Intimate ties of people living with HIV in France resulted both from social status and the experience of being HIV-infected: results from the ANRS-Vespa2 study, France.

Based on data from the ANRS-Vespa2 study, conducted among a representative sample of PLWHIV (France, 2011), we studied intimate ties with relatives and friends and their determinants. Six social network profiles were identified, with a clear association with socioepidemiological groups: the most surrounded individuals were MSM, and the most isolated ones were sub-Saharan African migrants (especially women). Social networks were shaped both by material socioeconomic status and HIV experience: involvement in PLWHIV organizations, disclosure of HIV infection, and the experience of discrimination. Among PLWHIV, intimate ties appeared to be shaped by both their multifaceted social position rooted in power relationships and by HIV-related stigma. Such a process nurtures social inequality in coping with HIV infection, since the most disadvantaged individuals appear to be the most isolated ones. A holistic approach to HIV care is still required to overcome the marginalization of PLWHIV .

Frequency and correlates of late presentation for HIV infection in France: older adults are a risk group - results from the ANRS-VESPA2 Study, France.

Correlates of late presentation (LP) for HIV infection in Metropolitan France and French overseas departments (FODs) were assessed among HIV-infected patients recently diagnosed, using data from a large cross-sectional survey, representative of the French HIV-infected population, conducted in 2011. LP was defined as presentation with either clinical AIDS events within the calendar year of diagnosis or CD4 < 350/mm(3) and presentation with advanced disease (PAD) was defined as presentation with either clinical AIDS events or CD4 < 200/mm(3). Correlates of LP/PAD were assessed through logistic modelling, separately in Metropolitan France and FODs. In Metropolitan France, 47.7% of participants were late presenters and 29.3% presented with advanced disease. LP was more frequent among male and female migrants from sub-Saharan Africa (SSA; 58.5% and 56.4%) and non-African heterosexual males (61.8%) than among men who have sex with men (34.8%). In FODs, 53.2% of participants were late presenters and 36.8% presented with an advanced disease. LP was more frequent among men than women (60.6% vs. 45.3%) and among those with a lower level of education (56.6% vs. 47.5%). A consistent positive association was found in adjusted analyses between LP/PAD and increasing age at diagnosis among all subpopulations, in both settings. In Metropolitan France, among men who have sex with men, those self-declaring as bisexual were at higher risk of LP/PAD; among non-African heterosexual males and females, religiosity was associated with increased risk of LP/PAD; and among SSA migrants, those diagnosed within the year following their arrival in France were at higher risk of LP/PAD. Older age at diagnosis is a major risk factor for LP/PAD independently of any other socio-demographic characteristics. Promotion of HIV testing should be renewed to target each subgroup at risk while paying a particular attention to middle-aged or older adults whose attitudes and beliefs towards HIV/AIDS might prevent them from seeking testing.

Multiple discriminations experienced by people living with HIV in France: results from the ANRS-Vespa2 study.

Since the advent of AIDS, discrimination has remained at the core of the experience of people living with HIV (PLHIV). PLHIV who belong to minority groups are exposed to discrimination not only on the grounds of their HIV infection but also because of rejecting attitudes towards drug users, homosexuals and black people. This article aimed to measure the frequency of discrimination and assess its correlates among PLHIV in France. We used data from a national representative survey, the ANRS-Vespa2 study, conducted in France in 2011 among 3022 male and female HIV-positive patients followed at hospitals. Respondents answered a face-to-face questionnaire documenting their health status and living conditions. Discrimination was documented during the previous two years on the grounds of HIV infection, gender, country of birth, skin colour, sexual orientation, place of residence, and substance abuse in a variety of contexts. For each context, we performed logistic regressions on discrimination, controlling for socio-epidemiological group, age, education level and employment status. Discrimination is frequently experienced by PLHIV in France (26%), particularly when applying for a job (24%), interacting with family (11%) or seeking health services (8%). Women from sub-Saharan Africa reported the highest levels of discrimination, whereas heterosexual non-African men reported the lowest. Men who have sex with men experienced levels of discrimination that fell between those of these two groups. The major perceived reason for discrimination was HIV status (13%). Nationality, skin colour and sexual orientation were cited by 5% each, whereas gender was cited by 1% of respondents. Our analyses show that discrimination is a frequent and cross-cutting experience with differences across the various contexts and among the diverse subpopulations. The intertwining of HIV-related stigma with sexism, racism and homophobia needs to be addressed to understand why discrimination against PLHIV persists when the disease itself has greatly evolved.

