selected from the electoral list. Separate models for Kanak (n = 329) and non-Kanak women (n = 426) were performed. Regression models adjusted for relevant socio-demographics factors were conducted to estimate the odds ratios for the associations between childhood sexual abuse and adult sexual health outcomes. Results: A non-significant difference between Kanak (11.8%) and non-Kanak women (14.4%) was found for the prevalence of CSA. Among Kanak women, CSA increases the risk of sexually transmitted infections, of non-desired sexual intercourse with an intimate partner and of experience of adult sexual violence. However, use of modern contraception as an adult was more frequent among CSA Kanak victims, as compared to other Kanak women. Among non-Kanak women, only abortion appeared significantly associated with CSA. Conclusions and Practice implications: The findings show that in all ethnic communities of New Caledonia, a history of child sexual abuse is not rare among women. They also shed light on the long-term consequences of CSA, suggesting that the effect of CSA may differ according to ethnic membership and subsequent social stratification and gender norms. Efforts to break the silence around violence against girls and establish a stronger foundation are required in New Caledonia. Prevention programs on violence against women and sexual health that take into account the cultural and social heterogeneity are needed. (Contains 3 tables.)

Introduction Pre?exposure prophylaxis (PrEP) with tenofovir disoproxil fumarate (TDF) ? emtricitabine (FTC) raises a lot of expectations to hamper HIV epidemic due to its high effectiveness to prevent HIV acquisition [...], : Introduction: Daily pre?exposure prophylaxis (PrEP) with tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) is associated with a small but statistically significant decrease in estimated glomerular filtration rate (eGFR). We assessed the renal safety of on?demand PrEP with TDF/FTC in HIV?1 uninfected men. Methods: We used data from the randomized double?blind placebo?controlled ANRS?IPERGAY trial and its open?label extension conducted between February 2012 and June 2016 among HIV?uninfected MSM starting on?demand PrEP. Using linear mixed model, we evaluated the mean eGFR decline from baseline over time and determined risks factors associated with eGFR decline during the study. Results: During the blind phase, with a median follow?up of 9.4 months, the mean decline slope of eGFR from baseline was ?0.88 and ?1.53 mL/min/1.73 m[sup.2] per year in the placebo (n = 201) and the TDF/FTC group (n = 198) respectively, with a slope difference of 0.65 mL/min/1.73 m[sup.2] per year (p = 0.27). Including both phases, 389 participants started on?demand TDF/FTC with a median follow?up of 19.2 months and a mean decline of eGFR from baseline of ?1.14 mL/min/1.73 m[sup.2] per year (p < 0.001). The slope of eGFR reduction was not significantly different in participants with baseline eGFR ? 90 mL/min/1.73 m[sup.2] (p = 0.44), age >40 years (p = 0.24) or hypertension (p = 0.21). There was a dose?response relationship between recent tenofovir exposure and lower eGFR when considering the number of pills taken in the two months prior the visit (eGFR difference of ?0.88 mL/min/1.73 m[sup.2] between >15 pills/month vs. ?15 pills/month, p < 0.01) or plasma tenofovir concentrations at the visit (eGFR difference compared to ?2 ng/mL: >2 to ?10ng/mL: ?0.98 mL/min/1.73 m[sup.2] , >10 to ?40ng/mL: ?1.28 mL/min/1.73 m[sup.2] , >40 ng/mL: ?1.82 mL/min/1.73 m[sup.2] , p < 0.001). Three participants discontinued TDF/FTC for eGFR < 60 mL/min/1.73 m[sup.2] during the OLE phase. No case of Fanconi syndrome was reported. Conclusions: The renal safety of on?demand PrEP with TDF/FTC was good. The overall reduction and intermittent exposure to TDF/FTC may explain this good renal safety.

Introduction Antiretroviral treatment (ART), when taken early has several benefits, both in terms of morbidity and mortality and in terms of reduction in HIV sexual transmission. Mathematical modelling work suggested [...], : Introduction: The universal test?and?treat (UTT) strategy aims to maximize population viral suppression (PVS), that is, the proportion of all people living with HIV (PLHIV) on antiretroviral treatment (ART) and virally suppressed, with the goal of reducing HIV transmission at the population level. This article explores the extent to which temporal changes in PVS explain the observed lack of association between universal treatment and cumulative HIV incidence seen in the ANRS 12249 TasP trial conducted in rural South Africa. Methods: The TasP cluster?randomized trial (2012 to 2016) implemented six?monthly repeat home?based HIV counselling and testing (RHBCT) and referral of PLHIV to local HIV clinics in 2 × 11 clusters opened sequentially. ART was initiated according to national guidelines in control clusters and regardless of CD4 count in intervention clusters. We measured residency status, HIV status, and HIV care status for each participant on a daily basis. PVS was computed per cluster among all resident PLHIV (?16, including those not in care) at cluster opening and daily thereafter. We used a mixed linear model to explore time patterns in PVS, adjusting for sociodemographic changes at the cluster level. Results: 8563 PLHIV were followed. During the course of the trial, PVS increased significantly in both arms (23.5% to 46.2% in intervention, +22.8, p < 0.001; 26.0% to 44.6% in control, +18.6, p < 0.001). That increase was similar in both arms (p = 0.514). In the final adjusted model, PVS increase was most associated with increased RHBCT and the implementation of local trial clinics (measured by time since cluster opening). Contextual changes (measured by calendar time) also contributed slightly. The effect of universal ART (trial arm) was positive but limited. Conclusions: PVS was improved significantly but similarly in both trial arms, explaining partly the null effect observed in terms of cumulative HIV incidence between arms. The PVS gains due to changes in ART?initiation guidelines alone are relatively small compared to gains obtained by strategies to maximize testing and linkage to care. The achievement of the 90?90?90 targets will not be met if the operational and implementational challenges limiting access to care and treatment, often context?specific, are not properly addressed. Clinical trial number: NCT01509508 (clinicalTrials.gov)/DOH?27?0512?3974 (South African National Clinical Trials Register).

