Bibliographie

2014


  • Larmarange Joseph (2014) Rwanda: Developing subnational estimates of HIV prevalence and the number of people living with HIV (JC2665E), Geneva : UNAIDS, 17 p. http://www.unaids.org/en/resources/documents/2014/2014_subnationalestimatessurvey_Rwanda.

  • Larmarange Joseph (2014) Lesotho: Developing subnational estimates of HIV prevalence and the number of people living with HIV (JC2665E), Geneva : UNAIDS, 16 p. http://www.unaids.org/en/resources/documents/2014/2014_subnationalestimatessurvey_Lesotho.

  • Larmarange Joseph (2014) Haiti: Developing subnational estimates of HIV prevalence and the number of people living with HIV (JC2665E), Geneva : UNAIDS, 17 p. http://www.unaids.org/en/resources/documents/2014/2014_subnationalestimatessurvey_Haiti.


  • Larmarange Joseph, Balestre Eric, Orne-Gliemann Joanna, Iwuji Collins, Okesola N., Newell M.L., Dabis François et Lert France (2014) « HIV ascertainment through repeat home-based testing in the context of a treatment as prevention trial (ANRS 12249 TasP) in rural South Africa », AIDS Research and Human Retroviruses, 30 (Suppl. 1), p. A287. DOI : 10.1089/aid.2014.5650.abstract. http://www.documentation.ird.fr/hor/fdi:010063442.


  • Larmarange Joseph et Bendaud Victoria (2014) « HIV estimates at second subnational level from national population-based surveys: », AIDS, 28, p. S469-S476. DOI : 10.1097/QAD.0000000000000480. http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00002030-201411004-00008.

  • Larmarange Joseph, Coulibaly Siriki, Koriko Ousman et Fall Madior (2014) « Appréhender la structure écodémographique des ménages à partir d’enquêtes économiques : l’exemple des Enquêtes sur les Dépenses des Ménages 2008 », Statéco, 108, p. 75-97. http://www.epsilon.insee.fr/jspui/handle/1/26633.
    Résumé : Lieu premier de socialisation des individus, le ménage constitue une dimension essentielle à la compréhension des changements à l’œuvre dans les sociétés africaines. Une description fine de la structure démographique des ménages nécessite des dispositifs de collecte complexes et coûteux. Cependant, même avec des enquêtes dont la finalité première n’est pas l’analyse démographique des ménages, il est déjà possible de dresser un panorama de leur diversité. Dans cet article, en partant des Enquêtes sur les Dépenses des Ménages menées en 2008 dans les capitales de l’UEMOA, nous montrons comment il est possible de tirer parti de la variable “dispose d’un revenu monétaire” pour construire une ypologie « éco-démographique » des ménages, rendant compte de leur taille et de leur structure de dépendance et permettant de raduire la diversité des situations rencontrées par les familles usuellement classées comme « élargies ».

  • Larmarange Joseph, Kassoum Ouattara, Kacou Élise, Fradier Yves, Lazare Sika, Danel Christine et groupe DOD-CI ANRS 12287 (2014) « Faisabilité et Représentativité d’un échantillonnage aléatoire de lignes mobiles en Côte d’Ivoire : résultats d’une étude pilote » (communication orale), présenté à 8e Colloque Francophone sur les Sondages, Dijon. http://sondages2014.sfds.asso.fr/prog/#2014-11-18.
    Résumé : Nous présentons les résultats d’une enquête exploratoire pilote visant à tester la faisabilité et la représentativité d’une enquête nationale en population générale en Côte d’Ivoire à partir d’un échantillon aléatoire de numéros de téléphone portable. Nous montrons que les ivoiriens sont aisément joignables et acceptent facilement de répondre à des questions par téléphone, y compris sur des sujets sensibles. Les refus étaient peu nombreux et inférieurs à ce qui est usuellement observé dans des enquêtes similaires en France. En termes de représentativité, l’échantillon obtenu s’avère être plus jeune, plus urbain et plus masculin. Nous avons comparé quatre indicateurs avec l’Enquête Démographique et de Santé (EDS) réalisée en 2011/12. Du fait des biais de sélection de notre enquête (recrutement uniquement d’abonnés mobiles en particulier), les indicateurs mesurés étaient plus élevés que ceux observés dans l’EDS 2011/12. Cependant, les différentiels observés par sexe, groupe d’âges, niveau d’instruction et milieu de résidence étaient similaires dans les deux enquêtes. Il nous paraît envisageable de réaliser aujourd’hui une enquête nationale en Côte d’Ivoire selon cette approche, moyennant quelques ajustements, dont la prise en compte des non abonnés mobile résidant dans le même ménage qu’un abonné mobile.
    Pièce jointe Résumé long.pdf 750.5 ko

  • Larmarange Joseph, Orne-Gliemann Joanna, Balestre Eric, Iwuji Collins, Okesola Nonhlanhla, Newell Marie-Louise, Dabis François, Lert France et TasP ANRS 12249 Study Group (2014) « HIV ascertainment through repeat home-based testing in the context of a Treatment as Prevention trial (ANRS 12249 TasP) in rural South Africa » (poster P52.05), présenté à HIV Research for Prevention, Cape Town. DOI : 10.1089/aid.2014.5650.abstract.
    Résumé : Background The ANRS 12249 TasP cluster-randomised trial evaluates whether HIV testing of all members of a community, followed by immediate antiretroviral treatment (ART) for infected people, will prevent onward sexual transmission and reduce HIV incidence at population level. Ascertaining the HIV status of a high proportion of the population regularly and repeatedly is key to the success of any universal test and treat strategy, as the first step of the HIV cascade. Methods Between March 2012 and March 2014, we implemented three six-monthly rounds of home-based HIV counselling and testing in ten local communities (clusters). At each home visit, individual questionnaires were administered and a rapid HIV test offered to all trial participants. We report early results on rates of HIV ascertainment, defined as undergoing a rapid HIV test or HIV-positive self-report. Results Of 12,911 eligible individuals (resident in the trial area and ≥16 years), 10,007 were successfully contacted at least once. At first contact, HIV status was ascertained for 7,628 (76.2% [95% CI: 75.4-77.1]) individuals. At second contact, among the 5,885 individuals contacted a second time, HIV status was ascertained for 2,829 (85.0% [95% CI: 83.7-86.2]) of the 3,328 tested negative at first contact and for 543 (45.7% [95% CI: 42.9-48.6]) of the 1,188 who refused a rapid test at first contact. Overall, HIV ascertainment rate was 89.0% (5,239/5,885 [95% CI: 88.2-89.8]) among trial participants contacted twice. Conclusions Repeat home-based HIV testing is acceptable and feasible in this rural area. Socio-demographic characteristics, behaviours, attitudes, household characteristics and experience of HIV infection and ART in the household will be explored for their association with HIV ascertainment uptake. This will inform whether this intervention reaches the individuals at higher risk in a rural South African region.

