Low Acceptability of A/H1N1 Pandemic Vaccination in French Adult Population: Did Public Health Policy Fuel Public Dissonance?

International audienceBACKGROUND: In July 2009, French public health authorities embarked in a mass vaccination campaign against A/H1N1 2009 pandemic-influenza. We explored the attitudes and behaviors of the general population toward pandemic vaccination. METHODOLOGY/PRINCIPAL FINDINGS: We conducted a cross-sectional online survey among 2,253 French representative adults aged 18 to 64 from November 17 to 25, 2009 (completion rate: 93.8%). The main outcome was the acceptability of A/H1N1 vaccination as defined by previous receipt or intention to get vaccinated ("Yes, certainly", "Yes, probably"). Overall 17.0% (CI 95%, 15.5% to 18.7%) of respondents accepted A/H1N1 vaccination. Independent factors associated with acceptability included: male sex (p = .0001); older age (p = .002); highest or lowest level of education (p = .016); non-clerical occupation (p = .011); having only one child (p = .008); and having received seasonal flu vaccination in prior 3 years (p<.0001). Acceptability was also significantly higher among pregnant women (37.9%) and other at risk groups with chronic diseases (34.8%) (p = .002). Only 35.5% of respondents perceived A/H1N1 influenza illness as a severe disease and 12.7% had experienced A/H1N1 cases in their close relationships with higher acceptability (p<.0001 and p = .006, respectively). In comparison to 26.0% respondents who did not consult their primary care physician, acceptability was significantly higher among 8.0% respondents who were formally advised to get vaccinated, and lower among 63.7% respondents who were not advised to get vaccinated (respectively: 15.8%, 59.5% and 11.7%- p<.0001). Among respondents who refused vaccination, 71.2% expressed concerns about vaccine safety. CONCLUSIONS/SIGNIFICANCE: Our survey occurred one week before the peak of the pandemic in France. We found that alarming public health messages aiming at increasing the perception of risk severity were counteracted by daily personal experience which did not confirm the threat, while vaccine safety was a major issue. This dissonance may have been amplified by having not involved primary care physicians in the mass vaccination campaign

Discrimination against HIV-Infected People and the Spread of HIV: Some Evidence from France

BACKGROUND: Many people living with HIV/AIDS (PLWHA) suffer from stigma and discrimination. There is an ongoing debate, however, about whether stigma, fear and discrimination actually fuel the persisting spread of HIV, or slow it down by reducing contacts between the whole population and high-risk minorities. To contribute to this debate, we analysed the relationship between perceived discrimination and unsafe sex in a large sample of French PLWHAs. METHODOLOGY/PRINCIPAL FINDINGS: In 2003, we conducted a national cross-sectional survey among a random sample of HIV-infected patients. The analysis was restricted to sexually active respondents (N = 2,136). Unsafe sex was defined as sexual intercourse without a condom with a seronegative/unknown serostatus partner during the prior 12 months. Separate analyses were performed for each transmission group (injecting drug use (IDU), homosexual contact, heterosexual contact). Overall, 24% of respondents reported experiences of discrimination in their close social environment (relatives, friends and colleagues) and 18% reported unsafe sex during the previous 12 months. Both prevalences were higher in the IDU group (32% for perceived discrimination, 23% for unsafe sex). In multivariate analyses, experience of discrimination in the close social environment was associated with an increase in unsafe sex for both PLWHAs infected through IDU and heterosexual contact (OR = 1.65 and 1.80 respectively). CONCLUSIONS: Our study clearly confirms a relationship between discrimination and unsafe sex among PLWHAs infected through either IDU or heterosexual contact. This relationship was especially strong in the heterosexual group that has become the main vector of HIV transmission in France, and who is the more likely of sexual mixing with the general population. These results seriously question the hypothesis that HIV-stigma has no effect or could even reduce the infection spread of HIV

Comportements à risque des personnes vivant avec le VIH en France dans le contexte des multithérapies antirétrovirales

