Knowledge gaps in existing research exploring sexual fluidity and mental health among young adults.

While there is a large body of evidence indicating that sexual minority youth experience inequitably high rates of mental health problems (e.g. depression, suicidality), we know little about how temporal changes in sexual attractions, identities and behaviour may impact mental health (and other) outcomes. In this essay, we review existing research regarding sexual fluidity and mental health among young adults in order to identify critical knowledge gaps with respect to an epidemiological understanding of the relationship between these factors. We describe three gaps that in turn inform a larger public health research agenda on this topic. First, there are a number of methodological challenges given that fluidity can occur over short or long periods of time and across multiple dimensions of sexual orientation (e.g. attractions, identities and behaviour) with various patterns (e.g. directionality of change). Tailored measures that accurately and inclusively reflect diversities of sexual fluidity trajectories are needed. Second, causal relationships between sexual fluidity and mental health remain uncertain and unquantified. Third, little is known about how features of context (e.g. gender norms and political climate) influence youth experiences with sexual fluidity and mental health. Finally, we propose a set of recommendations to address these knowledge gaps to improve the quality of epidemiological research involving young people

Expressed needs and risky sexual behaviors in men who have sex with men followed-up in a combined HIV prevention package in a community context

Les orientations en matière de lutte contre le VIH/Sida s’accordent sur la nécessité de mettre en œuvre une offre de prévention plus diversifiée pour limiter les nouvelles infections auprès des populations les plus touchées par l’épidémie. En Afrique de l’Ouest, les hommes ayant des relations sexuelles avec les hommes (HSH) sont particulièrement vulnérables à l’infection par le VIH. Dans ce contexte, la réponse des programmes VIH repose principalement sur les services de santé offerts par les associations communautaires. Cependant, peu de données sont disponibles sur les HSH séronégatifs bénéficiant d’une offre diversifiée de prévention en Afrique de l’Ouest, aussi bien sur leurs motivations à être suivi dans des services communautaires que sur leurs comportements sexuels à risque. Ce travail s’appuie sur les données recueillies dans une cohorte interventionnelle (CohMSM) offrant aux HSH séronégatifs un suivi trimestriel préventif mise en œuvre par des associations communautaires (Mali, Côte d’Ivoire, Burkina Faso, Togo). Les résultats montrent que les besoins de ces participants sont en faveur d’une offre de santé sexuelle globale. L’accès à la PrEP est également considéré par les HSH comme un besoin prioritaire au regard de leurs comportements sexuels à risque. Cette thèse a également permis de mieux identifier les HSH présentant un risque élevé d’exposition à l’infection par le VIH. Le suivi préventif offert semble aussi réduire les pratiques sexuelles à risque des HSH les plus exposés au risque d’infection. Ces résultats contribuent ainsi à mieux appréhender la mise en place d’une offre diversifiée de prévention auprès des HSH dans un cadre communautaire.The new HIV/AIDS guidelines recommend a combined package consisting of multiple preventive strategies to limit new infections among the most affected populations. In West Africa, men who have sex with men (MSM) are especially vulnerable to HIV infection. In this context, the response of HIV programs primarily relies on healthcare services provided by community-based organizations. However, there is limited data regarding HIV-negative MSM accessing a combined preventive package in West Africa as well as on their motivations for being followed-up in community-based services and on their risky sexual behaviors. This work used the data collected from an interventional cohort (CohMSM) offering a quarterly preventive follow-up to HIV-negative MSM in community-based settings in four West African countries (Mali, Côte d'Ivoire, Burkina Faso, Togo). The results demonstrate that the needs of the participants are in favor of a comprehensive sexual health offer. Access to PrEP is also considered by MSM as a priority need in view of their high-risk sexual behaviors. This also helps to better identify MSM who are at high-risk of exposure to HIV infection. Furthermore, the quarterly preventive follow-up also appears to reduce risky sexual practices in MSM most at risk. Thus, these results contribute to a better understanding of the implementation of a combined prevention package for MSM in a community setting

Polémoformes et zones humides dans la Montagne de Reims (Marne, France) – apport du lidar aéroporté