  • Vogt Adam, Andrew Alastair, Zvoleff Alex, Manton Ashley, Diggs Brian, Pereira Cassio, Robinson David, Hirschmann Fabian, Simeon Fitch, Detrez Gregoire, Wickham Hadley, Jeon Heewon, Burkhead Jake, Manton James, Arnold Jeff, Stephens Jeremy, Hester Jim, Cheng Joe, Honaker John, Keane Jonathan, Allaire J. J., Toloe Johan, Larmarange Joseph, Barnier Julien, Smith Kevin K., Mueller Kirill, Takahashi Kohske, Friendly Michael, Kuhlmann Michel, Caballero Nacho, Salkowski Nick, Ross Noam, Li Qiang, Vaidyanathan Ramnath, Cotton Richard, Francois Romain, Brouwer Sietse, Bernard Simon de, Wei Taiyun, Lamadon Thibaut, Leeper Thomas, Torsney-Weir Tom, Davis Trevor, Veitas Viktoras, Zhu Weicheng, Wu Wush et Xie Yihui (2014) Knitr: A General-Purpose Package for Dynamic Report Generation in R, version 1.8. http://cran.r-project.org/web/packages/knitr/index.html.
    Résumé : This package provides a general-purpose tool for dynamic report generation in R, which can be used to deal with any type of (plain text) files, including Sweave, HTML, Markdown, reStructuredText, AsciiDoc, and Textile. R code is evaluated as if it were copied and pasted in an R terminal thanks to the evaluate package (e.g., we do not need to explicitly print() plots from ggplot2 or lattice). R code can be reformatted by the formatR package so that long lines are automatically wrapped, with indent and spaces added, and comments preserved. A simple caching mechanism is provided to cache results from computations for the first time and the computations will be skipped the next time. Almost all common graphics devices, including those in base R and add-on packages like Cairo, cairoDevice and tikzDevice, are built-in with this package and it is straightforward to switch between devices without writing any special functions. The width and height as well as alignment of plots in the output document can be specified in chunk options (the size of plots for graphics devices is also supported). Multiple plots can be recorded in a single code chunk, and it is also allowed to rearrange plots to the end of a chunk or just keep the last plot. Warnings, messages and errors are written in the output document by default (can be turned off). The large collection of hooks in this package makes it possible for the user to control almost everything in the R code input and output. Hooks can be used either to format the output or to run R code fragments before or after a code chunk. The language in code chunks is not restricted to R (there is simple support to Python and shell scripts, etc). Many features are borrowed from or inspired by Sweave, cacheSweave, pgfSweave, brew and decumar.

2013


  • Barnier Julien, Briatte François et Larmarange Joseph (2013) Questionr, R package to make surveys processing easier, version 0.3.0. http://cran.r-project.org/web/packages/questionr/.
    Résumé : This R package provides some convenience functions to make the processing and analysis of surveys easier.

  • Barnier Julien et Larmarange Joseph (2013) « Introduction à l'analyse d'enquêtes avec R », Support de cours. https://github.com/larmarange/intro-r/tree/CoursM2.
    Résumé : A partir d’un document original de Julien Barnier, complété par Joseph Larmarange. Le chapitre sur l'analyse de séquences est une reprise d'un article original de Nicolas Robette. Ce document évolutif, sous licence Creative Commons, est développé sous GitHub : https://github.com/larmarange/intro-r/tree/CoursM2
  • Brouard Nicolas, Larmarange Joseph, Ambrosetti Elena, Duthé Géraldine et Giudici Cristina (2013) « Toward an harmonized second edition of the Multilingual Demographic Dictionary: the Demopædia project » (communication orale, session 70), présenté à XXVII IUSSP International Population Conference, Busan.
    Résumé : The Demopædia project has set, as a first goal, to give access to demographers all editions of the Multilingual Demographic Dictionary published since the 50's. Computerization has shown that if the first editions were consistent over the 1100 concepts, very large gaps, most often due to omissions undermined the overall quality of the second edition of the multilingual dictionary, 1492 concepts for the French (1981), 1475 for the English (1982), 1495 Spanish (1985),1555 for the German (1987). The harmonization process consists in maximizing the corpus to 1581 concepts. The Communication will review the volumes already harmonized in French and Italian, published or forthcoming, as the new Asian languages that emerged after the workshops of Paris (2007) and Chiang Mai (2012). If we may regret a modern third edition, this standardization process is a necessary step. The availability of all texts and cross-languages indexes on any kind of media from paper book up to digital tablets is an asset. This harmonization phase is also an opportunity for the community of demographers to prepare the third edition by proposing a succinct definition of new terms or expressions which are emerging on the Open Encyclopedia Population platform both in English and in about 20 languages.

  • Demopædia (2013) Cross-Reference Index of the Multilingual Demographic Dictionary in English, French and Spanish, Paris : Demopædia, 198 p. http://www.demopaedia.org.

