General Practitioners and Breast Surgeons in France, Germany, Netherlands and the UK show variable breast cancer risk communication profiles

International audienceBackground: No information is available on the attitudes of General Practitioners (GPs) and Breast Surgeons (BSs) to their delivery of genetic, environmental and lifestyle risk factor information about breast cancer. The aim of this study was to describe the Breast Cancer Risk Communication Behaviours (RCBs) reported by GPs and BSs in four European countries and to determine the relationships between their RCBs and their socio-occupational characteristics. Methods: Self-administered questionnaires assessing breast cancer risk communication behaviours using vignettes were mailed to a sample of Breast Surgeons (BS) and General Practitioners (GP) working in France, Germany, the Netherlands, and the UK (N = 7292). Their responses to questions about the risk factors were first ordered and compared by specialty and country after making multivariate adjustments. Rather than defining a standard Risk Presentation Format (RPF) a priori, the various RPFs used by the respondents were analyzed using cluster analysis. Results: Family history and hormonal replacement therapy were the risk factors most frequently mentioned by the 2094 respondents included in this study. Lifestyle BC risk factors such as obesity and alcohol were rarely/occasionally mentioned, but this point differed (p < 0.001) depending on the country and the specialty of the providers involved. Five distinct RPF profiles including the numerical/verbal presentation of absolute/relative risks were identified. The most frequently encountered RPF (34.2%) was characterized by the fact that it included no negative framing of the risks, i.e., the probability of not developing cancer was not mentioned. Age, specialty and country of practice were all found to be significant determinants of the RPF clusters. Conclusions: The increasing trend for GPs and BSs to discuss lifestyle risk factors with their patients suggests that this may be a relevant means of improving breast cancer prevention. Physicians' risk communication skills should be improved during their initial and vocational training

Travailler avec le VIH : quelles conditions de vie et de travail ?

Dans le cadre de l'enquête VESPA (2003), nous étudions les conditions de vie et de travail des patients séropositifs occupant un emploi. L'exercice d'une activité professionnelle peut avoir des effets positifs sur le quotidien des personnes infectées par le VIH. Toutefois, de fortes contraintes professionnelles (conjuguées parfois à des obligations familiales) et des conditions de travail difficiles ont un impact sur le suivi médical et compromettent ainsi l'efficacité thérapeutique, ou encore obligent le patient à révéler une séropositivité qu'il aurait préféré continuer à dissimuler. En outre, la croissance actuelle du nombre des personnes séropositives occupant un emploi est concomitante de profondes mutations et de changements organisationnels dans les entreprises, qui ne sont pas sans effet sur la gestion de la vie quotidienne des salariés. Les résultats d'une classification ascendante hiérarchique permettent de distinguer trois catégories : "les mieux armés", "les précaires et mal logés";"les malmenés du monde du travail"

Physician and patient's adherence to antiretroviral prophylaxis after sexual exposure to HIV: results from south-eastern France AIDS IMPACT

International audienceFrench national guidelines for the management of HIV non-occupational post-exposure (nPEP) were issued in 1998 and updated in 2003. NPEP is available and free of charge in all emergency or AIDS care units of French hospitals. A regional survey was carried out to study physicians' adherence to national guidelines, and determinants of adherence to nPEP follow-up in individuals sexually exposed to HIV. The survey was based on retrospective data collection of all consultations for nPEP made in the 3 AIDS information centers in south eastern France (January 2001- December 2002). Information included personal data, type of exposure, and treatment at the first visit after exposure and during follow-up. Exposures were classified into high risk (treatment highly recommended), moderate risk (treatment possibly recommended) and negligible risk (treatment never recommended) categories, according to the level of HIV risk of sexual transmission as indicated by the French national nPEP guidelines. Among the 910 sexual exposures, 56%, 37% and 4% were classified as cases with high, moderate and no risk respectively. NPEP was prescribed to 85% of cases. HIV risk of sexual exposure was significantly associated with nPEP receipt though more than half cases with negligible risk received nPEP. Independent characteristics associated with non adherence to nPEP follow up were younger age, being referred to hospital by a physician, sexual exposure with a casual partner or sexual assault, and “moderate risk” exposure. Better information should be provided to physicians prescribing nPEP to limit over-prescription while new strategies should be implemented to improve follow-up of individuals receiving nPEP, especially those who are younger or survivors of sexual assault

