Communiquer avec les femmes vulnérables pour un changement positif de comportement: L'exemple du projet Yêrêlon de Bobo-Dioulasso (Burkina Faso)

Context and objectives: Since 1998, researchers in Burkina Faso have enrolled about 760 vulnerable women (sex workers, bar waitresses, pedlars, students, etc.) in an open cohort (the Yerelon cohort) to determine whether adequate management of sexually transmissible infection and exposure to well-designed, well-delivered, and plentiful communication for behaviour change (CBC) can reduce their vulnerability to HIV. This qualitative social anthropology study was conducted to: i) analyse the messages assimilated by the women who follow CBC sessions; ii) determine the impact of these messages on the women's behaviour. Methods: The researchers observed CBC sessions in the clinic, in women's homes and at their places of work for 45 days. They also conducted 37 individual in-depth interviews, 8 group interviews and a focus group, selecting a "reasoned" sample of 80 women from the cohort. The data were entered with Word software ana analyzed with the 'Atlas TI' qualitative data analysis software. Results: This study shows that: i) these vulnerable women have good knowledge of the themes raised during CBC sessions with the Yerelon peer-leaders and are quite able to reproduce the messages. Most can repeat and explain them; ii) the women find the messages presented during CBC, by peers who live similar lives and speak their "language", to be understandable and applicable to them; iii) they learned much about condom use and negotiation, HIV/AIDS, genital herpes, and other STIs. They know for example that condoms have two sides, one lubricated and the other not, and that condoms effectively protect against pregnancy and some STIs; iv) they negotiate condom use better with all types of sexual partners, thus improving their relation to it; v) a large majority report new positive behaviour, selecting clients and partners, and using condoms routinely, taking it off after intercourse themselves. They also now routinely use modern medical care for any STIs; vi) Of 524 women seronegative at inclusion in 2003, only 0.8% became infected in the first three months of the study, and no others in the year that followed. Conclusion: In Bobo-Dioulasso, Burkina Faso, the communication offered in the CBC programme to vulnerable women by peer-advisers trained by a multidisciplinary team, improved to varying degrees the women's knowledge of the various topics covered. This improvement changed their behaviour positively, leading to routine condom use, especially with occasional partners. This has resulted in low HIV incidence. This model can and must be spread to other vulnerable populations. Admittedly, the free services and products provided in the programme make it harder to perpetuate and disseminate. The promotion of health mutuals is one method to provide funding.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Approche centrée sur le patient (ACP) et intégration des soins conventionnels TB/VIH à l'économie locale des pouvoirs :FORESA

info:eu-repo/semantics/publishedMazzochetti J, de Lame D, Interfaces empiriques de la mondialisation

Two edge-disjoint hop-constrained paths and polyhedra

International audienc

Rethinking methods for the study of sexual behaviour

During the past five years, researchers from the Medical Research Council and Uganda Virus Research Institute (MRC/UVRI) Programme on AIDS have studied sexual behaviour to better understand the risk and the spread of HIV infection in a rural Ugandan community. This paper aims at a reflective critique of the application of various methods of studying sexual behaviour in a series of six studies within the programme. The objectives of these various studies have been different: ranging from the natural history of HIV-infection to marital instability to household coping. This variety of foci has led to multiple research strategies. Three methodological factors influencing the research and the results were identified: the research model; the meanings of research questions; and personal factors affecting the interview relationship. Although the impact of these factors could not be entirely eliminated, precautions could be taken to diminish these biases. Comparing data obtained through different methods proved useful not only as a validity test but also as a mean to more deeply interpret the data according to culture, linguistics and society. Lessons learned during this piece of work include the importance to the quality of data by inviting local communities to participate in the research process; broadening the field of sexuality from a health-oriented model to reach an anthropological perspective; considering the influence of research organization on the context in which sexual behaviour takes place as a part of the study objectives and promoting an inter-disciplinary dialogue overcoming dogma and prejudices

Challenging Health Systems with Community’s perceptions and expectations through Socioanthropological feed-back data