  • Demopædia (2013) Multilingual Demographic Dictionary, unified second edition, English volume, Paris : Demopædia, 177 p. http://en-ii.demopaedia.org.
  • Imrie John, Larmarange Joseph, Orne-Gliemann Joanna, Iwuji Collins, Lert France et ANRS 12249 TasP Study Group (2013) « Issues emerging from universal test and treat (UTT) intervention trials » (communication orale n°CS20#2), présenté à 2nd International Conference for the Social Sciences and Humanities in HIV, Paris.
    Résumé : Universal repeat testing and early antiretroviral treatment (UTT) strategies to reduce onward sexual transmission are major social, as well as biomedical interventions. Several UTT trials are underway or being prepared. This paper discusses some emerging issues arguing extensive social science within UTT trials needs complementary enquiry to guide public health and operational decisions beyond the trials themselves. The issues fall under three broad headings: 1) Social and behavioural consequences of large numbers of people knowing their HIV-status and potentially beginning treatment early. Will the impacts on sexual behaviour, disclosure and stigma all be positive? Harmful? 2) Normative changes at individual and community levels. What normative changes occur in communities exposed to prolonged, intense research around unspoken or socially taboo subjects? Does seeing more healthy people attending clinics alter community perceptions of disease and care? Can salient positive changes be identified and replicated? 3) Operational and ethical implications of transforming research interventions into routine care. Who should lead? Requirements for sustainability. Impacts of institutions ‘knowing’ about individuals’ HIV status and care uptake, especially in contexts of criminalisation and marginalised or vulnerable populations? UTT strategies have potentially great social consequences that need to be explored alongside the actual trials, to guide and inform future decisions and policy.
  • Imrie John, Larmarange Joseph, Orne-Gliemann Joanna, Lert France et ANRS 12249 TasP Study Group (2013) « Taking test and treat interventions to the next level – Beginning to think what additional information needs to guide public health and operational decisions? » (poster n°2289118), présenté à 6th South African AIDS Conference, Durban.
    Résumé : Background The proposition universal repeat HIV testing and early initiation of antiretroviral treatment for all HIV-positives (UTT) can lead to reduced HIV incidence is being, or will be, tested in several studies. UTT interventions are major social, as well as biomedical interventions, for individuals and target communities. Implementing UTT trial (ANRS 12249 TasP Trial) provoked thinking about what is needed for public health and operational decisions to move to the next level if UTT efficacy is demonstrated. Methods In ANRS 12249 Tasp Trial innovative social science tools are implemented at each UTT stage to ensure a comprehensive understanding of the social determinants of intervention uptake at the individual and community-level and the impacts at individual, household and community level. But these alone cannot guide such a decision. Results Additional questions requiring answers: Social and Behavioural consequences of UTT: What are the long-term social and behavioural consequences of large numbers of people knowing their HIV-status and starting treatment early? Will impacts on sexual behaviour, disclosure and stigma necessarily be positive, now and in the long term? Changes in individual and community norms: Will community perceptions of HIV and healthcare be changed seeing healthy people going to clinics? How are community norms around testing and treatment, stigma and discrimination affected by prolonged, intense research? Can salient positive changes be identified and replicated? Operational and ethical implications of moving UTT into routine care: Who should lead? What are the sustainability requirements? What ethical issues are there in authorities ‘knowing’ individuals’ HIV status and care uptake? Conclusions UTT strategies have potentially great social consequences for the individuals and populations involved. Questions emerging from UTT trials need further enquiry before public health and operational decisions to move beyond the trials are made.


  • Iwuji Collins C, Orne-Gliemann Joanna, Tanser Frank, Boyer Sylvie, Lessells Richard J, Lert France, Imrie John, Bärnighausen Till, Rekacewicz Claire, Bazin Brigitte, Newell Marie-Louise, Dabis François et ANRS 12249 TasP study group (2013) « Evaluation of the impact of immediate versus WHO recommendations-guided antiretroviral therapy initiation on HIV incidence: the ANRS 12249 TasP (Treatment as Prevention) trial in Hlabisa sub-district, KwaZulu-Natal, South Africa: study protocol for a cluster randomised controlled trial », Trials, 14 (1), p. 230. DOI : 10.1186/1745-6215-14-230. http://clinicaltrials.gov/ct2/show/NCT01509508?term=anrs+12249&rank=1.
    Résumé : BACKGROUND: Antiretroviral therapy (ART) suppresses HIV viral load in all body compartments and so limits the risk of HIV transmission. It has been suggested that ART not only contributes to preventing transmission at individual but potentially also at population level. This trial aims to evaluate the effect of ART initiated immediately after identification/diagnosis of HIV-infected individuals, regardless of CD4 count, on HIV incidence in the surrounding population. The primary outcome of the overall trial will be HIV incidence over two years. Secondary outcomes will include i) socio-behavioural outcomes (acceptability of repeat HIV counselling and testing, treatment acceptance and linkage to care, sexual partnerships and quality of life); ii) clinical outcomes (mortality and morbidity, retention into care, adherence to ART, virologic failure and acquired HIV drug resistance), iii) cost-effectiveness of the intervention. The first phase will specifically focus on the trial's secondary outcomes. METHODS/DESIGN: A cluster-randomised trial in 34 (2 × 17) clusters within a rural area of northern KwaZulu-Natal (South Africa), covering a total population of 34,000 inhabitants aged 16 years and above, of whom an estimated 27,200 would be HIV-uninfected at start of the trial. The first phase of the trial will include ten (2 × 5) clusters. Consecutive rounds of home-based HIV testing will be carried out. HIV-infected participants will be followed in dedicated trial clinics: in intervention clusters, they will be offered immediate ART initiation regardless of CD4 count and clinical stage; in control clusters they will be offered ART according to national treatment eligibility guidelines (CD4 <350 cells/μL, World Health Organisation stage 3 or 4 disease or multidrug-resistant/extensively drug-resistant tuberculosis). Following proof of acceptability and feasibility from the first phase, the trial will be rolled out to further clusters. DISCUSSION: We aim to provide proof-of-principle evidence regarding the effectiveness of Treatment-as-Prevention in reducing HIV incidence at the population level. Data collected from the participants at home and in the clinics will inform understanding of socio-behavioural, economic and clinical impacts of the intervention as well as feasibility and generalizability. TRIAL REGISTRATION: Clinicaltrials.gov: NCT01509508; South African Trial Register: DOH-27-0512-3974.

  • Larmarange Joseph (2013) Biblio Check, plugin SPIP pour la vérification en ligne de références bibliographiques, SPIP, version 1.0. http://contrib.spip.net/?article4310.