L arrivée en 1996 des multithérapies a considérablement modifié les perspectives de vie des personnes vivant avec le VIH, faisant craindre une reprise des pratiques à risque. Cette thèse propose d étudier les déterminants des comportements à risque chez des personnes vivant avec le VIH en France, et d analyser dans quelle mesure le traitement par multithérapies a modifié ou non ces comportements. Cette thèse s appuie sur les données de deux enquêtes : - MANIF 2000, cohorte de 467 patients infectés par le VIH par injection de drogues intraveineuse, initiée en 1995. - L enquête ANRS-EN12-VESPA, conduite en 2003 auprès d un échantillon de près de 3000 personnes, représentative de la population séropositive suivie en milieu hospitalier. Les résultats empiriques montrent qu aucun marqueur lié à la progression de la maladie n apparaît comme un déterminant significatif des rapports non protégés, quelle que soient l orientation sexuelle et le type de partenaire considéré. En revanche, les effets secondaires apparaissent comme étant associés à une fréquence plus importante de prises de risque parmi les usagers/ex-usagers de drogue intraveineuse dans le cadre de relations avec des partenaires occasionnels. Il en est de même pour l altération de la qualité de vie mentale qui apparaît comme un déterminant capital des conduites à risque avec des partenaires occasionnels chez les homosexuels. Les analyses conduites auprès des hétérosexuels montrent le poids de la précarité financière sur la prévalence des rapports non protégés quelque soit le sexe. Au sein des couples séro-différents, il existe un lien significatif entre prise de risque et dissimulation du statut sérologique. Enfin, une dernière analyse montre l influence du vécu de la séropositivité sur les difficultés sexuelles perçues par les personnes vivant avec le VIH.The advent of Highly Active Antiretroviral Therapy (HAART) in 1996 considerably changed life perspectives of people living with HIV (PLWHs). However, concerns have been raised that these improvements may increase the opportunities for relapse to risk behaviors. This thesis proposes to study the determinants of risky behaviors among PLWHs in France, and to analyze to what extent HAART has modified or not these behaviors. This thesis uses data of two surveys: - MANIF 2000, cohort of 467 patients HIV-infected through injection drug use, initiated in 1995. - The ANRS-EN12-VESPA, conducted in 2003 among a sample of nearly 3000 individuals, representative of people living with HIV followed in hospital. Empirical results show that none of the HIV-clinical outcomes appears as significantly determinant of risky behaviors, whatever the sexual orientation and the type of partner considered. However, HAART related side effects appear as significantly associated with a higher frequency of unsafe sex among injecting drug users engaged in occasional relationships. Poor mental quality of life is also a capital determinant of unsafe sex with occasional partners among gay men. Within heterosexual men and women, analyses point out the impact of social vulnerability on risky behaviors. Among sero-nonconcordant couples, there is a significant relationship between risky behaviors and concealment of HIV-status. Finally, the last analysis shows the impact of HIV-experience on sexual difficulties perceived by PLWHs.AIX-MARSEILLE2-BU Méd/Odontol. (130552103) / SudocSudocFranceF

Pratiques de prise en charge des jeunes suicidants dans les établissements habilités à accueillir des urgences en région Provence-Alpes-Côte d’Azur

International audienceLes tentatives de suicide représentent un problème de santé publique important et posent la question des modalités de leur prise en charge. Une enquête prospective, d'une durée de trois mois, a été réalisée au sein de 18 centres hospitaliers, disposant d'une autorisation d'accueil des urgences, afin d'évaluer les pratiques de prise en charge des jeunes suicidants (11-25 ans). Au total, 393 jeunes suicidants ont été accueillis par ces établissements durant la période de l'enquête, dont une large majorité de filles (77 %). L'intoxication médicamenteuse était le moyen le plus utilisé (85,1 %). Les critères de bonnes pratiques liés à la prise en charge initiale aux urgences étaient les plus fréquemment réalisés contrairement à ceux concernant les modalités de l'hospitalisation et la préparation à la sortie. Les facteurs expliquant la réalisation de ces critères sont liés au type d'établissement d'accueil, à la présence d'une pathologie mentale et à la durée d'hospitalisation du patient. Ces résultats soulignent plusieurs points qui devraient être renforcés dans la prise en charge hospitalière des jeunes suicidants dans la région Paca. Summary : Suicide attempts (SA) represent a significant public health problem and raise questions with respect to the best, most appropriate methods for triage and the delivery of care. A prospective investigation to evaluate the quality of SA health care was carried out over a three month period within 18 hospitals having an emergency care unit. A total of 393 youth having attempted suicide were triaged and treated by these establishments during the period of the survey, with a large majority of them being girls (77%). Medicinal intoxication was the most often used method (85.1%). The criteria and regulations relating to the initial health care provided upon the patient's arrival were most followed, contrary Santé publique 2004, volume 16, n o 3, pp. 541-550 PRATIQUES Pratiques de prise en charge des jeunes suicidants en Provence-Alpes-Côte d'Azur Practice of trauma and emergency units in delivering care to youth who attempt suicide – experiences from Provenc

Drug use patterns and adherence to treatment among HIV-positive patients: evidence from a large sample of French outpatients (ANRS-EN12-VESPA 2003).

