Access to microcredit for women living with, or vulnerable to, HIV in Haïti

Haïti is the poorest country on the American continent. It is also the Caribbean nation where HIV prevalence is the highest: 2.2% of the adults carry the virus.In 2005, GHESKIO, a centre for the care of people living with HIV/AIDS; ACME, Association for Cooperation with Micro Enterprise; and Fondation Mérieux launched a microcredit programme to help women living with HIV/AIDS. The programme was subsequently extended to vulnerable women who had consulted at GHESKIO.In 2006, an impact assessment of the programme among the first 66 women benefiting from a loan showed better living conditions compared to a control group of 30 women with similar initial medical and socioeconomic status but no loan. By mid-2008, 1061 women were the beneficiaries of 1538 loans totalling 11 373 000 gourdes, i.e. approximately 216 000€. Of these, 247 received several loans (up to seven loans to date).Although the women are very poorly educated and live in arduous economic circumstances, the loan repayment records are excellent – around 94% as of mid 2008. There is no difference between HIV-negative women and those living with HIV. Combined with antiretroviral treatment, micro-financing is certainly one of the major instruments for reducing the impact of HIV on the infected populations in countries with limited resources. This programme in Haiti is a demonstration of the feasibility of microcredit in a difficult environment. The great professionalism of the institutions implementing the programme is a key factor in its success.<br>Haïti est le pays le plus pauvre du continent américain. C’est également la région des Caraïbes qui affiche la plus forte prévalence de VIH : 2,2 % des adultes sont porteurs du virus.En 2005, GHESKIO, un centre de soins pour les personnes atteintes du VIH/SIDA, ACME (Association for Cooperation with Micro Enterprise) et la Fondation Mérieux ont lancé un programme de microcrédit pour aider les femmes atteintes du VIH/SIDA. Le programme a ensuite été étendu aux femmes vulnérables qui avaient consulté chez GHESKIO.En 2006, une évaluation de l’impact du programme réalisée auprès des 66 premières femmes à avoir bénéficié d’un prêt, a montré de meilleures conditions de vie comparé à un groupe témoin de 30 femmes au statut médical et socioéconomique initial similaire mais n’ayant pas bénéficié de prêt. Mi-2008, 1061 femmes bénéficiaient de 1538 prêts soit l’équivalent de 11 373 000 gourdes, environ 216 000 euros. Parmi elles, 247 recevaient plusieurs prêts (jusqu’à sept à ce jour).Bien que les femmes aient un niveau d’instruction médiocre et vivent dans des conditions économiques difficiles, les taux de remboursement des prêts sont excellents : environ 94 % mi-2008. Aucune différence n’a été constatée entre les femmes VIH-négatives et les femmes atteintes du VIH. Associé à un traitement antirétroviral, le micro-financement est certainement l’un des principaux moyens pour réduire l’impact du VIH sur les populations infectées dans les pays aux ressources limitées. Ce programme mis en œuvre en Haïti démontre la faisabilité du microcrédit dans un environnement difficile. L’extrême professionnalisme des institutions qui appliquent le programme est essentiel à la réussite de celui-ci.<br>Haití es el país más pobre del continente norteamericano. También es la nación del Caribe donde la prevalencia del VIH es más alta: el 2,2% de los adultos son portadores del virus.En 2005, GHESKIO, un centro para el cuidado de las personas que viven con el VIH/SIDA; ACME, la Asociación para la Cooperación con Microempresas; y la Fundación Mérieux lanzaron un programa de microcréditos para ayudar a mujeres que viven con el VIH/SIDA. El programa se amplió posteriormente a mujeres vulnerables que habían sido atendidas en GHESKIO.En 2006, una evaluación del impacto del programa entre las primeras 66 mujeres que se beneficiaron de un préstamo mostraron mejores condiciones de vida en comparación con un grupo de control de 30 mujeres con una situación socioeconómica y médica inicial semejante, pero que no habían recibido ningún préstamo. A mediados de 2008, 1.061 mujeres se habían beneficiado de los 1.538 préstamos que ascienden a un total 11.373.000 gourdes, es decir aproximadamente 216.000 €. De éstas, 247 recibieron varios préstamos (hasta siete préstamos hasta la fecha).Aunque las mujeres tienen una educación muy pobre y viven en circunstancias económicas duras, los registros de devolución de préstamo son excelentes, alrededor del 94% a mediados de 2008. No hay diferencia entre mujeres VIH negativas y las que viven con el VIH.En combinación con el tratamiento antirretroviral, la microfinanciación es ciertamente uno de los principales instrumentos para reducir el impacto del VIH en las poblaciones infectadas de países con recursos limitados. Este programa en Haití es una demostración de la viabilidad del microcrédito en un medio difícil. La gran profesionalidad de las instituciones que ponen en práctica el programa es un factor clave para su éxito

Association of transcription factor 7-like 2 gene (TCF7L2) polymorphisms with stress-related hyperglycaemia (SRH) in intensive care and resulting outcomes: The READIAB study

International audienceObjective :The study aimed to evaluate the impact of the single nucleotide polymorphism (SNP) rs7903146 on the transcription factor 7-like 2 (TCF7L2) gene in stress-related hyperglycaemia (SRH), defined as blood glucose ≥ 11 mmol/L in at least two blood samples during the first 3 days in the intensive care unit (ICU), and on 28-day and 1-year mortality, and incidence of type 2 diabetes (T2D) at 6 months and 1 year in patients hospitalized in the ICU. Methods :This prospective observational (non-interventional) multicentre READIAB study, carried out during 2012–2016 in six French ICUs, involved adult patients admitted to ICUs for at least two organ failures; patients admitted for < 48 h were excluded. During the 3-day ICU observational period, genetic testing, blood glucose values and insulin treatment were recorded.Main results :The association of rs7903146 with SRH was assessed using logistic regression models. Cox proportional hazards regression models assessed the associations between rs7903146 and mortality and between SRH and mortality, both at 28 days and 1 year. A total of 991 of the 1000 enrolled patients were included in the READIAB–G4 cohort, but 242 (24.4%) had preexisting diabetes and were excluded from the analyses. SRH occurred within the first 3 days in the ICU for one-third of the non-diabetes patients. The association between the rs7903146 polymorphism and SRH did not reach significance (P = 0.078): OR(per one T copy): 1.24, 95% CI: 0.98–1.58. A significant association was found between rs7903146 and 28-day mortality after adjusting for severity scores (P = 0.026), but was no longer significant at 1 year (P = 0.61). At 28 days, mortality was increased in patients with SRH (HR: 2.09, 95% CI: 1.43–3.06; P < 0.001), and remained significant at 1 year after adjusting for severity scores (HR: 1.73, 95% CI: 1.32–2.28; P < 0.001). On admission, non-diabetes patients with SRH had a higher incidence of T2D at 6 months vs. those without SRH (16.0% vs. 7.6%, RR: 2.11, 95% CI: 1.07–4.20; P = 0.030). At 1 year, these figures were 13.4% vs. 9.2%, RR: 1.45, 95% CI: 0.71–2.96; P = 0.31). Moreover, the rs7903146 polymorphism was not significantly associated with T2D development at either 6 months (P = 0.72) or 1 year (P = 0.64).Conclusion :This study failed to demonstrate any significant association between rs7903146 and SRH. Nevertheless, the issue remains an important challenge, as SRH may be associated with increased rates of both mortality and T2D development