  • Larmarange Joseph (2013) « Impact de la couverture antirétrovirale dans la population générale en contexte hyper-endémique sud-africain », Vih.org, avril 29. http://www.vih.org/20130429/impact-couverture-antiretrovirale-dans-population-generale-en-contexte-hyper-endemique-sud-.
    Résumé : L'accès universel aux antirétroviraux (ARV) reste un des enjeux majeurs de la lutte contre l'épidémie de VIH. Il s'agit non seulement de réduire les décès en maintenant les personnes infectées en vie, mais également, espère-t-on depuis quelques années, de pouvoir réduire les nouvelles infections. Deux articles publiés récemment et conjointement dans la revue Science analyse l'impact en population générale de l'augmentation de l'accès aux ARV sur la mortalité et l'incidence dans une zone rurale sud-africaine.
  • Larmarange Joseph (2013) « Mapping Demographic and Health Surveys (DHS): a method to estimate regional trends of a proportion (prevR) » (poster, session 176), présenté à XXVII IUSSP International Population Conference, Busan.
    Résumé : For many countries, in particular in sub-Saharan Africa, Demographic and Health Surveys (DHS) are the main national source of data (depending on the subject). Several DHS collect latitude and longitude of surveyed clusters but the sampling method is not appropriate to derive local estimates: sample size is not large enough for a direct spatial interpolation. We develop a methodological approach for estimating a proportion by using kernel density estimators with adaptive bandwidths of equal number of persons surveyed. The method was tested by creating a fictitious country from which survey datasets were produced. We compared the prevalence surface estimated from survey data with the model’s original prevalence surface. This method makes it possible to achieve a smoothing effect that adapts to the high irregularity of spatial distribution among the survey clusters. The surfaces thus generated are relatively accurate for densely populated areas and strongly smoothed in sparsely surveyed areas. Although local variations were filtered out, the regional component in the spatial variation of prevalence was reproduced, and the estimated prevalence surfaces could be interpreted as regional trend surfaces. Furthermore, this approach could be easily applied using prevR, a dedicated package for the statistical software R.
  • Larmarange Joseph (2013) « Treatment as Prevention: new challenges regarding HIV testing in Southern Africa and Western Africa » (communication orale), présenté à Les Grands Défis Démographiques du 21e siècle - Saison croisée France Afrique du Sud - iPOPs, Paris.
    Résumé : Treatment as prevention (TasP) strategy or more precisely universal repeat HIV testing and early treatment initiation (UTT) could reduce significantly the number of new HIV infections in general population. Several on-going trials are currently testing the feasibility and the efficacy of this approach in Southern Africa. The UTT strategy changes the whole paradigm of HIV prevention and care and has potentially great social consequences that need to be explored. We will explore some of emerging issues in social science raised by these trials. Moreover, epidemiological contexts are different between Southern Africa and Western Africa: UTT strategies cannot be implemented in the same way. Which questions should be specifically addressed to implement UTT strategy in Western Africa?

  • Larmarange Joseph (2013) JLutils: a collection of diverse R functions, version 0.1.0. https://github.com/larmarange/JLutils.
    Résumé : A collection of diverse R functions who don't fit (yet?) in another package.
  • Larmarange Joseph, Imrie John, Orne-Gliemann Joanna, Iwuji Collins, Lert France et ANRS 12249 TasP Study Group (2013) « Socio-economic issues investigated in an HIV Treatment as Prevention (TasP) trial in rural KwaZulu-Natal: research questions, implementation and progress » (poster n°2288617), présenté à 6th South African AIDS Conference, Durban.
    Résumé : Background HIV testing of all adult members of a community, followed by immediate antiretroviral treatment (ART) initiation of HIV-infected participants, regardless of immunological or clinical staging, could prevent onward transmission and reduce HIV incidence. The community cluster-randomized ANRS 12249 Treatment as Prevention (TasP) trial has been designed to test acceptability, feasibility and efficacy of this strategy in Hlabisa sub-district, KwaZulu-Natal. In addition to epidemiological, clinical and operational challenges, TasP raises unprecedented social challenges at individual and population levels. Methods The trial began in March 2012. Innovative research tools are being implemented at each stage of the TasP intervention: repeat home-based questionnaires with household heads and individual household members; specific questionnaires for the HIV-infected individuals attending trial clinics and for those who choose not enter HIV care; combined with in-depth semi-structured individual qualitative interviews, repeat focus groups discussions (consumer panels) using participatory methods. Results We will be able to describe precisely participation in the trial and to understand the social determinants of uptake in terms of repeat HIV testing, linkage to and retention in HIV care; the impact of this TasP strategy on quality of life; the economic impact on households and the healthcare system; and consequences for people’s life in terms of HIV disclosure, stigma, sexual behaviours, social support, treatment experience and adherence. Conclusions TasP is not just a biomedical intervention. Understanding the consequences of implementing universal HIV testing and ART on individual behaviour changes and community social norms is crucial to explain any observe impact on HIV incidence.
  • Larmarange Joseph, Imrie John, Orne-Gliemann Joanna, Iwuji Collins, Lert France et ANRS 12249 TasP Study Group (2013) « Addressing social science in a HIV Treatment as Prevention trial in South Africa » (communication orale n°CS12#1), présenté à 2nd International Conference for the Social Sciences and Humanities in HIV, Paris.
    Résumé : Models show that universal HIV testing and early antiretroviral treatment (ART) could lead to reduced HIV incidence and potential eradication under assumptions that have yet to be observed in real life – high coverage and frequent repeat HIV testing, high levels of linkage and retention in care. ANRS 12249 Treatment as Prevention (TasP) trial in rural KwaZulu-Natal aims to evaluate acceptability, feasibility and efficacy of this strategy. It has two components: home-based testing of all ≥16 years every six months with immediate versus standard ART initiation for HIV-infected individuals (HIV+). TasP is a biomedical intervention raising unprecedented social challenges. Relationships between individual and community factors, their interactions and implications are all being investigated using innovative quantitative and qualitative tools. Key issues addressed include: Who accepts repeat testing/immediate ART and why? What are the obstacles? How TasP impacts on people’s lives in terms of quality of life; HIV disclosure; stigmatisation, relationships; sexual behaviours; perceptions; social support; treatment experience and adherence? Economic impact for households and health care systems? What are the changes at community level during TasP implementation and influences on individual behaviours? These are investigated in three groups: the general population; HIV+ attending clinics; and those who do not entre care, for a comprehensive understanding of the determinants of uptake.

  • Larmarange Joseph et Le Cœur Sophie (2013) La situation de l’épidémie VIH/Sida en 2013, Fiche d'actualité, Paris : Ined, 3 p. http://www.ined.fr/fr/tout_savoir_population/fiches_actualite/sida_2013/.
    Résumé : Dans son bilan pour l'année 2012, l'ONUSIDA estime à 35,3 millions le nombre de personnes infectées par le VIH dans le monde, avec 2,3 millions de nouvelles infections et 1,6 million de décès dans l'année. L'Afrique sub-saharienne est de loin la région du monde la plus touchée (25 millions de personnes infectées), suivie par l'Asie du Sud et du Sud-Est (4,8 millions). Le poids de l'épidémie dans un pays s'exprime par la proportion de personnes infectées dans l'ensemble de la population adulte (ou prévalence). Elle varie fortement d'un pays à l'autre, le maximum étant atteint en Afrique australe : plus de 20 % de la population adulte dans certains pays !