Kava drinking associated with suicidal behaviour among young Kanaks using kava in New Caledonia.

OBJECTIVE: To examine associations between recreational use of kava and indicators of suicidal behaviour among youth in New Caledonia. METHODS: This cross-sectional community-based survey was administered to 1,400 young people aged 16-25 years. A multivariate analysis tested for associations between lifetime kava use and lifetime suicidal ideation and attempts. Because ethnicity affected the correlation between kava use and suicidal behaviour, data were analysed separately for Kanak youth and youth of other ethnic communities. RESULTS: Overall, 42% of respondents reported any lifetime kava use, 34% reported past suicidal ideation and 12% any suicide attempts. Among Kanak youth, kava use increased the likelihood of reporting both suicidal ideation (aOR = 2.40, 95% CI: 1.58-3.66) and suicide attempts (aOR = 1.98, 95% CI: 1.11-3.52). No such association was found in the non-Kanak group. CONCLUSIONS: The discrepancy between the effects of kava drinking on suicidal behaviour between Kanak youth and youth of other ethnic groups may be related to differences in patterns and quantity of kava use. In view of the paucity of data on the effects of kava on mental health in young people, further investigation is required. IMPLICATIONS: The results call for an increased awareness of the potential adverse health effects of kava consumption in New Caledonia where it has spread in recent times and among communities where previously it was never used.

Childhood sexual abuse and adult sexual health among indigenous Kanak women and non-Kanak women of New Caledonia.

OBJECTIVES: Few studies have addressed the long-term consequences of adverse childhood experiences among women in Oceania, in particular among indigenous women. This paper aims to report prevalences of childhood sexual abuse (CSA) and to asses the negative sexual health consequences in adulthood by comparing indigenous Kanak to non-Kanak women in New Caledonia. METHODS: Data come from a population survey on violence against women and health. Face-to-face interviews were conducted in 2002-2003 with adult women randomly selected from the electoral list. Separate models for Kanak (n=329) and non-Kanak women (n=426) were performed. Regression models adjusted for relevant socio-demographics factors were conducted to estimate the odds ratios for the associations between childhood sexual abuse and adult sexual health outcomes. RESULTS: A non-significant difference between Kanak (11.8%) and non-Kanak women (14.4%) was found for the prevalence of CSA. Among Kanak women, CSA increases the risk of sexually transmitted infections, of non-desired sexual intercourse with an intimate partner and of experience of adult sexual violence. However, use of modern contraception as an adult was more frequent among CSA Kanak victims, as compared to other Kanak women. Among non-Kanak women, only abortion appeared significantly associated with CSA. CONCLUSIONS AND PRACTICE IMPLICATIONS: The findings show that in all ethnic communities of New Caledonia, a history of child sexual abuse is not rare among women. They also shed light on the long-term consequences of CSA, suggesting that the effect of CSA may differ according to ethnic membership and subsequent social stratification and gender norms. Efforts to break the silence around violence against girls and establish a stronger foundation are required in New Caledonia. Prevention programs on violence against women and sexual health that take into account the cultural and social heterogeneity are needed.

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.

HIV protection and screening in women in New Caledonia.

The paper examines HIV data in a Violence Against Women survey conducted in New Caledonia. A representative sample of 1012 women aged 18 to 54 were interviewed. It describes the effect on HIV prevention behavior of knowing someone who is HIV+ and examines condom use and other indicators of unprotected sexual behavior such as unwanted pregnancies and abortion. It also looks at HIV screening, both during antenatal care and at the woman's own initiative. Despite improved prevention behavior among young Islanders (18-24), the results indicate the persistence of strong inequalities among ethnic communities in HIV information and protection and in reproductive health. In New Caledonia to day, health inequity in these areas still clearly disadvantage the indigenous Melanesian and Polynesian women too, compared to European women.