International audienceLes morphologies liées aux conflits armés ou « polémoformes »déterminent potentiellement des zones humides sous la forme de mares ou d’étangs sur d’anciens champs de bataille. Ces milieux, fortement modifiés par la pédoturbation, et la bombturbation voire par des contaminations (ETM), constituent pourtant des ilots de biodiversité à forte valeur patrimoniale (Forêt d’exception, Réserves dirigées, ZNIEFF). C’est le cas de la Montagne de Reims, terminaison orientale de la côte d’Ile de France dominant la Champagne et coiffée par la formation des Argiles à meulières.L’objectif de cette contribution est de caractériser les polémoformes de la Montagne de Reims, située en arrière de la 4ème position de défense française durant la Grande Guerre. Cette position trop souvent assimilée à la « ligne des observatoires » est a priori pauvre en polémoformes.A l’hiver 2018, une campagne LiDAR aéroportée menée sur le massif forestier de la Montagne de Reims (Marne - 51) a révélé les traces d’un réseau de positions de batteries pour l’artillerie lourde (ALVF et affuts fixes) construit par l’armée française entre 1916 et 1918. L’utilisation d’une approche pluridisciplinaire à partir d’une analyse historique et géographique a permis de mieux comprendre l’étendue de ce système défensif et d’évaluer son empreinte sur le paysage. En effet, le croisement de documents textuels, de plans et de photographies aériennes anciennes aux données LiDAR, et leur intégration dans un système d’information géographique a permis de mettre en valeur ces vestiges de guerre de manière inédite. Ces derniers se présentent sous la forme d’un réseau ferrée complexe (rampe, voie de desserte, épis de tirs) pour l’artillerie lourde et de nombreuses positions de batterie d’artillerie de gros calibre sur affut fixe. Ces structures d’artillerie forment un géosystème, avec non seulement des observatoires camouflés au sommet de la cote d’ile de France permettant d’observer les réseaux de défense en contrebas dans la plaine de Reims mais aussi d’autres vestiges logistiques (boyaux, tranchées, abris, cantonnement).Une analyse de la rugosité à partir du modèle numérique de terrain, ainsi que des campagnes de prospection pédestre montrent une forte hétérogénéité de la lisibilité morphologique des polémoformes dépendant notamment de la nature géologique des terrains et du contexte géomorphologique mais aussi de la typologie des formes. Les premiers résultats témoignent d’un polyphasage des polémoformes qui représentent des marqueurs morphologiques des deux guerres mondiales et des opérations de déminage post-conflits.Ces résultats sont le fruit d’un partenariat inédit entre l’Université de Reims Champagne-Ardenne, l’Office National des Forêts et le Parc Naturel Régional de la Montagne de Reims

Empreinte morphologique de l'artillerie lourde de la Grande Guerre dans la Montagne de Reims (Marne, France) : apport du LiDAR aéroporté.

International audienc

Polémoformes et zones humides dans la Montagne de Reims (Marne, France) – apport du lidar aéroporté

International audienceLes morphologies liées aux conflits armés ou « polémoformes »déterminent potentiellement des zones humides sous la forme de mares ou d’étangs sur d’anciens champs de bataille. Ces milieux, fortement modifiés par la pédoturbation, et la bombturbation voire par des contaminations (ETM), constituent pourtant des ilots de biodiversité à forte valeur patrimoniale (Forêt d’exception, Réserves dirigées, ZNIEFF). C’est le cas de la Montagne de Reims, terminaison orientale de la côte d’Ile de France dominant la Champagne et coiffée par la formation des Argiles à meulières.L’objectif de cette contribution est de caractériser les polémoformes de la Montagne de Reims, située en arrière de la 4ème position de défense française durant la Grande Guerre. Cette position trop souvent assimilée à la « ligne des observatoires » est a priori pauvre en polémoformes.A l’hiver 2018, une campagne LiDAR aéroportée menée sur le massif forestier de la Montagne de Reims (Marne - 51) a révélé les traces d’un réseau de positions de batteries pour l’artillerie lourde (ALVF et affuts fixes) construit par l’armée française entre 1916 et 1918. L’utilisation d’une approche pluridisciplinaire à partir d’une analyse historique et géographique a permis de mieux comprendre l’étendue de ce système défensif et d’évaluer son empreinte sur le paysage. En effet, le croisement de documents textuels, de plans et de photographies aériennes anciennes aux données LiDAR, et leur intégration dans un système d’information géographique a permis de mettre en valeur ces vestiges de guerre de manière inédite. Ces derniers se présentent sous la forme d’un réseau ferrée complexe (rampe, voie de desserte, épis de tirs) pour l’artillerie lourde et de nombreuses positions de batterie d’artillerie de gros calibre sur affut fixe. Ces structures d’artillerie forment un géosystème, avec non seulement des observatoires camouflés au sommet de la cote d’ile de France permettant d’observer les réseaux de défense en contrebas dans la plaine de Reims mais aussi d’autres vestiges logistiques (boyaux, tranchées, abris, cantonnement).Une analyse de la rugosité à partir du modèle numérique de terrain, ainsi que des campagnes de prospection pédestre montrent une forte hétérogénéité de la lisibilité morphologique des polémoformes dépendant notamment de la nature géologique des terrains et du contexte géomorphologique mais aussi de la typologie des formes. Les premiers résultats témoignent d’un polyphasage des polémoformes qui représentent des marqueurs morphologiques des deux guerres mondiales et des opérations de déminage post-conflits.Ces résultats sont le fruit d’un partenariat inédit entre l’Université de Reims Champagne-Ardenne, l’Office National des Forêts et le Parc Naturel Régional de la Montagne de Reims