  • Larmarange Joseph et Le Cœur Sophie (2013) The current situation of the HIV/AIDS epidemic 2013, Information sheet, Paris : Ined, 3 p. http://www.ined.fr/en/everything_about_population/news/aids_2013/.
    Résumé : According to UNAIDS estimates for the year 2012, 35.3 million persons are infected with the HIV virus worldwide and there were 2.3 million new infections and 1.6 million deaths that year. Sub-Saharan Africa is by far the hardest-hit region, with 25 million people infected, followed by South and Southeast Asia, with a combined total of 4.8 million. The burden of the epidemic in a given country is expressed by the proportion of infected persons among the entire adult population, or prevalence. Prevalence varies greatly by country; the highest rates are in Southern Africa; in some Southern African countries over 20% of the adult population is infected.
  • Larmarange Joseph, Orne-Gliemann Joanna, Iwuji Collins, Imrie John, Lert France, Dabis François, Newell Marie-Louise et ANRS 12249 TasP Study Group (2013) « Acceptability and Uptake of Repeat Home-based HIV Counselling and Testing in Rural South Africa. Preliminary Data of the ANRS 12249 TasP Trial » (poster n°2406992), présenté à 17th International Conference on AIDS and STIs in Africa (ICASA), Cape Town.
    Résumé : Background: The ANRS 12249 Treatment as Prevention (TasP) trial is assessing whether HIV testing of all members of a community, followed by immediate ART initiation of all HIV-infected individuals, regardless of immunological or clinical staging, will prevent onward sexual transmission and reduce HIV incidence in the same population. The implementation of universal and repeat home-based HIV testing is not documented yet in a high HIV incidence and prevalence context. Methods: A cluster-randomised trial is implemented using a phased-approach in the Hlabisa sub-district (KwaZulu Natal, South Africa) where more than 20% of adults are living with HIV. The trial started in March 2012; ten clusters are implemented in the first phase to assess the feasibility and acceptability of the two consecutive interventions (test then treat). The HIV testing strategy consists in a large range of community and clinic HIV testing options including the implementation of 6-monthly rounds of home-based HIV counselling and testing by dedicated counsellors. At each home visit, trial participants are administered individual questionnaires and offered a rapid HIV test. Results: As of April 30, 2013, 6 907 eligible subjects (16 years or above) were registered in six clusters and 5 122 (74%) were contacted. HIV status of 3 923 (76.5% of those contacted) was ascertained, 3 256 accepting the rapid HIV test at home and 667 being already aware of their HIV-positive status. We will present updated data from the first four trial clusters, where all eligible members of the community will have been offered three rounds of home-based HIV testing within 18 months. Uptake of HIV testing at each round will be reported. Uptake of repeat HIV testing will be measured among those testing HIV-negative at first round and who accept repeat HIV testing at rounds 2 and 3. We will also describe the reasons for HIV test refusal. Finally, we will present participants' attitudes regarding repeat HIV testing, and changes between rounds 1 and 3. Conclusions: Acceptance of regular and frequent HIV testing is key to the community-based efficacy of treatment as prevention initiatives in settings with very high incidence. Our data will provide first indications of whether repeat home-based HIV testing is acceptable and feasible in such a rural South African region.

2012

2011



  • Larmarange Joseph, Vallo Roselyne, Yaro Seydou, Msellati Philippe et Méda Nicolas (2011) « Méthodes pour cartographier les tendances régionales de la prévalence du VIH à partir des enquêtes démographiques et de santé (EDS) », Cybergeo : European Journal of Geography, 539. DOI : 10.4000/cybergeo.23782. http://cybergeo.revues.org/23782.
    Résumé : Pour de nombreux pays, en particulier en Afrique subsaharienne, les Enquêtes Démographiques et de Santé (EDS) constituent la principale estimation de la prévalence du VIH au niveau national et en population générale. Plusieurs EDS collectent la longitude et la latitude des grappes enquêtées.Dans cet article, nous présentons trois approches méthodologiques pour cartographier les variations spatiales de la prévalence du VIH à partir des EDS. Ces approches sont appliquées à des simulations d’EDS échantillonnées à partir d’un pays modèle. Les surfaces estimées sont alors comparées à la surface initiale du modèle.Nous montrons qu’une méthode utilisant des estimateurs à noyau à fenêtres adaptatives de même effectif permet d’estimer les principales tendances régionales des épidémies. Son application aux données de l’EDS 2003 du Burkina Faso fournit une image plausible de la situation épidémiologique dans ce pays.For many countries, in particular in sub-Saharan Africa, Demographic and Health Surveys (DHS) are the main estimates of HIV prevalence at national level in general population. Several DHS collect longitude and latitude of surveyed clusters.In this paper, we present three methodological approaches for mapping spatial variations of HIV prevalence from DHS. These approaches are applied to DHS simulation sampled from a model country. The estimated surfaces are then compared with the initial surface of the model.We show that a method using kernel estimators with adaptive bandwidths of the same number of observed people allows estimating main regional trends of the epidemics. Its application to data from 2003 DHS of Burkina Faso give a plausible picture of the epidemiological situation in this country.


  • Larmarange Joseph, Vallo Roselyne, Yaro Seydou, Msellati Philippe et Méda Nicolas (2011) « Methods for mapping regional trends of HIV prevalence from Demographic and Health Surveys (DHS) », Cybergeo : European Journal of Geography, 558. DOI : 10.4000/cybergeo.24606. http://cybergeo.revues.org/24606.
    Résumé : In many countries, particularly in sub-Saharan Africa, Demographic and Health Surveys (DHSs) are the main way of estimating HIV prevalence nationally in the general population. Some DHSs record the longitude and latitude of the survey clusters. We present three methodological approaches for mapping spatial variations in HIV prevalence using the DHSs. These approaches are applied to simulated DHS samplings from a model country. The estimated surfaces are then compared with the model’s initial surface. We demonstrate that a method using kernel estimators with adaptive bandwidths size of equal number of persons observed can be used to estimate the main regional trends in epidemics. Application to Burkina Faso’s 2003 DHS data provides a plausible image of that country’s epidemiological situation.
    Mots-clés : demographic and health surveys, Developing Countries, enquêtes démographiques et de santé, HIV, interpolation, interpolation par noyaux, kernel interpolation, Méthodologie, Methodology, Pays en développement, regional trends, tendances régionales, VIH.

2010


  • Groupe ELIHoS (2010) Évaluer les interventions de prévention des IST et du VIH auprès des homosexuels masculins au Sénégal (projet ANRS 12139) – Rapport Scientifique, Working Papers du CEPED (06), Paris : CEPED, 108 p. http://www.ceped.org/wp.

