Les recompositions d’une centralité commerçante immigrée : la Place du Pont à Lyon

Le quartier de la Place du Pont est un quartier populaire et immigré du centre-ville de Lyon. Ce morceau de ville est de peu de poids à l’échelle de l’agglomération, en habitants et en superficie, et fait l’objet de procédures lourdes et disputées de renouvellement urbain depuis plus de 10 ans. Mais, la Place du Pont désigne, pour les populations notamment maghrébines qui la fréquentent, un lieu-relais de la ville, un carrefour de réseaux de sociabilités et d’affaires, un espace de ressources et d’approvisionnement. Aujourd’hui, la Place du Pont mobilise des clientèles habitant l’ensemble de l’agglomération, de l’aire urbaine, de la région et au-delà. Les offres commerciales qu’elle propose tendent à concentrer des services, requis par la circulation d’informations, d’hommes et de marchandises, ainsi que des produits pour des « mobilités culturelles sur place ». La Place du Pont apparaît ainsi comme une vitrine où s'exposent et se mettent à l'épreuve de nouveaux produits et de nouveaux services adaptés à des univers d’approvisionnement qui ont des dimensions commerciales et culturelles, économiques et sociales, et comme un espace de ressources pour des populations dont les manières de vivre en migration se diversifient et se recomposent. Alors même que son destin urbain est incertain, la Place du Pont s’affirme comme un lieu et un moment urbain de ritualités minoritaires.An immigrant market centre in transition: the Place du Pont, Lyon. The Place du Pont is a working-class immigrant neighbourhood in the centre of Lyon. This sector of the city, though relatively unimportant in terms of the population and area of the city, has been the object of extensive and controversial urban renewal policies for a decade. But for those who frequent the Place du Pont, the place is a key area of the city, a centre of social and commercial networks, a centre of resources and provisions. Today the Place du Pont is host to clienteles from all over city, the urban area, the region and beyond. The business opportunities and services it offers make for a concentration of resources that are needed for the circulation of information, people and commodities, as well as for products for « localized cultural circulation ». The Place du Pont is thus a showcase for new products and services corresponding to certain types of supplies in their cultural, economic and social aspects, and as an area of resources for groups whose mode of life has been changed and reorganized through migration. While its urban future may be uncertain, the Place du Pont has already established itself as an urban time-space for minority social patterns.Las recomposiciones de una zona comercial immigrante : la Place du Pont de Lyon. El barrio de la Place du Pont es un barrio popular y de inmigración del centro de la ciudad de Lyon. En lo que a habitantes y a superficie se refiere, esta zona de la ciudad ostenta poco peso en el seno de la aglomeración y, desde hace más de diez años, su renovación urbana ha dado lugar a procedimientos complicados y disputados. Pero, para la población, principalmente magrebí, que frecuenta el barrio, ésta constituye un lugar de referencia dentro de la ciudad, un cruce de redes de sociabilidad y de negocios, un espacio de recursos y de abastecimiento.Hoy en día, la Place du Pont atrae a clientelas de toda la aglomeración, del área urbana, de la región y de más allá. Las ofertas comerciales que propone se centran en servicios directamente ligados a la circulación de informaciones de hombres como de mercancías, y en productos destinados a las “movilidades culturales in situ”. La Place du Pont es una vitrina en la que se exponen y se prueban nuevos productos y servicios adaptados a universos de aprovisionamiento dotados de dimensiones comerciales y culturales, económicas y sociales. La Place du Pont es, al mismo tiempo, un espacio de recursos para las poblaciones cuya manera de vivir la inmigración se diversifica y se recompone. En un momento en el que reina la incertidumbre con respecto al destino urbano del barrio, éste se afirma como un lugar y un momento urbano de rituales minoritarios

L’histoire et les mémoires de la Guerre d’Algérie

Dans les musées d’histoire et « lieux de mémoires » dédiés à l’histoire des guerres, la guerre d’Algérie n’est guère évoquée. Le Mémorial de la prison de Montluc à Lyon, « haut lieu de la mémoire nationale » ne fait toujours pas place dans son exposition permanente, à la période algérienne 1958-1962 de la prison. Cet article enquête sur ce choix de « non figuration » validé par toute une chaîne d’acteurs publics et associatifs au moment de la transformation de la prison Montluc en « lieu de mémoire nationale ».In history museums and “places of memory” dedicated to the history of wars, the Algerian war is rarely mentioned. The Memorial of the Montluc prison in Lyon, «high place of national memory» still does not make room in its permanent exhibition, for the Algerian period 1958-1962 of the prison. This article investigates this choice of «non-figuration» validated by a whole chain of public and associative actors at the time of the transformation of the Montluc prison into a «place of national memory»