Empreinte morphologique de l'artillerie lourde de la Grande Guerre dans la Montagne de Reims (Marne, France) : apport du LiDAR aéroporté.

International audienc

Factors Associated with Self-Reported Changes in Alcohol Use among Young Adults during the COVID-19 Pandemic: A Comparative Analysis between Canada and France

While the COVID-19 pandemic impacted young adults’ alcohol use patterns, little is known about how changes in alcohol use may differ across different settings. Our objective was to identify and compare factors associated with changes in alcohol use among young adults in Canada and France during the first year of the COVID-19 pandemic. We conducted an online cross-sectional survey in October–December 2020 with young adults aged 18–29 (n = 5185) in Canada and France. In each country, weighted multinomial logistic regressions were performed to identify factors associated with self-reported decrease and increase in alcohol use separately (reference: no change). Respectively, 33.4% and 21.4% reported an increase in alcohol use in Canada and France, while 22.9% and 33.5% reported a decrease. Being 25–29 was a predictor of decrease in Canada, while living away from family was associated with an increase in France. In both countries, participants were more likely to report an increase if they reported depressive symptoms, smoking tobacco, or cannabis use. Conversely, those who had been tested for COVID-19 and those who were highly compliant with COVID-19 preventive measures were more likely to report a decrease. Efforts are needed to develop alcohol use interventions for young adults, including in ways that prioritize those with mental health challenges

Implementation opportunities and challenges to piloting a community-based drug-checking intervention for sexual and gender minority men in Vancouver, Canada: a qualitative study

Abstract Background In response to the overdose crisis, a collaborative group of two community-based organizations, a health authority and a research institute in Vancouver, Canada, implemented a pilot community-based drug checking (CBDC) intervention for sexual and gender minority (SGM) men. This study identified key factors that influenced the implementation of the CBDC intervention, including opportunities and challenges. Methods We conducted semi-structured interviews with seven pertinent parties involved in the CBDC, including policymakers, researchers and representatives from community-based organizations. These interviews were coded and analyzed using domains and constructs of the Consolidated Framework for Implementation Research. Results While drug-related stigma was identified as a challenge to deliver drug checking services, participants described the context of the overdose crisis as a key facilitator to engage collaboration between relevant organizations (e.g., health authorities, medical health officers, community organizations) to design, resource and implement the CBDC intervention. The implementation of the CBDC intervention was also influenced by SGM-specific needs and resources (e.g., lack of information about the drug supply). The high level of interest of SGM organizations in providing harm reduction services combined with the need to expand drug checking into community spaces represented two key opportunities for the CBDC intervention. Here, SGM organizations were recognized as valued partners that fostered a broader culture of harm reduction. Participants’ emphasis that knowing the composition of one’s drugs is a “right to know”, particularly in the context of a highly contaminated illicit drug market, emerged as a key implementation factor. Lastly, participants emphasized the importance of involving SGM community groups at all stages of the implementation process to ensure that the CBDC intervention is appropriately tailored to SGM men. Conclusions The context of the overdose crisis and the involvement of SGM organizations were key facilitators to the implementation of a drug checking intervention in SGM community spaces. This study offers contextualized understandings about how SGM knowledge and experiences can contribute to implement tailored drug checking interventions