Disclosure and religion among people living with HIV/AIDS in France. AIDSIMPACT SPECIAL ISSUE

International audienceThe aim of this study was to examine associations between the importance of religion and disclosure of HIV seropositivity within sero-nonconcordant couples. In 2003, a face-to-face survey was conducted among patients selected in a random stratified sample of 102 French hospital departments delivering HIV care. Respondents who reported being in a couple with a non-HIV-positive partner were asked whether they had disclosed their HIV positive status to their partner and if religion represented an important aspect of their life. Among the 2,932 respondents, 1,285 were in a sero-non-concordant regular partnership. Among these, 37.5% reported that religion played an important role in their life; 7.2% had not disclosed their HIV-positive status to their partner, and 11.6% were unaware of their partner's HIV status. Lack of HIV-disclosure to the partner was encountered more often among those who considered religion as an important aspect of their life. After multiple adjustment for socio-demographic factors, and for partnership characteristics, the importance of religion in the respondent's life remained independently associated with a lack of HIV-disclosure to the regular partner. In conclusion, individuals who place importance on religion appear to have difficulties in disclosing their HIV-positive status due to the associated stigma and fear of discrimination

Sexual Difficulties in People Living with HIV in France—Results from a Large Representative Sample of Outpatients Attending French Hospitals (ANRS-EN12-VESPA)

International audienceWe analysed sexual difficulties in a nationally representative sample of HIV-infected outpatients in France. Analyses were restricted to the 1,812 HIV-treated participants who reported at least one sexual partner during the 12 months prior to the study. The sample included 40.6% homosexual men and 24.4% women; 68.1% had a steady partner and 48.2% reported casual partners. Sexual difficulties were reported by 33.3% of the selected individuals and were more frequent in those with low sexual activity. Immuno-virological outcomes were not associated with sexual difficulties. After multiple adjustment for sexual frequency and antidepressant consumption , it was found that a larger HIV-network, reporting HIV-discrimination from friends and/or sexual partners, suffering from lipodystrophy and reporting very disturbing HIV-related symptoms were all significantly associated with sexual difficulties. HIV and HIV-treatment experience are associated with sexual difficulties. Psychological support focused on HIV-experience should be tested as a possible tool for improving sexual quality of life

Suicide attempts among people living with HIV in France

International audienceObjectives: This study examined the prevalence and characteristics of attempted suicide (AS) among a representative sample of French Human Immunodeficiency virus (HIV) infected individuals. Method: In 2003, a face-to-face survey was conducted among people living with HIV (PLWHA) selected in a random, stratified sample of French hospital departments. Among solicited individuals, 2,932 agreed to participate and were asked if they had ever AS. Results: Among the respondents, 23% had AS. Female gender, younger age, native French citizenship, reporting household financial difficulties, having been HIV-contaminated through homosexual contact or through IDU and suffering from lipodystrophy-related symptoms were all independently associated with AS. HIV-discrimination and the lack of social support from family remained independently associated with AS. Conclusions: The findings indicate a high level of AS among PLWHA and emphasize the multiple roles of factors associated with living with HIV, together with socio-demographic factors. Our results enable the possibility for vulnerable groups to be targeted for specific future interventions in order to prevent AS

Cancer survivors: familial risk perception and management advice given to their relatives