  • Henry Emile, Marcellin Fabienne, Yomb Yves, Fugon Lionel, Nemande Steave, Gueboguo Charles, Larmarange Joseph, Trenado Emmanuel Eboko et Spire Bruno (2010) « Factors associated with unprotected anal intercourse among men who have sex with men in Douala, Cameroon », Sexually Transmitted Infections, 86 (2), p. 136-140. DOI : 10.1136/sti.2009.036939.
    Résumé : Objectives Research on men who have sex with men (MSM) in sub-Saharan Africa was neglected for a long time. The objective of this study was to understand factors associated with unprotected anal intercourse (UAI) with male partners among a group of MSM living in the city of Douala, Cameroon. Methods In 2008, a survey on the sexual activity and practices of MSM was set up in Douala in collaboration with a local community-based organisation. Data were collected among a convenience sample of 168 MSM during face-to-face interviews with trained interviewers. Results A total of 142 individuals reported sexual activity during the previous 6 months, among whom 80 (57%) reported UAI with male partners. In a multivariate logistic regression model adjusted for the frequency of sexual intercourse, not having had access to prevention interventions and not knowing any HIV-infected person were both independently associated with a higher risk of UAI. Other factors associated with this higher risk included having had a stable male partnership at some point in one's life and not having been out of Douala for more than 4 weeks during the previous year. Conclusions This community-based research is the first study of MSM in Cameroon and the HIV transmission risks they face. Results show the importance of HIV prevention interventions from peers, and underline the need to maintain efforts to develop specific interventions targeting MSM more efficiently in the African context.
  • Larmarange Joseph (2010) « Recherches sur les homosexuels en Afrique » (communication orale), présenté à 5e Conférence Francophone sur le VIH/Sida de l'AFRAVIH, Casablanca.
    Résumé : Symposium ANRS “Populations vulnérables et VIH/Sida : le rôle de la recherche”

  • Larmarange Joseph (2010) « Homo-bisexuels masculins au Sud : il est temps d’agir ! », Transcriptases, 144, novembre 22, p. 68-70. http://vih.org/20101122/homo-bisexuels-masculins-au-sud-il-est-temps-d-agir-19660.
    Résumé : La problématique des hommes ayant des rapports sexuels avec d’autres hommes (HSH) en Afrique avait émergé lors de la conférence de Bangkok en 2004. La conférence de Toronto en 2006 avait bousculé, quant à elle, l’idée selon laquelle l’épidémie de sida au Sud serait seulement hétérosexuelle. À Mexico en 2008, le nombre d’études épidémiologiques avait augmenté, permettant ainsi de confirmer le fait que les HSH étaient, y compris dans les pays à faibles et moyens revenus, particulièrement touchés par le VIH. A cela s’ajoutent leur faible prise en compte dans les programmes de lutte contre le sida et une criminalisation et une stigmatisation de l’homosexualité très fortes dans de nombreux pays.
  • Larmarange Joseph, Desgrées du Loû Annabel, Enel Catherine, Wade Abdoulaye S. et Groupe ELIHoS (2010) « Diversité des homo-bisexualités au Sénégal et exposition au VIH » (communication orale), présenté à 5e Conférence Francophone sur le VIH/Sida de l'AFRAVIH, Casablanca.
    Résumé : Objet Les hommes ayant des rapports sexuels avec d’autres hommes (HSH) constituent en Afrique une population vulnérable encore trop peu étudiée (prévalence du VIH de 22 % au Sénégal). La bisexualité dans l’année est élevée (>70 %). Une catégorisation binaire homosexuels/bisexuels est de fait inadaptée pour traduire la diversité des situations et des comportements. Méthodes Une enquête socio-comportementale a été menée en 2007 auprès de 501 HSH sénégalais recrutés par la méthode « boules de neige ». La bisexualité est appréhendée au travers du pôle d’activité sexuelle des enquêtés, déterminé à partir du sexe des partenaires sexuels (homosexuel ou bisexuel dans l’année) et des partenaires déclarés réguliers au moment de l’enquête (hommes, femmes, les deux, sans), soit six combinaisons de ces deux variables. Le pôle d’activité sexuelle est croisé avec différents indicateurs épidémiologiques et socio-comportementaux. Résultats obtenus Les profils sociodémographiques (âge, site, instruction, activité, membres d’association) des enquêtés sont similaires sur les différents pôles. On constate deux pôles opposés : les homosexuels exclusifs dans l’année et les bisexuels n’ayant que des partenaires régulières femmes. Les premiers ont commencé leur sexualité avec un homme plus jeune (15,4 ans versus 18,6). Ils ont eu, en moyenne, plus de partenaires sexuels masculins (15,1 vs 6,6) et, pour les 53 % bisexuels sur la vie, moins de partenaires féminines (2,1 vs 5,5). Ils sont plus infectés par le VIH (29,0 vs 9,8 %). L’utilisation d’un préservatif n’est pas liée au pôle d’activité sexuel. Les homosexuels pratiquent plus la sodomie réceptive qu’insertive (inverse observé pour les bisexuels ayant une partenaire régulière femme), d’où une vulnérabilité accrue au VIH. La fréquence des rapports sur le mois dépend, quant à elle, du fait d’avoir un ou plusieurs partenaires réguliers du sexe considéré. Conclusion Les pôles d’activité sexuelle présentent des profils comportementaux contrastés qui doivent être pris en compte par les programmes de prévention HSH. Les différences d’exposition au VIH ne découlent pas d’un recours différencié au préservatif mais sont fonction de la fréquence des rapports, des pratiques (insertives/réceptives) et de réseaux sexuels différents.
  • Larmarange Joseph, Vallo Roselyne, Yaro Seydou, Msellati Philippe, Méda Nicolas et Ferry Benoît (2010) « Cartographier la prévalence du VIH pour mieux comprendre l’épidémie : l’exemple du Burkina Faso à partir de l’Enquête Démographique et de Santé de 2003 » (communication orale), présenté à 5e Conférence Francophone sur le VIH/Sida de l'AFRAVIH, Casablanca.
    Résumé : Objet Depuis 2001, plusieurs Enquêtes Démographiques et de Sante (EDS) incorporent le dépistage du VIH. Pour de nombreux pays, il s’agit de l’unique source de données sur la prévalence du VIH en population générale à l’échelle nationale. Nous avons développé une approche générique pour cartographier la prévalence du VIH à partir des EDS (logiciel prevR disponible en ligne) et l’avons appliquée à l’EDS 2003 du Burkina Faso. Nous montrons ensuite comment nos résultats apportent un éclairage nouveau sur l’épidémie au Burkina Faso. Méthodes Une tendance spatiale régionale de la prévalence du VIH est calculée pour chaque zone enquêtée à partir de techniques en composantes d’échelle en ayant recours à des cercles de même effectifs et en tenant compte des principales agglomérations urbaines. Une carte est ensuite produite par interpolation spatiale selon la méthode du krigeage ordinaire. Elle reproduit les gradients spatiaux de la prévalence du VIH à des échelles infrarégionales (dans un rayon de 30 à 100 kilomètres). Résultats obtenus Les foyers d’infections se situent principalement au niveau des agglomérations urbaines : Ouagadougou, la capitale, mais aussi les principales villes situées sur les axes routiers vers le Mali et la Côte d’Ivoire. La région entre Débougou et Gaoua est particulièrement touchée, ce qui n’était pas visible à partir de la surveillance sentinelle des femmes enceintes. Outre sa proximité avec la Côte d’Ivoire et le Ghana, elle est connue comme une zone importante d’orpaillage. La carte obtenue présente des similitudes avec celle des zones migratoires traditionnelles du Burkina Faso et avec celle des retours de rapatriés burkinabés depuis la Côte d’Ivoire fin 2002. Enfin, nos résultats montrent des divergences avec la surveillance sentinelle en milieu rural autour de Kaya. Cette dernière a observé une prévalence élevée qui, en fait, ne traduit pas l’épidémie régionale mais seulement un pic local. Conclusion La cartographie des prévalences met en évidence des différentiels non visibles via la surveillance sentinelle des femmes enceintes ; permet d’identifier les zones les plus touchées, constituant en cela un outil de planification et d’évaluation ; et suggère de nouvelles pistes de recherche à explorer.
  • Larmarange Joseph, Vallo Roselyne, Yaro Seydou, Msellati Philippe, Méda Nicolas et Ferry Benoît (2010) « Calculer des tendances régionales à partir d’une enquête auprès des ménages : cas de la prévalence du VIH dans les Enquêtes Démographiques et de Santé (EDS) » (communication orale n°04B-1), présenté à 6e Colloque francophone sur les sondages, Tanger.
    Résumé : Les Enquêtes Démographiques et de Santé (EDS) constituent un important programme mené dans plus de 75 pays du Sud. Ces enquêtes portent sur des sujets variées et nombre d’EDS incorporent également la géolocalisation des zones enquêtées (longitude et latitude). Depuis 2001, plusieurs EDS ont intégré un module de dépistage du VIH. Les EDS sont des enquêtes auprès des ménages, en population générale, représentatives usuellement au niveau national et régional, stratifiées par région et milieu de résidence, avec un sondage en grappe à deux degrés. Au premier degré, les grappes (zones de dénombrement au dernier recensement) sont sélectionnées avec une probabilité proportionnelle à leur nombre de ménages. La répartition spatiale de ces grappes reflète de fait la densité de la population. Au second degré, les ménages enquêtés sont sélectionnés par tirage au sort simple. Pour le dépistage du VIH, le nombre de personnes testées varie entre 5 000 et 12 000 et celui de grappes entre 300 et 500, soit un nombre moyen de personnes testées par grappe de 12 à 40 personnes. Du fait des petits effectifs, le calcul d’une prévalence du VIH (proportion de personnes infectées) pour chaque grappe n’est pas pertinent : les prévalences observées par grappe traduisent plus les variations aléatoires de l’échantillonnage que les variations réelles des épidémies. Les analyses spatiales en composantes d’échelles consistent à séparer un phénomène comme une somme d’une composante d’échelle supérieure (composante régionale) et une composante d’échelle inférieure (résidu local). Cette décomposition peut être obtenue en procédant à un lissage spatial, le plus souvent par des cercles de même rayon. Les EDS étant échantillonnées proportionnellement à leur population, une approche par cercle de même rayon est peu pertinente en raison de la répartition très inégale des grappes sur le territoire. Nous avons développé une approche calculant les composantes régionales de chaque grappe en agrégeant les observations des grappes voisines par le biais de cercles de même effectif. Ces composantes régionales peuvent ensuite être interpolées spatialement pour produire une carte. L’estimation des composantes régionales de chaque grappe vise à réduire les aléas statistiques du tirage au second degré des EDS. L’interpolation spatiale, quant à elle, permet de compenser le tirage au premier degré. Pour tester et vérifier notre approche, nous avons eu recours à un pays virtuel sur lequel nous avons simulé des EDS. Il est alors possible de comparer graphiquement les résultats obtenus après lissage des données d’enquêtes simulées avec l’épidémie initiale du modèle. De même, nous avons pu calculer les valeurs de N (effectif minimum des cercles de lissage) qui minimisaient simultanément les erreurs aléatoires et les résidus locaux. Nous avons pu reconstituer les principales tendances régionales de l’épidémie du modèle. Ainsi, cette approche permet une première exploration des données présentes dans une EDS et d’obtenir des cartes plus fines que des aplats de couleurs par région administrative. Sa mise en œuvre est en outre aisée grâce à prevR, un package R que nous avons développé, disponible en ligne. Enfin, elle peut être appliquée à d’autres indicateurs des EDS.

