Randomized, Controlled Intervention Trial of Male Circumcision for Reduction of HIV Infection Risk: The ANRS 1265 Trial

BACKGROUND: Observational studies suggest that male circumcision may provide protection against HIV-1 infection. A randomized, controlled intervention trial was conducted in a general population of South Africa to test this hypothesis. METHODS AND FINDINGS: A total of 3,274 uncircumcised men, aged 18–24 y, were randomized to a control or an intervention group with follow-up visits at months 3, 12, and 21. Male circumcision was offered to the intervention group immediately after randomization and to the control group at the end of the follow-up. The grouped censored data were analyzed in intention-to-treat, univariate and multivariate, analyses, using piecewise exponential, proportional hazards models. Rate ratios (RR) of HIV incidence were determined with 95% CI. Protection against HIV infection was calculated as 1 − RR. The trial was stopped at the interim analysis, and the mean (interquartile range) follow-up was 18.1 mo (13.0–21.0) when the data were analyzed. There were 20 HIV infections (incidence rate = 0.85 per 100 person-years) in the intervention group and 49 (2.1 per 100 person-years) in the control group, corresponding to an RR of 0.40 (95% CI: 0.24%–0.68%; p < 0.001). This RR corresponds to a protection of 60% (95% CI: 32%–76%). When controlling for behavioural factors, including sexual behaviour that increased slightly in the intervention group, condom use, and health-seeking behaviour, the protection was of 61% (95% CI: 34%–77%). CONCLUSION: Male circumcision provides a degree of protection against acquiring HIV infection, equivalent to what a vaccine of high efficacy would have achieved. Male circumcision may provide an important way of reducing the spread of HIV infection in sub-Saharan Africa. (Preliminary and partial results were presented at the International AIDS Society 2005 Conference, on 26 July 2005, in Rio de Janeiro, Brazil.

The CONSTANCES cohort: an open epidemiological laboratory

<p>Abstract</p> <p>Background</p> <p>Prospective cohorts represent an essential design for epidemiological studies and allow for the study of the combined effects of lifestyle, environment, genetic predisposition, and other risk factors on a large variety of disease endpoints. The CONSTANCES cohort is intended to provide public health information and to serve as an "open epidemiologic laboratory" accessible to the epidemiologic research community. Although designed as a "general-purpose" cohort with very broad coverage, it will particularly focus on occupational and social determinants of health, and on aging.</p> <p>Methods/Design</p> <p>The CONSTANCES cohort is designed as a randomly selected representative sample of French adults aged 18-69 years at inception; 200,000 subjects will be included over a five-year period. At inclusion, the selected subjects will be invited to fill a questionnaire and to attend a Health Screening Center (HSC) for a comprehensive health examination: weight, height, blood pressure, electrocardiogram, vision, auditory, spirometry, and biological parameters; for those aged 45 years and older, a specific work-up of functional, physical, and cognitive capacities will be performed. A biobank will be set up. The follow-up includes a yearly self-administered questionnaire, and a periodic visit to an HSC. Social and work-related events and health data will be collected from the French national retirement, health and death databases. The data that will be collected include social and demographic characteristics, socioeconomic status, life events, behaviors, and occupational factors. The health data will cover a wide spectrum: self-reported health scales, reported prevalent and incident diseases, long-term chronic diseases and hospitalizations, sick-leaves, handicaps, limitations, disabilities and injuries, healthcare utilization and services provided, and causes of death.</p> <p>To take into account non-participation at inclusion and attrition throughout the longitudinal follow-up, a cohort of non-participants will be set up and followed through the same national databases as participants.</p> <p>A field-pilot was performed in 2010 in seven HSCs, which included about 3,500 subjects; it showed a satisfactory structure of the sample and a good validity of the collected data.</p> <p>Discussion</p> <p>The constitution of the full eligible sample is planned during the last trimester of 2010, and the cohort will be launched at the beginning of 2011.</p

Projets parentaux des femmes vivant avec le VIH/sida à l'ère des thérapies antirétrovirales