Impact of Baseline Echocardiography on Treatment Outcome in Primary Care Patients With Newly Detected Arterial Hypertension: A Randomized Trial

Background: The objective of this study was to test whether baseline echocardiography in newly detected hypertension improves left ventricular mass index and blood pressure control. This is a randomized trial with primary care patients. Methods: After routine clinical work-up 177 consecutive patients with newly detected hypertension were randomized according to result of their echocardiogram (echo group and control group). Treating physicians were encouraged to prescribe angiotensin II receptor antagonist therapy for patients with evidence of hypertensive target organ damage. Mean blood pressure (BP) and echocardiographic left ventricular mass index were measured at baseline and after 6 months of therapy in both groups. Results: More patients with hypertensive target organ damage were identified in the echo group as compared to the control group (58 of 91 [64%] v 42 of 86 [49%] patients (difference 15%, 95% CI 1%-29%). In the echo group, 41 patients (45%) received angiotensin II receptor antagonist therapy as compared to 27 patients (31%) in the control group (difference 14%, 95% CI 0-28%). After 6 months, there were no differences in mean left ventricular mass index, mean diastolic 24-h ambulatory BP monitoring, or mean systolic and diastolic office BP between the two groups. Conclusions: In patients with newly detected hypertension, baseline echocardiography detects more patients with hypertensive target organ damage, but does not lead to a reduction in left ventricular mass index or improved BP control after 6 months of therap

Incidence and Risk Factors for Chronic Elevation of Alanine Aminotransferase Levels in HIV-Infected Persons without Hepatitis B or C Virus Co-Infection

Background. Chronic liver disease in human immunodeficiency virus (HIV)-infected patients is mostly caused by hepatitis virus co-infection. Other reasons for chronic alanine aminotransferase (ALT) elevation are more difficult to diagnose. Methods. We studied the incidence of and risk factors for chronic elevation of ALT levels (greater than the upper limit of normal at ⩾2 consecutive semi-annual visits) in participants of the Swiss HIV Cohort Study without hepatitis B virus (HBV) or hepatitis C virus (HCV) infection who were seen during the period 2002-2008. Poisson regression analysis was used. Results. A total of 2365 participants were followed up for 9972 person-years (median age, 38 years; male sex, 66%; median CD4+ cell count, 426/µL; receipt of antiretroviral therapy [ART], 56%). A total of 385 participants (16%) developed chronic elevated ALT levels, with an incidence of 3.9 cases per 100 person-years (95% confidence interval [CI], 3.5-4.3 cases per 100 person-years). In multivariable analysis, chronic elevated ALT levels were associated with HIV RNA level >100,000 copies/mL (incidence rate ratio [IRR], 2.23; 95% CI, 1.45-3.43), increased body mass index (BMI, defined as weight in kilograms divided by the square of height in meters) (BMI of 25-29.9 was associated with an IRR of 1.56 [95% CI, 1.24-1.96]; a BMI ⩾30 was associated with an IRR of 1.70 [95% CI, 1.16-2.51]), severe alcohol use (1.83 [1.19-2.80]), exposure to stavudine (IRR per year exposure, 1.12 [95% CI, 1.07-1.17]) and zidovudine (IRR per years of exposure, 1.04 [95% CI, 1.00-1.08]). Associations with cumulative exposure to combination ART, nucleoside reverse-transcriptase inhibitors, and unboosted protease inhibitors did not remain statistically significant after adjustment for exposure to stavudine. Black ethnicity was inversely correlated (IRR, 0.52 [95% CI, 0.33-0.82]). Treatment outcome and mortality did not differ between groups with and groups without elevated ALT levels. Conclusions. Among patients without hepatitis virus co-infection, the incidence of chronic elevated ALT levels was 3.9 cases per 100 person-years, which was associated with high HIV RNA levels, increased BMI, severe alcohol use, and prolonged stavudine and zidovudine exposure. Long-term follow-up is needed to assess whether chronic elevation of ALT levels will result in increased morbidity or mortalit

Switch to second-line versus continued first-line antiretroviral therapy for patients with low-level HIV-1 viremia: an open-label randomized controlled trial in Lesotho

