The influenza A (H1N1) pandemic in Reunion Island: knowledge, perceived risk and precautionary behaviour.

BACKGROUND: The effectiveness of preventive measures depends on prevailing attitudes and mindsets within a population. Perceived risk is central to a shift in mindset and behaviour. The present study aims to investigate the perceived severity, vulnerability and precautionary behaviour adopted in response to the influenza A (H1N1) epidemic that broke out in 2009 on Reunion Island (Indian Ocean). As no H1N1 vaccination was available at the time, non-medical interventions appeared of crucial importance to the control of the epidemic. METHODS: A cross sectional survey was conducted in Reunion Island between November 2009 and April 2010 within 2 months of the passage of the influenza A (H1N1) epidemic wave. Individual contacts representing 725 households (one contact per household) were interviewed by telephone using validated questionnaires on perceived risks. Mean scores were calculated for perceived severity, vulnerability, efficacy of preventive measures and precautionary behaviour. Univariate analysis was applied to identify preventive measures and attitudes and multivariate analysis was used to study the determinants of precautionary behaviour. RESULTS: More than 95% of contacted persons accepted to participate to the survey. Eighty seven percent of respondents believed that prevention was possible. On average, three out of six preventive measures were deemed effective. Spontaneously, 57% of the respondents reported that they took one or more preventive measures. This percentage increased to 87% after the interviewer detailed possible precautions one by one. The main precautions taken were frequent hand washing (59%) and avoidance of crowded places (34%). In multivariate logistic regression analysis the following factors were significantly associated with taking one or more preventive measures: young age, previous vaccination against seasonal influenza, having had seasonal influenza in the last five years, effectiveness of the preventive measures taken and low standards of education. CONCLUSION: Inhabitants of Reunion Island have expressed a preventive approach adapted to the realities of the H1N1 pandemic, a feature that likely reflects some preparedness gained after the large and severe chikungunya epidemic that hit the island in 2006. The degree of severity was well assessed despite the initial alarmist messages disseminated by national and international media. Precautions that were undertaken matched the degree of severity of the epidemic and the recommendations issued by health authorities. Further qualitative studies are needed to help adapting public messages to the social and cultural realities of diverse communities and to prevent misconceptions.

[Sexual behaviors and acceptability of STI (including HIV) testing outside nightclubs in Saint-Gilles, Reunion]. / Comportements sexuels et acceptabilité du dépistage des IST (dont le VIH) à la sortie de discothèques à Saint-Gilles les Bains, île de la Réunion.

The CDAG/CIDDIST centers (CDAG: Free Anonymous Testing Center/CIDDIST: STI Information, Testing and Diagnosis Center) were created in response to the demands of a population at risk of contracting sexually transmitted infections (STIs) wanting to undergo free, anonymous and confidential testing. On the occasion of Sidaction 2010, a study based on a sample of 100 individuals leaving nightclubs in Saint-Gilles (Réunion) was conducted to evaluate the effectiveness of mobile interventions (i.e. measures to promote HIV and STI information, prevention and testing) beyond the confines of CDAG/CIDDIST centers, focusing specifically on at-risk populations. Data were collected on the acceptability of the intervention and HIV/STI testing and on sexual behaviors among the studied population. In addition to STI-related information, participants were offered a more in-depth consultation with a doctor, followed, if necessary, by a test (blood sample). The results show that there was significant interest in the new measures among the population. 77% considered them necessary. 43% intended to come to the information and testing stand for contraceptives. A small proportion of participants (15%) completed the full screening process in situ. In addition, among the studied population (which included individuals with high-risk behaviors), 40% had never undergone HIV testing. The study highlighted various sexual risk behaviors. 69% of the participants engaged in unprotected anal intercourse, including 46% of single people (defined as living alone and not in a stable relationship). The two indicators (i.e. acceptability of local interventions outside CDAG/CIDDIST centers and risk behaviors among the targeted population) suggest the need to pursue "extramural" interventions among targeted populations and to promote them widely.

Is sexually transmitted infection management among sex workers still able to mitigate the spread of HIV infection in West Africa?