L'évolution, au cours de la dernière décennie, de la structure démographique et épidémiologique de l'épidémie par le VIH/sida amène à faire le point sur les projets parentaux des personnes atteintes. En effet, dans le contexte actuel, grâce aux traitements antirétroviraux, un contrôle efficace de l'infection chez les parents potentiels vivant avec le VIH est assuré, de même qu'un fort taux de réduction du risque de transmission du virus de la mère à l'enfant. L'étude présentée ici concerne le désir d'enfant des femmes en âge de reproduction, ayant participé à l'enquête Anrs-Vespa, en fonction de l'origine ethnique, du mode de vie, de facteurs culturels et de santé (état immunovirologique, traitement). Cinq cent cinquante cinq femmes se déclarant hétérosexuelles et qui n'avaient pas d'antécédent connu d'infertilité ont été incluses dans l'analyse. Parmi elles, 33 % ont rapporté le désir d'avoir des enfants. L'âge moyen des femmes retenues dans l'analyse est de 36 ans (31-40). L'Afrique sub-saharienne est le pays d'origine de 30 % d'entre elles. Chez les femmes séropositives, les déterminants d'un projet d'enfant mis en évidence dans cette étude comprennent d'une part, des facteurs classiques comme le jeune âge, le fait de vivre en couple stable et de ne pas être déjà mère et, d'autre part, des facteurs culturels comme l'origine ethnique (naissance au Maghreb ou en Afrique sub-saharienne). Par ailleurs, les couples sont plus susceptibles de s'engager dans un projet parental si au moins l'un d'eux n'est pas infecté par le VIH. L'état de santé par rapport au VIH/sida n'est pas associé au projet parental. Au vu de ces résultats, il semble que la problématique de la parentalité devrait dorénavant être mieux prise en compte au cours de la prise en charge médicale de la séropositivité

Les femmes séropositives : vie sexuelle et prévention

La vie sexuelle est profondément affectée par la séropositivité. Les 1 712 hommes et femmes hétérosexuels ayant participé à l'enquête Anrs-Vespa réalisée en 2003 ont été répartis par sexe en distinguant les immigrés, les personnes ayant une histoire de consommation de drogue par injection et les autres, français non immigrés et non-usagers de drogue. L'activité sexuelle est réduite par la moindre fréquence des relations de couple dans cette population, les différences entre hommes et femmes portent principalement sur les partenaires occasionnels comme en population générale. Les enjeux importants que constituent la révélation de la séropositivité dans le couple et l'utilisation systématique du préservatif apparaissent relativement homogènes entre hommes et femmes et entre groupes. Le maintien du secret envers le partenaire stable est un peu plus rare chez les personnes immigrées, tandis que les femmes consommatrices ou ex-consommatrices de drogue apparaissent les plus en difficulté dans le comportement de protection. Les résultats observés suggèrent que l'infection à VIH tend à araser l'hétérogénéité des comportements sexuels et préventifs. Des travaux complémentaires sont nécessaires pour saisir les situations de risque de façon dynamique

: No variability in response to HAART

International audienceOBJECTIVE: Because a centre effect can sometimes exist in HIV treatment, we sought to measure the heterogeneity of French hospital departments delivering HIV care and to test the presence of such an effect on adherence and response to highly active antiretroviral therapy. METHODS: The ANRS-EN12-VESPA study is a nationally representative 2-stage cross-sectional survey conducted in France in 2003 and covering 102 hospital departments providing HIV care. Each department described its HIV care activities and care provision. Analyses of adherence and 4 indicators of treatment outcome were restricted to the 699 patients diagnosed from 1996 onwards and treated with highly active antiretroviral therapy for at least 6 months. The variability between departments was assessed with random-effect models for binary outcomes. RESULTS: The departments delivering HIV care proved to be somewhat heterogeneous in numerous respects, including their size and their onsite provision of consultancies and other services, and the characteristics of their patient population. Mean observed adherence was 63.3%, and the means of the different treatment failure indicators ranged from 6.1% to 59.8%. The departments showed some variability for these outcomes, but no significant centre effect was detected. CONCLUSIONS: Despite the heterogeneity of the specific types of medical services offered by the hospitals providing HIV care, the nationwide treatment results seem homogeneous. This homogeneity could be attributed to the widespread and consistent application of therapeutic guidelines, which are regularly updated by consensus

Childhood sexual abuse and adult binge drinking among Kanak women in New Caledonia.