Current World Health Organization (WHO) antiretroviral therapy (ART) guidelines define virologic failure as two consecutive viral load (VL) measurements ≥1,000 copies/mL, triggering empiric switch to next-line ART. This trial assessed if patients with sustained low-level HIV-1 viremia on first-line ART benefit from a switch to second-line treatment.; This multicenter, parallel-group, open-label, superiority, randomized controlled trial enrolled patients on first-line ART containing non-nucleoside reverse transcriptase inhibitors (NNRTI) with two consecutive VLs ≥100 copies/mL, with the second VL between 100-999 copies/mL, from eight clinics in Lesotho. Consenting participants were randomly assigned (1:1), stratified by facility, demographic group, and baseline VL, to either switch to second-line ART (switch group) or continued first-line ART (control group; WHO guidelines). The primary endpoint was viral suppression (<50 copies/mL) at 36 weeks. Analyses were by intention to treat, using logistic regression models, adjusted for demographic group and baseline VL. Between August 1, 2017, and August 7, 2019, 137 individuals were screened, of whom 80 were eligible and randomly assigned to switch (n = 40) or control group (n = 40). The majority of participants were female (54 [68%]) with a median age of 42 y (interquartile range [IQR] 35-51), taking tenofovir disoproxil fumarate/lamivudine/efavirenz (49 [61%]) and on ART for a median of 5.9 y (IQR 3.3-8.6). At 36 weeks, 22/40 (55%) participants in the switch versus 10/40 (25%) in the control group achieved viral suppression (adjusted difference 29%, 95% CI 8%-50%, p = 0.009). The switch group had significantly higher probability of viral suppression across different VL thresholds (<20, <100, <200, <400, and <600 copies/mL) but not for <1,000 copies/mL. Thirty-four (85%) participants in switch group and 21 (53%) in control group experienced at least one adverse event (AE) (p = 0.002). No hospitalization or death or other serious adverse events were observed. Study limitations include a follow-up period too short to observe differences in clinical outcomes, missing values in CD4 cell counts due to national stockout of reagents during the study, and limited generalizability of findings to other than NNRTI-based first-line ART regimens.; In this study, switching to second-line ART among patients with sustained low-level HIV-1 viremia resulted in a higher proportion of participants with viral suppression. These results endorse lowering the threshold for virologic failure in future WHO guidelines.; The trial is registered at ClinicalTrials.gov, NCT03088241

SESOTHO trial ("Switch Either near Suppression Or THOusand") - switch to second-line versus WHO-guided standard of care for unsuppressed patients on first-line ART with viremia below 1000 copies/mL: protocol of a multicenter, parallel-group, open-label, randomized clinical trial in Lesotho, Southern Africa

The World Health Organization (WHO) recommends viral load (VL) measurement as the preferred monitoring strategy for HIV-infected individuals on antiretroviral therapy (ART) in resource-limited settings. The new WHO guidelines 2016 continue to define virologic failure as two consecutive VL ≥1000 copies/mL (at least 3 months apart) despite good adherence, triggering switch to second-line therapy. However, the threshold of 1000 copies/mL for defining virologic failure is based on low-quality evidence. Observational studies have shown that individuals with low-level viremia (measurable but below 1000 copies/mL) are at increased risk for accumulation of resistance mutations and subsequent virologic failure. The SESOTHO trial assesses a lower threshold for switch to second-line ART in patients with sustained unsuppressed VL.; In this multicenter, parallel-group, open-label, randomized controlled trial conducted in Lesotho, patients on first-line ART with two consecutive unsuppressed VL measurements ≥100 copies/mL, where the second VL is between 100 and 999 copies/mL, will either be switched to second-line ART immediately (intervention group) or not be switched (standard of care, according to WHO guidelines). The primary endpoint is viral resuppression (VL &lt; 50 copies/mL) 9 months after randomization. We will enrol 80 patients, giving us 90% power to detect a difference of 35% in viral resuppression between the groups (assuming two-sided 5% alpha error). For our primary analysis, we will use a modified intention-to-treat set, with those lost to care, death, or crossed over considered failure to resuppress, and using logistic regression models adjusted for the prespecified stratification variables.; The SESOTHO trial challenges the current WHO guidelines, assessing an alternative, lower VL threshold for patients with unsuppressed VL on first-line ART. This trial will provide data to inform future WHO guidelines on VL thresholds to recommend switch to second-line ART.; ClinicalTrials.gov ( NCT03088241 ), registered May 05, 2017

VIBRA trial - Effect of village-based refill of ART following home-based same-day ART initiation vs clinic-based ART refill on viral suppression among individuals living with HIV : protocol of a cluster-randomized clinical trial in rural Lesotho

