38 research outputs found
HIV-testing among female sex workers on the border between Brazil and French Guiana: the need for targeted interventions
Connaissances, attitudes et pratiques vis-à -vis du VIH et des IST parmi les travailleuses du sexe en Guyane et à Oiapoque, Brésil
The HIV epidemic in French Guiana is often described as generalized. However, some vulnerable groups appear particularly affected. Among these groups, female sex workers hold a special place because of the frequency of transactional relationships in the region. These sexualâeconomic exchanges go beyond the borders since many customers from French Guiana solicit female sex workers in Oiapoque, the Brazilian border town. Despite the potential importance of sex work in the HIV epidemic, there is scarce data on the subject in the area.The main objective of this study was to address this knowledge gap and to describe the knowledge, attitudes and practices among female sex workers in French Guiana and Oiapoque in order to optimize and subsequently evaluate prevention.The results of the survey conducted in French Guiana and Oiapoque in 2010 and 2011 highlighted a number of events promoting the spread of the epidemic among female sex workers, but also promoting the spread of the epidemic in the general population. Thus, condom use was not always adequate. Although it was consistent with the customers, it was much less with intimate partners, in a common multiple sexual partnerships context. The HIV screening rate was particularly low in Oiapoque as well. Beyond the individual aspect, the structural framework clearly impacted the vulnerability of female sex workers. Thus, the nonâavailability of treatment in Oiapoque, the precariousness in which people live and the legislative framework of the two countries are major barriers to female sex workersâ support.Different levels of understanding are necessary to disentangle the complexity of behaviors facing the risk of transmission of HIV among female sex workers. Prevention must be considered at each level, not only at the individual level, to be effective. Furthermore, prevention must be considered more generally to provide an efficient response to the HIV epidemic by combining behavioral, biomedical and structural prevention elements.LâĂ©pidĂ©mie de VIH en Guyane est souvent prĂ©sentĂ©e comme gĂ©nĂ©ralisĂ©e. Cependant, certains groupes semblent plus particuliĂšrement touchĂ©s. Parmi ces groupes vulnĂ©rables, les travailleuses du sexe tiennent une place particuliĂšre compte tenu de la frĂ©quence des rapports transactionnels dans la rĂ©gion. Ces Ă©changes Ă©conomicoâsexuels dĂ©passent les frontiĂšres puisque de nombreux clients venant de Guyane rencontrent des travailleuses du sexe Ă Oiapoque, ville brĂ©silienne frontaliĂšre. MalgrĂ© l'importance potentielle de la prostitution dans la dynamique de l'Ă©pidĂ©mie VIH, peu de donnĂ©es existent sur le sujet dans la rĂ©gion.Lâobjectif principal de cette Ă©tude Ă©tait de rĂ©pondre Ă ce manque de donnĂ©es et de dĂ©crire les connaissances, attitudes et pratiques des travailleuses du sexe en Guyane et Ă Oiapoque afin de pouvoir ajuster au mieux les actions de prĂ©vention.Les rĂ©sultats des enquĂȘtes menĂ©es en Guyane et Ă Oiapoque en 2010 et 2011 ont mis en lumiĂšre un certain nombre de faits favorisant la progression de lâĂ©pidĂ©mie au sein des travailleuses du sexe, mais Ă©galement favorisant la diffusion de lâĂ©pidĂ©mie en population gĂ©nĂ©rale. Ainsi lâutilisation du prĂ©servatif nâĂ©tait pas toujours adĂ©quate et bien quâelle Ă©tait constante avec les clients, elle lâĂ©tait beaucoup moins avec les partenaires intimes, dans un contexte de multipartenariat frĂ©quent. Le taux de dĂ©pistage Ă Oiapoque Ă©tait particuliĂšrement faible Ă©galement. AuâdelĂ de lâaspect individuel, le cadre structurel impactait clairement la vulnĂ©rabilitĂ© des travailleuses du sexe. Ainsi, la nonâdisponibilitĂ© des traitements Ă Oiapoque, la prĂ©caritĂ© dans laquelle se trouvent les personnes et le cadre lĂ©gislatif des deux pays reprĂ©sentent des obstacles majeurs Ă la prise en charge destravailleuses du sexe.DiffĂ©rents niveaux de lecture sont nĂ©cessaires pour essayer de percevoir la complexitĂ© des comportements face au risque de transmission du VIH parmi les travailleuses du sexe. Câest Ă chacun de ces niveaux quâil faut envisager la prĂ©vention, et non plus au seul niveau individuel, pour quâelle puisse ĂȘtre efficace. Cette prĂ©vention doit, elleâmĂȘme, ĂȘtre envisagĂ©e plus globalement pour apporter une rĂ©ponse efficace Ă lâĂ©pidĂ©mie de VIH en combinant des Ă©lĂ©ments de prĂ©vention comportementale, biomĂ©dicale et structurelle
Knowledge, attitudes and practices towards STIs and HIV among female sex workers in French Guiana and Oiapoque (Brazil).