PURPOSE: To study the relationship between drug use and adherence to highly active antiretroviral therapy (HAART) among HIV-positive people, with two alternative measures of drug use: a set of drug uses considered independent and patterns capturing combinations of drug uses. METHODS: A cross-sectional survey conducted among a nationally representative sample of 4963 HIV-positive people randomly recruited in 102 French hospital departments delivering HIV care. The researchers modelled non-adherence to HAART with a set of binary indicators of drug use (model I) or comprehensive patterns obtained with a cluster analysis (model II). RESULTS: In model 1, heroin use, injection drug use, and cocaine/amphetamine/ecstasy use were not significant predictors of poor adherence in contrast with nicotine dependence, cannabis use, and amyl nitrate use. In model II, non-adherence to HAART was more prevalent among profiles characterised by alcohol abuse and multiple addictions, including nicotine dependence and use of various illicit drugs. CONCLUSIONS: Nicotine dependence, cannabis use, and amyl nitrate use are associated with non-adherence only if they are embedded in drug use patterns characterised by alcohol abuse or heroin use. The results also illustrate the interest in investigating the effects of drug use patterns on behavioural outcomes, rather than measuring independent effects of various drug use indicators that are highly correlated

Drug use patterns and adherence to treatment among HIV-positive patients: evidence from a large sample of French outpatients (ANRS-EN12-VESPA 2003).

PURPOSE: To study the relationship between drug use and adherence to highly active antiretroviral therapy (HAART) among HIV-positive people, with two alternative measures of drug use: a set of drug uses considered independent and patterns capturing combinations of drug uses. METHODS: A cross-sectional survey conducted among a nationally representative sample of 4963 HIV-positive people randomly recruited in 102 French hospital departments delivering HIV care. The researchers modelled non-adherence to HAART with a set of binary indicators of drug use (model I) or comprehensive patterns obtained with a cluster analysis (model II). RESULTS: In model 1, heroin use, injection drug use, and cocaine/amphetamine/ecstasy use were not significant predictors of poor adherence in contrast with nicotine dependence, cannabis use, and amyl nitrate use. In model II, non-adherence to HAART was more prevalent among profiles characterised by alcohol abuse and multiple addictions, including nicotine dependence and use of various illicit drugs. CONCLUSIONS: Nicotine dependence, cannabis use, and amyl nitrate use are associated with non-adherence only if they are embedded in drug use patterns characterised by alcohol abuse or heroin use. The results also illustrate the interest in investigating the effects of drug use patterns on behavioural outcomes, rather than measuring independent effects of various drug use indicators that are highly correlated

Health-related quality of life in French people living with HIV in 2003: results from the national ANRS-EN12-VESPA Study

International audienceObjective: Since the advent of HAART, the assessment of health-related quality of life (HRQL) has become a major concern in the therapeutic follow-up of people living with HIV. Design: HRQL was evaluated for 2235 participants in the ANRS-EN12-VESPA Study. These participants completed the Medical Outcome Study 36-Item Short Form Health Survey (MOS SF-36) questionnaire. Anxiety and depression were assessed using the Hospital Anxiety and Depression (HAD) scale. Individuals were considered to have an 'acceptable' physical (and mental) HRQL if their MOS SF-36 scores were greater than the 25 th percentile of the corresponding age-sex-specific distribution of scores in the French general population. Methods: Logistic regression models were used to identify factors associated with an 'acceptable' physical and mental HRQL among demographic, psychosocial and clinical characteristics. Potential selection bias caused by non-random missing responses to the MOS SF-36 questionnaire was statistically tested. Results: Physical and mental HRQL were 'acceptable' in 1176 (53%) and 1152 (51%) individuals, respectively. After adjusting for sociodemographic factors, HIV clinical status and hepatitis C co-infection, high HAD scores and the consumption of anxiolytic, antidepressant and hypnotic drugs were found to be negatively associated with normal physical and mental HRQL. Conclusion: The role of disclosure and discrimination is determinant in HRQL, and the various cultural and psychological dimensions require further research. The presence of other infections or co-morbidities requires a comprehensive care system including medical staff and social worker teams. HIV should increasingly be regarded as a chronic disease characterized by different pathological conditions requiring a comprehensive and multidisciplinary approach

Living with HIV/AIDS in France

Antiretroviral treatments have turned AIDS into a chronic illness. In western industrialized countries where these therapies have been available since 1996, people living with HIV/AIDS no longer face the permanent threat of imminent death. But do they live the same lives as non-HIV-infected persons? The VESPA survey has cast light on who is living with HIV/AIDS today in metropolitan France, how they live and in what major ways the infection has changed their lives

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

Comment vit-on en France avec le VIH/sida ?

Les traitements antirétroviraux ont fait du sida une maladie chronique. Dans les pays développés où ils sont disponibles depuis 1996, les personnes infectées par le VIH n’ont plus en permanence la menace d’une mort prochaine. Mais vivent-elles pour autant comme les autres ? L’enquête « Vespa » a permis de savoir qui sont les personnes vivant avec le VIH/sida en France métropolitaine aujourd’hui, comment elles vivent et quels bouleversements l’infection a-t-elle entraînés dans leur vie