There is a need for evaluating community-based antiretroviral therapy (ART) delivery models to improve overall performance of HIV programs, specifically in populations that may have difficulties to access continuous care. This cluster-randomized clinical trial aims to evaluate the effectiveness of a multicomponent differentiated ART delivery model (VIBRA model) after home-based same-day ART initiation in remote villages in Lesotho, southern Africa.; The VIBRA trial (VIllage-Based Refill of ART) is a cluster-randomized parallel-group superiority clinical trial conducted in two districts in Lesotho, southern Africa. Clusters (i.e., villages) are randomly assigned to either the VIBRA model or standard care. The clusters are stratified by district, village size, and village access to the nearest health facility. Eligible individuals (HIV-positive, aged 10 years or older, and not taking ART) identified during community-based HIV testing campaigns are offered same-day home-based ART initiation. The intervention clusters offer a differentiated ART delivery package with two features: (1) drug refills and follow-ups by trained and supervised village health workers (VHWs) and (2) the option of receiving individually tailored adherence reminders and notifications of viral load results via SMS. The control clusters will continue to receive standard care, i.e., collecting ART refills from a clinic and no SMS notifications. The primary endpoint is viral suppression 12 months after enrolment. Secondary endpoints include linkage to and engagement in care. Furthermore, safety and cost-effectiveness analyses plus qualitative research are planned. The minimum target sample size is 262 participants. The statistical analyses will follow the CONSORT guidelines. The VIBRA trial is linked to another trial, the HOSENG (HOme-based SElf-testiNG) trial, both of which are within the GET ON (GETing tOwards Ninety) research project.; The VIBRA trial is among the first to evaluate the delivery of ART by VHWs immediately after ART initiation. It assesses the entire HIV care cascade from testing to viral suppression. As most countries in sub-Saharan Africa have cadres like the VHW program in Lesotho, this model-if shown to be effective-has the potential to be scaled up. The system impact evaluation will provide valuable cost estimations, and the qualitative research will suggest how the model could be further modified to optimize its impact.; Clinicaltrials.gov, NCT03630549 . Registered on 15 August 2018

The HOSENG trial - effect of the provision of oral self-testing for absent and refusing individuals during a door-to-door HIV-testing campaign on testing coverage : protocol of a cluster-randomized clinical trial in rural Lesotho

HIV-testing coverage remains below the targeted 90% despite efforts and resources invested. Home-based HIV-testing is a key approach endorsed by the World Health Organization (WHO), especially to reach individuals who might not seek testing otherwise. Although acceptance of testing during such campaigns is high, coverage remains low due to absent household members. This cluster-randomized trial aims to assess increase in testing coverage using oral HIV self-testing (HIVST) among individuals who are absent or decline testing during home-based HIV-testing.; The HOSENG (HOme-based SElf-testiNG) trial is a cluster-randomized, parallel-group, superiority trial in two districts of Lesotho, Southern Africa. Clusters are stratified by district, village size, and village access to the nearest health facility. Cluster eligibility criteria include: village is in catchment area of one of the study facilities, village authority provides consent, and village has a registered, capable, and consenting village health worker (VHW). In intervention clusters, HIV self-tests are provided for eligible household members who are absent or decline HIV-testing in the presence of the campaign team. In control clusters, standard of care for absent and refusing individuals applies, i.e., referral to a health facility. The primary outcome is HIV-testing coverage among individuals aged 12 years or older within 120 days after enrollment. Secondary objectives include HIV-testing coverage among other age groups, and uptake of the different testing modalities. Statistical analyses will be conducted and reported in line with CONSORT guidelines. The HOSENG trial is linked to the VIBRA (Village-Based Refill of ART) trial. Together, they constitute the GET ON (GETting tOwards Ninety) research project.; The HOSENG trial tests whether oral HIVST may be an add-on during door-to-door testing campaigns towards achieving optimal testing coverage. The provision of oral self-test kits, followed up by VHWs, requires little additional human resources, finances and logistics. If cost-effective, this approach should inform home-based HIV-testing policies not only in Lesotho, but in similar high-prevalence settings.; ClinicalTrials.gov, (ID: NCT03598686 ). Registered on 25 July 2018. More information is available at www.getonproject.wordpress.com

Les commerces ethniques et le milieu urbain : les commerces de kebabs, analyseurs d'un régime ambivalent de citoyenneté ?

Dossier : Les états ambivalents de la citoyennetéInternational audienc