  • Larmarange Joseph, Vallo Roselyne, Yaro Seydou, Msellati Philippe, Méda Nicolas et Ferry Benoît (2010) « Mapping HIV prevalence in Africa for a better understanding of epidemics: example from Burkina Faso using 2003 demographic and health survey data » (poster n°THPE0379 , a obtenu ‘the IAS/ANRS Young Investigator Award’), présenté à XVIII International AIDS Conference, Vienna. http://www.iasociety.org/Default.aspx?pageId=11&abstractId=200737136.
    Résumé : Backgrounds Since 2001, several Demographic and Health Surveys (DHS) include HIV testing. We developed a generic approach to map spatial trends of HIV prevalence from DHS (free software online). We present how our results from Burkina Faso 2003 DHS shed new light on HIV epidemics. Methods An estimation is made of regional spatial trends of HIV prevalence for each surveyed cluster by aggregating data from neighbouring clusters, using rings of the same number of tested persons and taking into account main urban agglomerations. The map is then generated by spatial interpolation. Results This map is coherent with the knowledge we had of HIV epidemic in this country. Prevalence is higher in main cities and small cities along main roads. The region around Diébougou and Gaoua was particularly affected, a data which had not shown on antenatal surveillance. In addition to its proximity to Ivory Coast and Ghana, it is a major gold-washing zone which also has lot of migrant men and sex workers. The map showed similarities with migration areas in the 80’s and 90’s and with repatriate returns from Ivory Coast at the end of 2002 and beginning of 2003. Lastly, our results diverge from antenatal surveillance around Kaya. The high prevalence observed in this rural clinic is not representative of the low prevalence at a regional level. Conclusion HIV prevalence mapping highlights differences that were not visible using antenatal surveillance; allows identifying most prevalent areas; constitutes a monitoring and evaluation tool; and suggest new research fields to investigate.

