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Additional file 1. Modified MARAIS Score (modified from Marais et al. [27]).

Additional file 1. Supplementary material relative to methods applied and results presented in the main manuscript

Additional file 1. Semistructured qualitative guide for interviews with women living with HIV. Qualitative guide used during semistructred inteviews with women living with HIV.

Manuela Viviano,1 Pierre DeBeaudrap,2 Pierre-Marie Tebeu,3 Jovanny T Fouogue,3 Pierre Vassilakos,4 Patrick Petignat1 1Gynecology Division, Geneva University Hospitals, Geneva, Switzerland; 2Centre Population et Développement – UMR 196, Institute of Research for the Development, University of Paris-Descartes, Paris, France; 3Faculty of Medicine and Biomedical Sciences and Centre Hospitalier Universitaire (CHUY), Yaoundé, Cameroon, Africa; 4Geneva Foundation for Medical Education and Research, Geneva, Switzerland Abstract: Cervical cancer (CC) is a leading cause of cancer-related death and a major public health issue in sub-Saharan Africa. This heavy burden parallels that of the human immunodeficiency virus (HIV) infection, which increases the risk of developing CC. Despite the progressive reduction of HIV prevalence in the past decade, the CC incidence and mortality rates in sub-Saharan Africa remain high. The heterogeneity of the distribution of the two diseases in the African continent, together with the different availability of human and material resources, stands in the way of finding an appropriate screening strategy. The lack of high-quality evidence on the prevention of CC for HIV-positive women, which is necessary for the implementation of efficient screening and treatment strategies, results in the absence of a clearly defined program, which is responsible for the low screening uptake and high mortality rates in sub-Saharan Africa. By taking advantage of the HIV-positive women’s frequent access to health facilities, one way to increase the CC screening coverage rates would be by providing integrated HIV and screening services within the same infrastructure. With the increasing availability of cost-effective methods, screening is becoming more andmore available to women who have limited access to health care. Moreover, the introduction of point-of-care technologies for human papillomavirus testing and the subsequent implementation of screen-and-treat strategies, by reducing the number of clinical appointments and, in the long term, the loss to follow-up rates, open up new opportunities for all women, regardless of their HIV status. The purpose of this review is to provide an insight into the different screening practices for CC in order to help define one that is adapted to the resources and necessities of HIV-positive women living in middle-to-low income countries. Keywords: cervical cancer, screening, human papillomavirus (HPV), human immunodeficiency virus (HIV)

International audience; Les personnes sourdes constituent en Afrique subsaharienne une minorité importante fortement exposée aux pratiques sexuelles à risques. Peu de travaux prennent pourtant en compte leur situation. La méconnaissance de cette population et de leurs langues des signes en fait un groupe d’exclus parce que difficile à atteindre.Cette étude qualitative menée à Ouagadougou, Burkina Faso, s’intègre dans un programme de recherche plus large mené par Handicap International et l’Institut de Recherche pour le Développement sur la vulnérabilité des personnes handicapées face au VIH, au Cameroun et au Burkina Faso. Une centaine d’entretiens semi directifs ont été menés auprès : d’hommes et de femmes sourds communiquant en langue des signes, de membres de leurs familles, de personnels soignants et/ou associatifs. Le côté novateur de ce travail tient à la prise en compte des différents niveaux de langue des signes (très hétérogènes selon le niveau de scolarisation et socialisation), à l’étroite collaboration entre chercheur et assistant de recherche sourd et à l’utilisation de la caméra.La recherche met en avant :1/ Des modes de connaissances distinctifs : accès à l’information très limité, modes de transmission du VIH mal connus, déformation d’information et faibles moyens de protection, absence des Sourds au sein des structures de suivi VIH, remise en cause de la confidentialité des informations à communiquer au patient en présence d’un accompagnant entendant2/ Des modes de vie spécifiques : pratiques sexuelles marquées par la fréquence de multipartenariats (peu de relations stables, grossesses multiples et violences sexuelles), forte précarité, sentiment d’exclusion social et familial. Peu scolarisés et cantonnés aux tâches ménagères, les Sourds sont souvent contraints de se livrer à des activités génératrices de revenus pouvant les exposer à de gros risques. Des réseaux de « mendicité par les papiers » sont développés au Burkina Faso et dans les pays avoisinants, par des chefs sourds locaux et étrangers. Les filles sourdes recrutées (« pêchées ») et emmenées à l’étranger sont généralement soumises à une exploitation sexuelle. Invisibles et peu entendus, les Sourds sont très fortement exposés aux pratiques sexuelles à risques, dont la principale vulnérabilité est l’absence d’une prévention adaptée, en particulier par des professionnels sourds, et d’échanges avec les soignants. Il semble urgent de prendre en compte la langue des signes et de mettre en place une recherche action engagée au sein de structures de références. La question de la « mendicité par les papiers », connue et cachée par une grande partie de la communauté sourde, mérite d’être prise très au sérieux. Elle nous éclaire sur la situation des Sourds au Burkina Faso (et en Afrique de l’ouest) et devient un axe central dans la compréhension des pratiques sexuelles à risques.

Summary Background In resource-limited settings, people with disabilities have been left behind in the response to HIV. In the HandiVIH study, we estimate and compare HIV prevalence and associated risk factors between people with and without disabilities. Methods In this cross-sectional, population-based, observational study, we used two-phase random sampling to recruit adults with disabilities and a control group matched for age, sex, and residential location from households of the general population. We used the Washington Group Short Set of Questions on Disability to identify people with disabilities. We administered an HIV test and a life-course history interview to participants. The primary outcome was the prevalence of HIV among participants with and without disabilities. Findings Between Oct 2, 2014, and Nov 30, 2015, we recruited 807 people with disabilities and 807 participants without disabilities from Yaounde, Cameroon. 28 of 716 people in the control population had a positive HIV test result (crude prevalence 3·9%, 95% CI 2·9–5·3) compared with 50 of 739 people with disabilities (6·8%, 5·0–8·6; conditional odds ratio [OR] 1·7; p=0·04). Women with disabilities were more often involved in paid sexual relationships than were women without disabilities (2·5% vs 0·5%, p=0·05). People with disabilities were also at increased risk of sexual violence than were women without disabilities (11·0% vs 7·5%, OR 1·5; p=0·01). Sexual violence and sex work were strongly associated with increased risk of HIV infection among participants with disabilities but not among controls (OR 3·0, 95% CI 1·6–5·6 for sexual violence and 12·3, 4·4–34·6 for sex work). Analyses were done in men and women. Interpretation The higher prevalence of HIV infection in people with disabilities than people without disabilities reflects a higher exposure to HIV infection as well as the presence of disability-associated HIV infection. The susceptibility of people with disabilities to HIV infection seems to be shaped by social and environmental factors. Research is needed to inform firm recommendations on how to protect this vulnerable population. Funding Agence nationale de recherches sur le sida et les hepatites virales (ANRS-Inserm) and the 5% Initiative.