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Men who have sex with men (MSM) are an HIV key population in Haiti. However, little data exists on that population and on factors associated with this infection. Our study carried out the factors associated with HIV-positive screening among MSM in a community-based rapid testing program in Haiti between 2015 and 2018. Among the 1416 MSM screened, a third reported that it was their very first HIV test and 7.0% had an HIV-positive test. With a median age of 25 years old [21-29], over half of them were living in urban areas (60.7%) and were in financial precarious conditions (68.6%). Multivariate analysis showed that two factors were significantly associated with an HIVpositive result: having had an STI in the last 12 months, strengthened by psychoactive drug use; transactional sex practice in the last 12 months, strengthened by the age between 18 and 20 years old. These results should be taken into account when developing and implementing targeted and comprehensive HIV prevention programs and services for young MSM in Haiti.

Intraflagellar transport protein 88 (Ift88) is required for ciliogenesis and shear stress-induced dissolution of cilia in embryonic endothelial cells coincides with endothelial-to-mesenchymal transition (EndMT) in the developing heart. EndMT is also suggested to underlie heart and lung fibrosis, however, the mechanism linking endothelial Ift88, its effect on EndMT and organ fibrosis remains mainly unexplored. We silenced Ift88 in endothelial cells (ECs) in vitro and generated endothelial cell-specific Ift88-knockout mice (Ift88endo) in vivo to evaluate EndMT and its contribution towards organ fibrosis, respectively. Ift88-silencing in ECs led to mesenchymal cells-like changes in endothelial cells. The expression level of the endothelial markers (CD31, Tie-2 and VE-cadherin) were significantly reduced with a concomitant increase in the expression level of mesenchymal markers (αSMA, N-Cadherin and FSP-1) in Ift88-silenced ECs. Increased EndMT was associated with increased expression of profibrotic Collagen I expression and increased proliferation in Ift88-silenced ECs. Loss of Ift88 in ECs was further associated with increased expression of Sonic Hedgehog signaling effectors. In vivo, endothelial cells isolated from the heart and lung of Ift88endo mice demonstrated loss of Ift88 expression in the endothelium. The Ift88endo mice were born in expected Mendelian ratios without any adverse cardiac phenotypes at baseline. Cardiac and pulmonary endothelial cells isolated from the Ift88endo mice demonstrated signs of EndMT and bleomycin treatment exacerbated pulmonary fibrosis in Ift88endo mice. Pressure overload stress in the form of aortic banding did not reveal a significant difference in cardiac fibrosis between Ift88endo mice and control mice. Our findings demonstrate a novel association between endothelial cilia with EndMT and cell proliferation and also show that loss of endothelial cilia-associated increase in EndMT contributes specifically towards pulmonary fibrosis.

The objective of this study was to describe stakeholders’ perspectives on the acceptability of WeFLASH© (AADISS, Paris, France), a digital smartphone sexually transmitted infection (STI) patient notification (PN) tool to be launched among French HIV pre-exposure prophylaxis users (PrEPers). In Paris, Lyon, and Nice, we conducted 2-hour focus group discussions with PrEPers (n = 21) and community mediators (n = 10), and one-on-one interviews with PrEP-prescribing physicians (n = 5) and HIV/STI management decision-makers (n = 4). Recordings were transcribed. The analysis focused on perceived benefits and risks. Concerning benefits, participants mentioned that WeFLASH© could provide: improved PN and STI screening, by refining the notification of anonymous partners; customized linkage-to-care, by providing users with tailored information on care; and transferable epidemiological data, by filling a need for real-time data. Participants anticipated risks for: privacy and confidentiality and suggested specific security settings to protect users’ identity; sexual behavior and suggested game-like functions to improve the integration of the tool in sexual contexts; and fairness and emphasized the importance of making WeFLASH© accessible to all men who have sex with men. WeFLASH© could facilitate PN for an increasing proportion of anonymous partners met online, and empower users, including notified partners, on questions of confidentiality and consent, access to STI prevention and screening services, and access to data.

This chapter addresses the emerging regulatory framework for cybersecurity and considers its implications for the provision and use of cloud services. It focuses on cybersecurity measures that target service providers on whom large numbers of consumers and businesses depend, rather than measures triggered by the nature of the data being processed. The chapter first reviews the main elements of the Network and Information Systems (NIS) Directive, one of the principal cybersecurity instruments in the EU. It then examines how cloud providers are regulated as Digital Service Providers (DSPs) under the NIS Directive. Cloud providers are also indirectly regulated by the NIS Directive, when they form part of the supply chain of a regulated operator of essential services (OES), the primary target of the measure. The chapter also looks at other EU legal instruments that impose cybersecurity requirements in relation to specific sectors and activities. Finally, it considers concerns that this new regulatory framework may lead to only incremental improvements in the cybersecurity of Europe's critical infrastructure and digital services, while generating substantial compliance activity, aimed at placating regulators and reassuring the general public.

Digital assets - such as social media accounts, emails, crypto-assets and photographs - are an increasingly important part of people’s lives. But what happens to these assets when someone dies or is incapacitated? Are families able to access them? The Cloud Legal Project worked with the Society of Trust and Estate Practitioners to survey 500+ estate practitioners. The survey asked practitioners about their experiences with clients' digital assets. We found that there are difficulties involved in obtaining access to digital assets on death or incapacity. These difficulties include a lack of clarity around property rights and a lack of cooperation from cloud service providers. Given the sentimental and monetary value such assets can hold, we believe families deserve better. To resolve these problems, we call for improved legislation, more awareness for both estate practitioners and clients, and better cooperation with cloud service providers.