International audienceThe aim of this study was to describe 2 years cancer survivors' perception of the cancer risk running in their family, and to describe how frequently these survivors recommended cancer screening to their relatives. A national cross-sectional survey was launched by the French Ministry of Health to investigate the living conditions of adult cancer patients 2 years after cancer diagnosis. Among the 13,923 patients identified, 6,957 were eligible to participate in this study and 4460 (64.1%) answered the questionnaire administered by telephone. One participant out of every two (50.8%) reported that they thought their relatives' risk of cancer was greater than that of the relatives of unaffected persons. Higher percentages were recorded among breast and colorectal cancer patients (65 and 65.1%, respectively), and lower percentages among those with lung and hematological cancer (34.9 and 28.4%, respectively). Overall, 61.1% of the participants had already advised relatives to undergo cancer screening and 10.4% planned to do so. Eighty-one percent of the participants with breast cancer and 76.3% of those with colorectal cancer said they had advised relatives to undergo screening. Lower percentages were obtained among patients with urinary tract (41.7%) and hematological malignancies (27.1%). Although patients' perceptions tend to fit the latest data on the frequency of cancer germline mutations, physicians should help their patients to convey more accurate advice to their families. If survivors were better informed, they could play a critical role by conveying relevant and sound risk reduction messages to their relatives

Heterogeneity of Cancer Patient Information-Seeking Behaviors

International audienc

Factors associated with mammography screening among Reunionese women : a cross-sectional study

International audienceObjective: To explore the factors associated with the uptake of mammography screening in Reunionese women aged 50-65 years.Methods: This study included all women aged 50 to 65 years participating in a population-based cross-sectional study "FOSFORE". Participants were recruited between March and June 2017 using two sampling frames. The first frame consisted of households with a landline telephone, with or without a mobile line, by first randomly generating a telephone number and then randomly selecting an individual from among all eligible women in the household. The second sampling frame was constituted of women with an exclusive mobile line, who were selected directly if they met the eligibility criteria. Data were weighted for age and socio-professional status to ensure representativeness at the Reunion Island level. Weighted logistic regression was used to calculate odds ratios while adjusting for confounders.Results: 417 women were included in the study; 63.8% were up to date with guidelines on mammography screening and 36.2% were not up to date. Four factors were significantly associated with mammography screening, with an adjusted odds ratio of 2.92 (95% CI 1.51-5.61) for not having an Active Solidarity Income, 1.98 (95% CI 1.22-3.23) for having a regular gynecological follow-up by a physician, 6.53 (95% CI 3.23-13.21) for performing a Pap smear test in the past two years, and 2.07 (95% CI 1.21-3.52) for having an adequate literacy level (HLQ3).Conclusion: The findings of this study suggest that higher socio-economic status is an indicator of participation in mammography screening in La Réunion, and future educational and intervention programs should target women in deprived areas

Unprotected sex in regular partnerships among homosexual men living with HIV: a comparison between sero-nonconcordant and seroconcordant couples (ANRS-EN12-VESPA Study)

International audienceObjective: We investigated factors associated with unprotected sex in regular partnershipsamong homosexual men living with HIV.Method: We used data from a French national representative sample of people livingwith HIV (ANRS-EN12-VESPA survey). This analysis included men in a regular partnershipwith another man for at least twelve months. Unprotected sex was defined asreporting at least one episode of sexual intercourse without a condom with this regularpartner in the previous 12 months. Separate analyses were conducted in sero-nonconcordantcouples and in HIV-positive seroconcordant couples.Results: 285 and 193 homosexual men respectively reported a regular sero-nonconcordantand seroconcordant partner. Unprotected sex was reported by a higher numberof respondents within seroconcordant (46.7%) than within sero-nonconcordant couples(15.6%).In both seroconcordant and sero-nonconcordant partnerships, unprotected sex wassignificantly more frequent when episodes of unprotected sex with casual partners werereported. In seroconcordant couples, those who had more than four casual partnerswere also more likely to practise unprotected sex with their regular partner. Amongsero-nonconcordant couples, binge drinking and absence of disclosure of one’s HIVpositivestatus to the partner were also independently associated with unprotected sex.Conclusions: A limited number of sero-nonconcordant homosexual couples persist inreporting risky sexual behaviour. Prevention messages should encourage communicationand HIV disclosure. The relationship between unprotected sex with both casualand regular partners also calls attention about the underlying psycho-social andinteractional factors that may influence sexual behaviours of people living with HIVin regular relationships, independently of the status of the partner