LâĂ©pidĂ©mie de VIH en Guyane est souvent prĂ©sentĂ©e comme gĂ©nĂ©ralisĂ©e. Cependant, certains groupes semblent plus particuliĂšrement touchĂ©s. Parmi ces groupes vulnĂ©rables, les travailleuses du sexe tiennent une place particuliĂšre compte tenu de la frĂ©quence des rapports transactionnels dans la rĂ©gion. Ces Ă©changes Ă©conomicoâsexuels dĂ©passent les frontiĂšres puisque de nombreux clients venant de Guyane rencontrent des travailleuses du sexe Ă Oiapoque, ville brĂ©silienne frontaliĂšre. MalgrĂ© l'importance potentielle de la prostitution dans la dynamique de l'Ă©pidĂ©mie VIH, peu de donnĂ©es existent sur le sujet dans la rĂ©gion.Lâobjectif principal de cette Ă©tude Ă©tait de rĂ©pondre Ă ce manque de donnĂ©es et de dĂ©crire les connaissances, attitudes et pratiques des travailleuses du sexe en Guyane et Ă Oiapoque afin de pouvoir ajuster au mieux les actions de prĂ©vention.Les rĂ©sultats des enquĂȘtes menĂ©es en Guyane et Ă Oiapoque en 2010 et 2011 ont mis en lumiĂšre un certain nombre de faits favorisant la progression de lâĂ©pidĂ©mie au sein des travailleuses du sexe, mais Ă©galement favorisant la diffusion de lâĂ©pidĂ©mie en population gĂ©nĂ©rale. Ainsi lâutilisation du prĂ©servatif nâĂ©tait pas toujours adĂ©quate et bien quâelle Ă©tait constante avec les clients, elle lâĂ©tait beaucoup moins avec les partenaires intimes, dans un contexte de multipartenariat frĂ©quent. Le taux de dĂ©pistage Ă Oiapoque Ă©tait particuliĂšrement faible Ă©galement. AuâdelĂ de lâaspect individuel, le cadre structurel impactait clairement la vulnĂ©rabilitĂ© des travailleuses du sexe. Ainsi, la nonâdisponibilitĂ© des traitements Ă Oiapoque, la prĂ©caritĂ© dans laquelle se trouvent les personnes et le cadre lĂ©gislatif des deux pays reprĂ©sentent des obstacles majeurs Ă la prise en charge destravailleuses du sexe.DiffĂ©rents niveaux de lecture sont nĂ©cessaires pour essayer de percevoir la complexitĂ© des comportements face au risque de transmission du VIH parmi les travailleuses du sexe. Câest Ă chacun de ces niveaux quâil faut envisager la prĂ©vention, et non plus au seul niveau individuel, pour quâelle puisse ĂȘtre efficace. Cette prĂ©vention doit, elleâmĂȘme, ĂȘtre envisagĂ©e plus globalement pour apporter une rĂ©ponse efficace Ă lâĂ©pidĂ©mie de VIH en combinant des Ă©lĂ©ments de prĂ©vention comportementale, biomĂ©dicale et structurelle.The HIV epidemic in French Guiana is often described as generalized. However, some vulnerable groups appear particularly affected. Among these groups, female sex workers hold a special place because of the frequency of transactional relationships in the region. These sexualâeconomic exchanges go beyond the borders since many customers from French Guiana solicit female sex workers in Oiapoque, the Brazilian border town. Despite the potential importance of sex work in the HIV epidemic, there is scarce data on the subject in the area.The main objective of this study was to address this knowledge gap and to describe the knowledge, attitudes and practices among female sex workers in French Guiana and Oiapoque in order to optimize and subsequently evaluate prevention.The results of the survey conducted in French Guiana and Oiapoque in 2010 and 2011 highlighted a number of events promoting the spread of the epidemic among female sex workers, but also promoting the spread of the epidemic in the general population. Thus, condom use was not always adequate. Although it was consistent with the customers, it was much less with intimate partners, in a common multiple sexual partnerships context. The HIV screening rate was particularly low in Oiapoque as well. Beyond the individual aspect, the structural framework clearly impacted the vulnerability of female sex workers. Thus, the nonâavailability of treatment in Oiapoque, the precariousness in which people live and the legislative framework of the two countries are major barriers to female sex workersâ support.Different levels of understanding are necessary to disentangle the complexity of behaviors facing the risk of transmission of HIV among female sex workers. Prevention must be considered at each level, not only at the individual level, to be effective. Furthermore, prevention must be considered more generally to provide an efficient response to the HIV epidemic by combining behavioral, biomedical and structural prevention elements