  • Larmarange Joseph, Wade Abdoulaye S., Diop Abdou K., Diop Oulimata, Gueye Khady, Marra Adama, Desgrées du Loû Annabel et ELIHoS Group (2010) « Men who have sex with men (MSM) and risk factors associated with last sexual intercourse with a man and a woman in Senegal - ELIHoS Project, ANRS 12139 » (poster n°WEPDC102 avec présentation orale), présenté à XVIII International AIDS Conference, Vienna. http://www.iasociety.org/Default.aspx?pageId=11&abstractId=200737147.
    Résumé : Background Men who have sex with other men (MSM) are in Africa a vulnerable population which has hitherto been insufficiently explored. Given the high rate of bisexuality among MSM, it is important to understand their risk-taking behaviours regarding both men and women. Methods A socio-behavioural survey was carried out in 2007 among 501 MSM recruited using the snowball sampling method. We explore in this article why a condom was not used during last sexual intercourse with a man and with a woman, bearing in mind the respondent’s characteristics, type of relationship and the context of the sexual act. Results 489 men reported that they had had sexual intercourse at least once with another man during the previous year, and 358 with a man and with a woman. With another man, the main risk factors are sexual intercourse in a public place (adjusted OR = 6.8), and non-participation in an MSM prevention program (adjusted OR = 3.1). The risks, although non-significant at 5%, are higher among younger men (18-19 years) and older men (35 years and over), and among vulnerable people (unemployed). With a woman, sexual intercourse with the respondent’s wife is hardly ever protected (2%). Otherwise, risks are high when the female partner is very young (15 years or younger, adjusted OR = 5.3) and when the man has not participated in an MSM prevention campaign (adjusted OR = 2.3). Conclusion Having participated in a prevention program specifically targeting MSM constitutes a major prevention factor. However, these programs targeting MSM must address their heterosexual practices and the specific risks involved.


  • Larmarange Joseph, Wade Abdoulaye S., Diop Abdou K., Diop Oulimata, Gueye Khady, Marra Adama, Desgrées du Loû Annabel et ELIHoS Group (2010) « Men Who Have Sex with Men (MSM) and Factors Associated with Not Using a Condom at Last Sexual Intercourse with a Man and with a Woman in Senegal », PLoS ONE, 5 (10), p. 1-7 (e13189). DOI : 10.1371/journal.pone.0013189. http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0013189.
    Résumé : BackgroundMen who have sex with other men (MSM) are a vulnerable population in Africa that has been insufficiently explored. Given the high rate of bisexuality among MSM (73% in the past year), it is important to understand their risk-taking behaviors regarding both men and women.Methodology/Principal FindingsA socio-behavioral survey was carried out in 2007 among 501 MSM recruited using the snowball sampling method. We explore in this article why a condom was not used during last sexual intercourse with a man and with a woman, taking into account the respondent's characteristics, type of relationship and the context of the sexual act. In the survey, 489 men reported that they had had sexual intercourse at least once with another man during the previous year, and 358 with a man and with a woman. The main risk factors for not using a condom at last sexual intercourse with another man were having sex in a public place (aOR = 6.26 [95%CI: 2.71–14.46]), non-participation in an MSM prevention program (aOR = 3.47 [95%CI: 2.12–5.69]), a 19 years old or younger partner (aOR = 2.6 [95%CI: 1.23–4.53]), being 24 years or younger (aOR = 2.07 [95%CI: 1.20–3.58]) or being 35 years or over (aOR = 3.08 [95%CI:1.11–8.53]) and being unemployed (aOR = 0.36 [95%CI: 0.10–1.25]). The last sexual intercourse with the respondent's wife was hardly ever protected (2%). With women, the other factors were a 15 years or younger partner (aOR = 6.45 [95%CI: 2.56–16.28]), being educated (primary: aOR = 0.45 [95%CI: 0.21–0.95], secondary or higher: aOR = 0.26 [95%CI: 0.11–0.62]), being a student (aOR = 2.20 [95%CI: 1.07–4.54]) or unemployed (aOR = 3.72 [95%CI: 1.31–10.61]) and having participated in a MSM prevention program (aOR = 0.57 [95%CI: 0.34–0.93]).ConclusionHaving participated in a prevention program specifically targeting MSM constitutes a major prevention factor. However, these programs targeting MSM must address their heterosexual practices and the specific risks involved.

  • Wade Abdoulaye S., Larmarange Joseph, Diop Abdou K., Diop Oulimata, Gueye Khady, Marra Adama, Sene Amsata, Enel Catherine, Niang Diallo Pape, Toure Kane Ndeye Coumba, Mboup Souleymane et Desgrées du Loû Annabel (2010) « Reduction in risk-taking behaviors among MSM in Senegal between 2004 and 2007 and prevalence of HIV and other STIs. ELIHoS Project, ANRS 12139 », AIDS Care, 22 (4), p. 409-414. DOI : 10.1080/09540120903253973.
    Résumé : An epidemiological survey conducted in Senegal in 2004 among men having sex with men (MSM) revealed high HIV prevalence and a high rate of risky behaviors within this population. Consequently, several prevention campaigns targeting MSM were implemented. A second survey was carried out in 2007 to assess the impact of these measures. This paper aims to examine trends in HIV and STI prevalence and in sexual behaviors between 2004 and 2007. The two surveys were conducted in four urban sites among 440 and 501 MSM – recruited using the snowball sampling method – in 2004 and 2007, respectively. A similar methodology was applied for both surveys. This consisted of a closed-ended questionnaire concerning socio-demographic, behavioral, and biomedical information plus a clinical examination including urine and blood tests to detect STIs and HIV infection. Between 2004 and 2007, the frequency of different sexual practices reported by MSM remained stable, but condom use for each type of sexual practice rose. The percentage of men who reported consistent condom use during previous-month anal sex has increased by about 35% (p<0.01). The percentage of men who reported consistent condom use during previous-month non-commercial sex with women has increased by 14% (p<0.01). HIV prevalence remained stable from 22.4% [95% CI: 18.6-26.8] in 2004 to 21.8% [95% CI: 18.3-25.7] in 2007 (adjusted OR = 1.05, p=0.8). Gonorrhea prevalence decreased from 5.5% [95% CI: 3.6-8.3] in 2004 to 2.6% [95% CI: 1.5-4.5] in 2007 (adjusted OR = 0.5, p=0.07). The prevention campaigns, STI and HIV care and support programs conducted in Senegal among MSM have been followed by a reduction of risk-taking behaviors and STI prevalence among this population. Specific targeting of this group within HIV/STI prevention programs seems to be effective in decreasing sexual infections.
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