Mutations in the tumor suppressor gene BRCA2 (BReast CAncer susceptibility gene 2) predispose carriers to breast, ovarian, and other cancers. In response to DNA damage, BRCA2 participates in homology‐directed DNA damage repair to maintain genome stability. Genome‐wide association studies have identified an association between BRCA2 single nucleotide polymorphisms and plasma‐lipid levels and lipid deregulation in humans. To date, DNA damage, apoptosis, and lipid deregulation are recognized as central pathways for endothelial dysfunction and atherosclerosis; however, the role of BRCA2 in endothelial dysfunction remains to be elucidated. To determine the role of BRCA2 in endothelial dysfunction, BRCA2 was silenced in human umbilical vein endothelial cells (ECs) and assessed for markers of DNA damage, apoptosis, and endothelial function following oxidized low‐density lipoprotein (oxLDL) treatment. OxLDL was found to induce significant reactive oxygen species (ROS) production in BRCA2‐silenced ECs. This increase in ROS production was associated with exacerbated DNA damage evidenced by increased expression and activation of DNA double‐stranded break (DSB) marker γH2AX and reduced RAD51‐foci formation—an essential regulator of DSB repair. Increased DSBs were associated with enhanced expression and activation of pro‐apoptotic p53 and significant apoptosis in oxLDL‐treated BRCA2‐silenced ECs. Loss of BRCA2 in ECs was further associated with oxLDL‐induced impaired tube‐forming potential and eNOS expression. Collectively, the data reveals, for the first time, a novel role of BRCA2 as a regulator of EC survival and function in the setting of oxLDL treatment in vitro. Additionally, the data provide important clues regarding the potential susceptibility of BRCA2 mutation carriers to endothelial dysfunction, atherosclerosis, and other cardiovascular diseases., We, for the first time, demonstrate that BRCA2 is basally expressed in endothelial cells. Loss of BRCA2 in endothelial cells significantly exacerbated oxLDL‐induced DNA damage and apoptosis indicating that BRCA2‐mutation positive individuals might be at increased risk of endothelial dysfunction–associated diseases.

International audience; 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.

International audience; Communities have been a driving force in the response to the HIV epidemic, advocating for research, the access to treatment and healthcare, and human rights for key populations (KP) and people living with HIV (PLHIV). The importance of community engagement (CE) in the development and implementation of pertinent programmes throughout the HIV care continuum has been widely recognized 1-3. In the context of increasing pre‐exposure prophylaxis (PrEP) research, interest and access (though still limited), there is an opportunity to have a fresh look at CE regarding HIV/STI research and care delivery. France, where PrEP has been authorized and fully reimbursed since 2016, may provide key lessons for CE in the provision of comprehensive, culturally adapted HIV/STI prevention and treatment services.

How will blockchain technology impact telecoms policy and regulation? This short paper looks at the possible adoption of blockchain technology in the telecoms sector, both by industry and by regulators, and considers what impact this might have on the regulatory framework. It is published in IIC InterMedia Magazine, January 2019, Volume 46 Issue 04.

Distributed ledger technologies (DLTs) are receiving much attention. As discussion focuses on the potential applications of DLTs, Blockchain-as-a-Service (BaaS) offerings are emerging to provide the underlying supporting infrastructure. BaaS entails a service provider supplying and managing aspects of a DLT infrastructure to facilitate and bring efficiencies regarding the development, experimentation, deployment, and the ongoing management of DLT applications. However, much of the interest in DLTs stems from their potential to decentralise, disintermediate, and enable ‘trustless’ interactions. At first sight, BaaS – being offered by a provider – appears to run counter to this. In practice, whether BaaS raises substantive trust concerns depends on the nature of the offering, the application's specifics, and the participants' goals and risk appetite. This paper elaborates the nature of BaaS and explores the trust considerations it raises, particularly regarding the role of providers as part of a wider infrastructure.

Background Monitoring of emerging modes of drug consumption in France has identified new patterns of injection among youths with diverse social backgrounds, which may explain the persistence of high rates of hepatitis C virus infection. The circumstances surrounding the first injection have been poorly documented in the group of heavy drug users and in the context of the French opioid substitution treatment (OST) policy that provides expanded access to high-dosage buprenorphine (BHD) Methods An Internet survey (Priminject) was conducted from October 2010 to March 2011 with French drug users. Four time periods were compared based on critical dates throughout the implementation of the Harm Reduction Policy in France. Results Compared with drug users who injected for the first time prior to 1995, the aspects of drug use for users who recently injected for the first time were as follows: (1) experimentation with miscellaneous drugs before the first injection; (2) an older age at the time of first injection; (3) heroin as the drug of choice for an individual's first injection, notwithstanding the increased usage of stimulant drugs; (4) BHD did not appear to be a pathway to injection; and (5) an increased number of users who injected their first time alone, without the help or presence of another individual. Conclusion The PrimInject study showed that there is a group of injection drug users that is larger than the group of injection drug users observed in previous studies; therefore, it is necessary to diversify programs to reach the entire spectrum of high-risk users.