Air DrepâA Retrospective Study Evaluating the Influence of Weather Conditions and Viral Epidemics on Vaso-Occlusive Crises in Patients with Sickle Cell Disease Living in French Guiana
(1) Objectives: French Guiana is the French territory most affected by sickle cell disease (SCD). This study investigates the associations between different environmental factors relative to climate, infectious outbreaks, and emergency visits or weekly hospital admissions for vaso-occlusive crisis (VOC). The identification of risk factors would lead to better patient care and patient management, and more targeted prevention and therapeutic education for patients with SCD in French Guiana. (2) Methods: This study was performed using data collected from the medicalized information system and emergency medical records of Cayenne General Hospital, between 1 January 2010 and 31 December 2016. ARIMA models were used to investigate the potential impact of weather conditions and flu epidemics on VOC occurrence. (3) Results: During the study period, 1739 emergency visits were recorded among 384 patients, of which 856 (49.2%) resulted in hospitalization, 811 (46.6%) resulted in hospital discharge, and 72 (4.2%) in another orientation. Decreased temperature and decreased humidity were both independent factors associated with an increase of VOC cases (p = 0.0128 and p = 0.0004, respectively). When studying severe VOC (leading to hospitalization, with or without prior emergency visit), 2104 hospital admissions were recorded for 326 patients. The only factor associated with severe VOC, in the multivariate analysis, was flu epidemics (p = 0.0148). (4) Conclusions: This study shows a link between climate, flu epidemics, and VOC in French Guiana. Patient’s awareness of risks related to climate and flu epidemics should be encouraged, as home prevention measures can help avoid painful crises. Moreover, physicians should encourage patients to get immunized for influenza every year
Factors associated with sexual risk taking behavior by precarious urban migrants in French Guiana
International audienceBackground: French Guiana is highly affected by HIV. The migrant population is particularly susceptible. The objective of this study was to evaluate the level of risk of HIV transmission and its perception among migrants in French Guiana and to identify predictive factors. Methods: An HIV/AIDS Knowledge, Attitudes, Behaviors and Practices study was conducted in 2012 among migrants living in precarious neighborhoods of French Guiana. Results: Of the 1039 participants surveyed, 893 were analyzed, of which 35.6% had risky sex during the past 12 months. Sexual risk taking was higher among the migrant population than in the general population. The predictors of sexual risk taking behavior were: younger age groups, males, having a job, not living with a spouse, having first had sex before age 16, using alcohol or drugs before sex, and having engaged in commercial sex recently. The factors associated with not being aware of one's risk were: being a woman, being from Guyana or Suriname, non-systematic use of condoms with a regular partner, and never or not recently having been tested for HIV. Conclusions: The results suggest there is still a need for information on HIV risks in a highly vulnerable population
Country of infection among HIV-infected patients born abroad living in French Guiana.