The French system for drug substitution, or maintenance treatment, established in 1996, differs from the often strict conditions attached to methadone clinics in other countries. Because of the predominant role of general practitioners and the flexible prescription rules for Subutex[R] in France, the relationship between the physician and the drug user becomes a central element in the treatment. This article deals with the expectations that these users have of the physician, and their perception of his or her attitude towards them. In order to identify possible reasons for the absence of treatment compliance and of Subutex[R] misuse, it focuses on the users' assessment of the physician's response to the problems they report. This study, based on a diversified convenience sample of 28 persons (19 men, 9 women) in treatment, showed 4 patterns of relationships between physicians and users, which differed in their focus: (1) closely focused on the posology of the prescription; (2) compliance with the prescribed regimen is the main issue in a relationship dominated by the physician; (3) an alliance between the physician and the user who is acknowledged as a person, and (4) a instrumental solely on the part of the user, who comes to procure a free, legal drug from a doctor's office. In all four case types, users had difficulty reporting other drug use or intravenous Subutex[R] injection within this relationship, in which the stigma attached to drug dependence seems to reappear. Moreover, the lack of clarity about the treatment objectives and the time frame of the consultation limits the users' ability to integrate the treatment into their lives and to commit themselves to it. The heterogeneity and fragility of the users' situations, and the treatment objectives require regular assessment during contact with the physician. This constant reappraisal of the situation with the physician should help to optimize the treatment and avoid the hiatus that can generate or continue 'misuse.' Keywords: France; Drug use; Substitution treatment; Buprenorphine; Doctor-user relationship; Drug users' views

Objectives. We sought to measure the difference in employment rates between HIV-seropositive and HIV-seronegative persons and to establish whether this difference varied according to the HIV-infected persons' socioeconomic position as defined by education level. Methods. We used data from the VESPA (VIH: Enquete Sur les Personnes Atteintes) study, a large cross-sectional survey conducted among a nationally representative sample of 2932 HIV-infected patients in France. Age-, gender-, nationality-, and education-standardized employment rates were estimated with the French general population as the reference. The differences in employment rates with the general population were computed overall and according to education level. Results. Compared with that of the general population, the overall employment rate was 25% lower (95% confidence interval [CI] = 16%, 32%) among HIV-infected patients diagnosed before 1994 and 9% lower (95% C1=5%, 16%) among HIV-infected patients diagnosed from 1994 onward. The difference in employment rates with the general population was significantly higher among patients with a low education level. The employment rate of highly educated HIV-infected patients diagnosed from 1994 onward did not differ from that of the general population. Conclusions. HIV infection was associated with decreased workforce participation among those with a Iow education level but not among highly educated individuals. doi:10.2105/AJPH.2005.081083

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.socscimed.2006.07.029 Byline: Maria Melchior (a), France Lert (a), Magali Martin (b), Isabelle Ville (b) Keywords: Lifecourse; Socioeconomic position; Functional limitations; France Abstract: Research shows that lifetime socioeconomic circumstances are associated with adult health. Yet most studies to date have focused on mortality and additional data on morbidity outcomes are needed. Additionally, most research in this area has been conducted in Northern European countries or in the United States, and less is known about the extent of socioeconomic inequalities in health in other industrialized countries with different health and labour market characteristics. In this study, we examined the relationship between the socioeconomic trajectory from childhood to adulthood and functional limitations in midlife in France. We used data from a nationally-representative sample of French men and women conducted in 2002-2003 (the Life History survey). Participants (n=4798) were 35-64 years of age at the time of the survey. standardized morbidity ratios (SMRs) associated with different lifelong trajectories were estimated using indirect age standardization. Overall, the socioeconomic trajectory from childhood to adulthood was associated with functional limitations in midlife in both men and women. The experience of lifelong socioeconomic disadvantage was associated with SMRs of 1.44, p Author Affiliation: (a) INSERM (National Institute of Health and Medical Research), U687-IFR69, 14 rue du Val d'Osne, 94415 Saint Maurice, France (b) INSERM (National Institute of Health and Medical Research), U750-IFR69, Villejuif, France Article Note: (footnote) [star] The authors wish to thank Myriam Khlat and Avshalom Caspi, whose comments helped improve the paper. This research was funded by France's Ministry of Health (MIRE-DREES); 'Exploitation de l'enquete Histoire de Vie'. Maria Melchoi was funded by the Sociobiomedical Research Program of France's National Institute for Health and Medical Research (INSERM-CNRS).

The influences of lifestyle characteristics and health-related quality of life (HRQL) on unsafe sex with casual partners in a representative sample of HIV-infected gay men are assessed. Risky sexual behavior with casual partners is frequent among HIV-infected gay men and this behavior is related to poor mental HRQL.

The preventive programs are carried out to increase the knowledge of HIV postexposure prophylaxis (PEP) among HIV-positive individuals. Lack of knowledge is associated with older age, low educational level, and lack of ability to confide in nurses and to seek out information from various sources.