OBJECTIVE: To assess the role of sexually transmitted infection (STI) management to prevent HIV acquisition among sex workers in Burkina Faso. DESIGN: Open cohort study of professional and nonprofessional sex workers with 3-month follow-up visits. METHODS: Baseline and follow-up visits consisted of the administration of a behavioral questionnaire, education sessions on HIV and STIs, a medical examination, and laboratory testing for STI and HIV diagnosis. RESULTS: Three hundred seventy-seven HIV-negative women were enrolled in the study. The cumulated HIV incidence was 3.2 per 100 person-years (Poisson 95% confidence interval: 1.9-4.9). Bacterial and parasitic STIs were low at baseline, whereas herpes simplex virus-2 (HSV-2) prevalence was 54.7%. By a Cox regression model, self-assessment of high HIV risk in the past, less than 5 clients per week, and no change of a steady partner were independently associated with HIV acquisition. Among STIs, only infection with HSV-2 tended to be associated with HIV acquisition (odds ratio = 2.45; P = 0.15). Overall, condom use increased during the study but to a lesser extent with steady partners. CONCLUSIONS: Bacterial and parasitic STIs are no longer a key determinant of HIV acquisition, given the current stage of the outbreak in Burkina Faso. Although efforts for STI control should be maintained, strategies should focus on nonprofessional sex workers, steady partners, and HSV-2 infection to tackle HIV transmission further in this high-risk group.

Retroviral Transmission and Breast-feeding.

Transmission of animal retroviruses has been demonstrated both for oncogenic retroviruses and animal lentiviruses. In humans, breast-feeding is the major route for mother-to-child transmission of Human T-cell Leukemia/Lymphoma Virus type I (HTLV-I). HTLV-I transmission by breast milk is associated with ingestion of infected cells and can be prevented by formula-feeding. Breast-feeding transmission of the Human Immunodeficiency Virus type 1 (HIV-1) has only been recently recognized as responsible for one to two thirds of mother-to-child transmission in breast-fed populations. A primary HIV-1 infection acquired in mothers after the baby has begun breast-feeding is associated with a particularly high risk of transmission. Breast milk transmission appears to result from the coexistence of HIV-1 and an inadequate humoral response in milk. Due to the dramatic impact of formula-feeding on child morbidity and mortality, it is suggested that present recommendation continue to promote breast-feeding in women living in settings where infectious diseases and malnutrition are the primary causes of infant deaths, as in many developing countries. On the other hand, in settings where infectious diseases and malnutrition are not the primary causes of infant deaths, as in most of the developed world, mothers with a proven HIV-1 infection should be advised not to breast-feed their babies.

Spectrum of commercial sex activity in Burkina Faso: classification model and risk of exposure to HIV.

OBJECTIVE: Before designing a sexually transmitted infection (STI)/HIV intervention study targeting female commercial sex workers in Bobo Dioulasso, Burkina Faso, we conducted a socioanthropologic survey to analyze the prostitution network in the city in 1998. According to social characteristics, women were classified in six different categories, including four groups of nonprofessional sex workers. The aim of the current study is to assess HIV exposure across this classification model. METHODS: A total of 447 women belonging to the six categories were enrolled in the study. After collection of social and behavioral data by means of a questionnaire, each woman received a physical examination and a blood sample was taken for HIV serologic testing. RESULTS: The category of "seaters" was the most often infected, with an HIV prevalence of 57% (58 of 101 women). Nonprofessional "sellers" and "bar waitresses" were more often infected than professional "roamers," with an HIV prevalence of 37% (24 of 65 women), 40% (27 of 67 women), and 29% (27 of 92 women), respectively, despite a much lower number of clients per week (average of 2.6 clients, 3.3 clients, and 18.6 clients, respectively). Finally, "students" and "cabarets" (women making and selling local beer in huts) were infected with an HIV prevalence of 15% (9 of 62 women and 9 of 60 women, respectively), which remains higher than the prevalence measured recently in the general female population in the city (6.4%). CONCLUSION: Our results highlight the high level of vulnerability of nonprofessional sex workers, who need to be considered in the design of any program targeting this population for STI/HIV control purposes.