Over 75% of patients in the HIV cohort in French Guiana are of foreign origin. Our objective was to estimate what proportion of the migrant population of HIV-infected patients in Cayenne had been infected in French Guiana.We included patients of known foreign origin who were followed in Cayenne, for whom the year of arrival in French Guiana was known and the initial CD4 count at the time of diagnosis was available. The time between seroconversion and time at diagnosis was estimated using the formula [square root (CD4 at seroconversion)-square root(CD4 at HIV diagnosis)] / slope of CD4 decline.CD4 counts at the time of infection and the slope were computed in an age and ethnicity-dependent variable.The median estimated time between infection and diagnosis was 4.5 years (IQR = 0.2-9.2). Overall, using a median estimate of CD4 count at the time of infection, it was estimated that 53.2% (95% CI = 48.3-58%) of HIV infected foreign patients had acquired HIV after having arrived in French Guiana. Patients having arrived in French Guiana before and during the 1990s and those receiving their HIV diagnosis before 2010 were more likely to have been infected in French Guiana.Contrary to widespread belief suggesting that most migrants are already HIV-infected when they arrive in French Guiana, a large proportion of foreign HIV patients seem acquire the virus in French Guiana.There is still much to do in terms of primary prevention and testing among migrants
Penile implants and other high risk practices in French Guianaâs correctional facility: A cause for concern
International audienceBACKGROUND: Prisoners in French Guiana, a French territory located in South America, have a HIV and hepatitis B prevalence of 4%. Body modifications such as penile implants, tattoos, and body piercings are common among detainees, increasing the risk of blood-borne virus transmission.METHODS: We conducted a cross-sectional randomised survey in which the primary objective was to estimate the prevalence of high risk 'bloody practices' (penile implants, tattoos, body piercings) in French Guiana's only correctional facility. The secondary objective was to describe the risk factors for penile implants, the procedures and motivations for insertion, the reported complications, their risk factors and adverse impact on condom use.RESULTS: Of the 221 male inmates interviewed, 19% had tattoos or body piercings while incarcerated, and 68% had penile implants, of which, 85% had been inserted inside the correctional facility. Addictive behaviors such as cannabis use and alcohol addiction (positive AUDIT-C score), early age at first sexual intercourse, and the number of incarcerations correlated positively with having inserted one or more penile implants while incarcerated. In contrast, having reported previous psychiatric hospitalizations and having a high knowledge score for HIV/AIDS and sexually transmitted infections (STIs) were negatively correlated with the insertion of penile implants while incarcerated. Penile implants were inserted in poor hygienic conditions, usually using the sharp lid of a canned food container, with 18% of early complications, mostly haemorrhage and edema. Condom use was negatively impacted for 52% of men with penile implants.CONCLUSIONS: Our results highlight the need for prevention interventions which should aim at increasing knowledge levels and at implementing comprehensive risk-reduction measures
Knowledge of free voluntary HIV testing centres and willingness to do a test among migrants in Cayenne, French Guiana
International audienceIn Cayenne, French Guiana, 80% of HIV+ patients followed at the hospital are migrants. Behavioral information is crucial for optimizing HIV testing for this vulnerable group. Predictors of ignorance of the existence of free VCT centre and willingness to get tested were investigated in 2006 among 398 migrants from Haiti, Guyana, Suriname, and Brazil using a structured questionnaire. Only 27 % of migrants knew simultaneously about the existence of free VCT, its localisation and its operating hours. Factors associated with ignorance of the existence of free VCT centre were birthplace in Haiti, being in French Guiana for less than 3 years, not thinking one's birth country as strongly affected by HIV, and not thinking to be personally at risk for HIV. Factors independently associated with willingness to get tested were thinking to be at risk for HIV, birthplace in Brazil and Haiti, having a high integration level and fear of suffering if HIV test was positive. In order to improve testing among migrants, the accessibility of testing facilities and the knowledge of their whereabouts and operating hours must be improved to promote the desired behaviour among the majority of migrants which is often willing to do the test