COVID-19 vaccine intention among young adults: Comparative results from a cross-sectional study in Canada and France

International audienceBackground: High rates of COVID-19 vaccination uptake are required to attain community immunity. This study aims to identify factors associated with COVID-19 vaccine uncertainty and refusal among young adults, an underexplored population with regards to vaccine intention generally, in two high-income settings: Canada and France.Methods: A cross-sectional online survey was conducted from October to December 2020 among young adults ages 18-29 years (n = 6663) living in Canada (51.9%) and France (48.1%). Multinomial logistic regression analyses were performed to identify the sociodemographic and COVID-19-related measures (e.g., prevention behavior and perspectives, health-related concerns) associated with vaccine uncertainty and refusal. We conducted weighted analyses by age, gender and province/region of residence.Results: Intention to accept vaccination was reported by 84.3% and 59.7% of the sample in Canada and France, respectively. Higher levels of vaccine uncertainty and refusal were observed in France compared to Canada (30.1% versus 11%, 10.2% versus 4.7%). In both countries, we found higher levels of vaccine acceptance among young adults who reported COVID-19 prevention actions. Vaccine uncertainty and refusal were associated with living in a rural area, having lower levels of educational attainment, not looking for information about COVID-19, not wearing a face mask, and reporting a lower level of concern for COVID-19's impact on family. Participants who had been tested for COVID-19 were less likely to intend to refuse a vaccine.Conclusions: COVID-19 vaccine acceptance was high among young adults in Canada and France during a time in which vaccines were approved for use. Targeted interventions to build confidence in demographic groups with greater hesitance (e.g., rural and with less personal experience with COVID-19) may further boost acceptance and improve equity as vaccine efforts continue to unfold

Individual and healthcare supply-related HIV transmission factors in HIV-positive patients enrolled in the antiretroviral treatment access program in the Centre and Littoral regions in Cameroon (ANRS-12288 EVOLCam survey)

International audienceBackground: Despite great progress in antiretroviral treatment (ART) access in recent decades, HIV incidence remains high in sub-Saharan Africa. We investigated the role of individual and healthcare supply-related factors in HIV transmission risk in HIV-positive adults enrolled in 19 HIV services in the Centre and Littoral regions of Cameroon.Methods: Factors associated with HIV transmission risk (defined as both unstable aviremia and inconsistent condom use with HIV-negative or unknown status partners) were identified using a multi-level logistic regression model. Besides socio-demographic and behavioral individual variables, the following four HIV-service profiles, identified using cluster analysis, were used in regression analyses as healthcare supply-related variables: 1) district services with large numbers of patients, almost all practicing task-shifting and not experiencing antiretroviral drugs (ARV) stock-outs (n = 4); 2) experienced and well-equipped national reference services, most practicing task-shifting and not experiencing ARV stock-outs (n = 5); 3) small district services with limited resources and activities, almost all experiencing ARV stock-outs (n = 6); 4) small district services with a wide range of activities and half not experiencing ARV stock-outs (n = 4).Results: Of the 1372 patients (women 67%, median age [Interquartile]: 39 [33-44] years) reporting sexual activity in the previous 12 months, 39% [min-max across HIV services: 25%-63%] were at risk of transmitting HIV. The final model showed that being a woman (adjusted Odd Ratio [95% Confidence Interval], p-value: 2.13 [1.60-2.82], p<0.001), not having an economic activity (1.34 [1.05-1.72], p = 0.019), having at least two sexual partners (2.45 [1.83-3.29], p<0.001), reporting disease symptoms at HIV diagnosis (1.38 [1.08-1.75], p = 0.011), delayed ART initiation (1.32 [1.02-1.71], p = 0.034) and not being ART treated (2.28 [1.48-3.49], p<0.001) were all associated with HIV transmission risk. Conversely, longer time since HIV diagnosis was associated with a lower risk of transmitting HIV (0.96 [0.92-0.99] per one-year increase, p = 0.024). Patients followed in the third profile had a higher risk of transmitting HIV (1.71 [1.05-2.79], p = 0.031) than those in the first profile.Conclusions: Healthcare supply constraints, including limited resources and ARV supply chain deficiency may impact HIV transmission risk. To reduce HIV incidence, HIV services need adequate resources to relieve healthcare supply-related barriers and provide suitable support activities throughout the continuum of care