International audienceThe long-term consequences of violence against women are poorly documented within the context of political domination, economic inequalities and rapid social change of indigenous communities. Using data from the first population study on violence against women and their consequences on health in New Caledonia, South Pacific, this article investigates the association between childhood sexual abuse and binge drinking among 441 adult Kanak women. Face-to-face standardised interviews were conducted in 2002-2003, among women aged 18-54 years drawn from the electoral rolls. Childhood sexual abuse before 15 years of age was reported by 11.6% of respondents. Nearly all the perpetrators (96%) were known to the victims (63% being a close relative). The rate of frequent binge drinking amongst the women within the last 12 months was 34%. After controlling for social and demographic factors, an independent association was found between childhood sexual abuse and current binge drinking. This study is the first to analyse the contribution of childhood sexual abuse to the likelihood of later heavy alcohol use in an indigenous population in the South Pacific. The findings call for improving and giving priority to care for children who are victims of violence to prevent long-term health consequences and to develop prevention programs aimed at alcohol-related behaviour in women, while taking into account simultaneous individual and collective factors

Factors correlated with disclosure of HIV infection in the French Antilles and French Guiana: results from the ANRS-EN13-VESPA-DFA Study.

OBJECTIVES: To determine the rate, patterns and predictors of HIV disclosure in the French Antilles and French Guiana. METHODS: A cross-sectional survey was carried out among a 15% random sample (n=398) of the hospital caseload in hospitals providing HIV care. Determinants of disclosure to a steady partner and other members of the individual's social network were analysed using logistic regression. RESULTS: From the time of diagnosis, 84.6% of those in a couple (n=173) disclosed their HIV-positive status to their steady partner, 55.6% disclosed to others, and 30.3% did not tell their status to anyone. Disclosure within a steady partnership was less likely among non-French individuals [Haitians: adjusted odds ratio (AOR) 0.11, 95% confidence interval (CI) 0.02-0.72; other nationalities: AOR 0.13, 95% CI 0.02-0.68]; and among those diagnosed with HIV after 1997 (AOR 0.21, 95% CI 0.05-0.86). Determinants of disclosure to others were found to be sex (women: AOR 2.04, 95% CI 1.24-3.36), age at diagnosis (>or=50 versus<30 years: AOR 0.42, 95% CI 0.19-0.90), nationality (Haitians versus French: AOR 0.39, 95% CI 0.19-0.77), transmission route (non-sexual versus sexual: AOR 3.38, 95% CI 1.12-10.23) and hospital inpatients (hospitalized versus non-hospitalized patients: AOR 1.98, 95% CI 1.17-3.37). After disclosing, social and emotional support from confidants was common and discrimination was infrequent. CONCLUSION: One third of PLWHA had kept their HIV status secret. Interventions targeting the general population and social institutions, and support for PLWHA by healthcare staff are needed to improve the situation

Childhood sexual abuse and adult binge drinking among Kanak women in New Caledonia

The long-term consequences of violence against women are poorly documented within the context of political domination, economic inequalities and rapid social change of indigenous communities. Using data from the first population study on violence against women and their consequences on health in New Caledonia, South Pacific, this article investigates the association between childhood sexual abuse and binge drinking among 441 adult Kanak women. Face-to-face standardised interviews were conducted in 2002-2003, among women aged 18-54 years drawn from the electoral rolls. Childhood sexual abuse before 15 years of age was reported by 11.6% of respondents. Nearly all the perpetrators (96%) were known to the victims (63% being a close relative). The rate of frequent binge drinking amongst the women within the last 12 months was 34%. After controlling for social and demographic factors, an independent association was found between childhood sexual abuse and current binge drinking. This study is the first to analyse the contribution of childhood sexual abuse to the likelihood of later heavy alcohol use in an indigenous population in the South Pacific. The findings call for improving and giving priority to care for children who are victims of violence to prevent long-term health consequences and to develop prevention programs aimed at alcohol-related behaviour in women, while taking into account simultaneous individual and collective factors.New Caledonia South Pacific Indigenous women Childhood sexual abuse Binge drinking Kanak women Alcohol