Sexual risk behaviors and predictors of inconsistent condom use among crack cocaine users in the French overseas territories in the Americas
International audienceThe French overseas territories in the Americas are the French territories most affected by HIV. Crack cocaine users are particularly impacted. The objective of this study was to describe sexual risk behaviors and inconsistent condom use among crack cocaine users. A total of 640 crack cocaine users were interviewed. The sampling method was non-probabilistic. An anonymous standardized questionnaire of 110 questions was used. Over a third of persons did not use condoms systematically with casual sex partners (36.2%) or commercial sex partners (32.3%), and 64% did not use condoms systematically with regular sex partners. In a context of multiple sexual partnerships, frequent forced sex, and insufficient HIV testing, the lack of systematic condom use may favor the spread of HIV. Different predictive factors of inconsistent condom use were identified, depending on the type of partner, with a log binomial regression. However, among the predictor variables identified, two predictive factors frequently occur among the different type of sex partners: high perceived risk of HIV and self-perceived capacity to persuade a sex partner to use condom. These results pointed towards interventions improving access to rights and raising perceived self-efficacy
Comportements sexuels à risque et facteurs prédictifs de non utilisation du préservatif parmi les usagers de crack dans les Départements Français d'Amérique
International audienceRĂ©sumĂ© :Introduction : Les dĂ©partements Français dâAmĂ©rique sont Ă la fois parmi les territoiresfrançais les plus affectĂ©s par le VIH et parmi les territoires français les plus impactĂ©s par laconsommation de crack. LâĂ©pidĂ©mie de VIH en Guyane est une Ă©pidĂ©mie concentrĂ©e quitouche plus spĂ©cifiquement certains groupes vulnĂ©rables. Parmi ces groupes, les usagers decrack sont particuliĂšrement touchĂ©s.MatĂ©riel et MĂ©thodes : Une Ă©tude a Ă©tĂ© rĂ©alisĂ©e simultanĂ©ment dans les trois dĂ©partements en2012 dans le but de dĂ©crire les connaissances, les attitudes et les pratiques vis-Ă -vis du VIH etdes IST chez les usagers de crack. Au total 640 personnes ont Ă©tĂ© interrogĂ©es. La mĂ©thodedâĂ©chantillonnage utilisĂ©e Ă©tait non probabiliste et combinait un Ă©chantillonnage deconvenance dans les associations recevant ce public (75% de lâĂ©chantillon), et unĂ©chantillonnage en boule de neige en dehors afin dâatteindre les personnes ne frĂ©quentant pasles structures (25% de lâĂ©chantillon).RĂ©sultats : Un tiers des personnes nâutilisait pas systĂ©matiquement le prĂ©servatif avec lespartenaires occasionnels (36,2%) ou avec les partenaires commerciaux (32,3%), et 64%nâutilisaient pas le prĂ©servatif Ă chaque fois avec les partenaires rĂ©guliers. DiffĂ©rents facteursprĂ©dictifs de la non utilisation du prĂ©servatif ont Ă©tĂ© identifiĂ©s selon le type de partenaire Ă lâaide dâun modĂšle log-binomial. Parmi les diffĂ©rents facteurs repĂ©rĂ©s, deux Ă©taient communsĂ chaque type de partenaire : la perception Ă©levĂ©e de son risque face au VIH et le fait de nepas se sentir Ă lâaise pour persuader un partenaire Ă utiliser le prĂ©servatif.Discussion : Dans un contexte de multipartenariat, de violences sexuelles frĂ©quentes et dedĂ©pistage insuffisant du VIH, la non utilisation systĂ©matique du prĂ©servatif peut avoir unimpact non nĂ©gligeable dans la diffusion de lâĂ©pidĂ©mie. Bien que la non utilisation duprĂ©servatif soit sensiblement infĂ©rieure Ă ce que lâon retrouve dans la littĂ©rature, cesproportions traduisent un rĂ©el problĂšme.La capacitĂ© Ă persuader un partenaire sexuel Ă utiliser un prĂ©servatif Ă©tait nĂ©gativementcorrĂ©lĂ©e avec la non utilisation du prĂ©servatif quel que soit le type de partenaire. Ainsi, ilsemble que lorsque les personnes se sentaient capables de nĂ©gocier l'utilisation du prĂ©servatif,elles lâutilisaient de maniĂšre plus systĂ©matique. La capacitĂ© personnelle perçue est souventconsidĂ©rĂ©e comme un levier important pour adapter les comportements de santĂ©. Or, elle peutĂȘtre affectĂ©e dans des situations de stigmatisation, dâaddiction ou de relation violente. CesrĂ©sultats soulignent lâimportance dâinterventions spĂ©cifiques de prĂ©vention parmi les usagersde crack et notamment des interventions visant Ă amĂ©liorer le sentiment dâefficacitĂ©personnelle (perceived self-efficacy) et dâestime de soi