Objectives: FORESA3 is an operational research programme aiming at improving health care making it more sensitive to patients’ expectations and needs. Taking TB as an entry-point to criticize health systems in four West African countries implementing ‘patient-centred approach’ (PCA), the project ultimately research dysfunctions and strategies to overcome them. Methods: Qualitative operational research has been used, questioning health practitioners and other actors on results obtained in the field by a multidisciplinary team of socioanthropologists and public health specialists about access to TB care and prevention. 160 semi-structured interviews were conducted in the 4 sites together with direct observation. Participatory methods of group discussions were also used. Data were transcribed in French and analysed using Atlas-ti. Results: The method proved efficient in stimulating reflexivity on health practices and interactions amongst health workers and politics. In the field, new synergies were created with the civil society, notably between traditional healers and health workers. However, the extension to be given to the well-known concept of PCA was found variable according to the actors. Causes of resistances to change attitudes and practices amongst Health Workers will be elicited from the data. Conclusion: Restitution of socioanthropological feed-back data from the civil society about their perceptions and expectations of the ‘patient-centred approach’, often demonstrates controversies according to the actors. Arena of discussions around PCA often tells us more about the motivations of ‘holders’ criticizing or establishing the legitimacy of powers around the stake of patients ‘wellbeing’.info:eu-repo/semantics/publishe

Les mécanismes de solidarité face à la maladie

nrpages: 67status: publishe

On the k edge-disjoint 2-hop-constrained paths polytope

The k edge-disjoint 2-hop-constrained paths problem consists in finding a minimum cost subgraph such that between two given nodes s and t there exist at least k edge-disjoint paths of at most 2 edges. We give an integer programming formulation for this problem and characterize the associated polytope. (c) 2005 Elsevier B.V. All rights reserved

Rethinking methods for the study of sexual behaviour

During the past five years, researchers from the Medical Research Council and Uganda Virus Research Institute (MRC/UVRI) Programme on AIDS have studied sexual behaviour to better understand the risk and the spread of HIV infection in a rural Ugandan community. This paper aims at a reflective critique of the application of various methods of studying sexual behaviour in a series of six studies within the programme. The objectives of these various studies have been different: ranging from the natural history of HIV-infection to marital instability to household coping. This variety of foci has led to multiple research strategies. Three methodological factors influencing the research and the results were identified: the research model; the meanings of research questions; and personal factors affecting the interview relationship. Although the impact of these factors could not be entirely eliminated, precautions could be taken to diminish these biases. Comparing data obtained through different methods proved useful not only as a validity test but also as a mean to more deeply interpret the data according to culture, linguistics and society. Lessons learned during this piece of work include the importance to the quality of data by inviting local communities to participate in the research process; broadening the field of sexuality from a health-oriented model to reach an anthropological perspective; considering the influence of research organization on the context in which sexual behaviour takes place as a part of the study objectives and promoting an inter-disciplinary dialogue overcoming dogma and prejudices.AIDS sexuality methodology Uganda

The two-edge connected hop-constrained network design problem: valid inequalities and Branch-and-Cut

This article deals with the Two-edge connected Hop-constrained Network Design Problem (or THNDP for short). Given a weighted graph G = (N,E), an integer L >= 2, and a subset of pairs of nodes D, the problem consists of finding the minimum cost subgraph in G containing at least two edge-disjoint paths of at most L hops between all the pairs in D. First, we show that the THNDP is strongly NP-hard even when the demands in D are rooted at some node s and the costs are unitary. However, if the graph is complete, we prove that the problem in this case can be solved in polynomial time. We give an integer programming formulation of the problem in the space of the design variables when L = 2,3. Then we study the associated polytope. In particular, we consider the case where all the pairs of nodes of D are rooted at a node s. We give several classes of valid inequalities along with necessary and/or sufficient conditions for these inequalities to be facet defining. We also derive separation routines for these inequalities. We finally develop a branch-and-cut algorithm based on these results and discuss some computational results for L = 2,3. (c) 2006 Wiley Periodicals, Inc