[Dialogue between general practitioner and patient regarding tobacco and alcohol consumption, from the patient's standpoint]. / Dialogue entre médecin généraliste et patient : les consommations de tabac et d'alcool en question, du point de vue du patient.

BACKGROUND: General practitioners (GP) are key players in screening and counselling for smokers and alcohol drinkers exceeding French guidelines for low-risk consumption thresholds. Tackling the subject from the patients' perspective, the authors aim at estimating the proportion of the population having discussed their smoking and alcohol consumption with their GPs, and to pinpoint the factors associated with their having done so. METHODS: The data (n=6346) are derived from nationwide representative phone survey in mainland France conducted by the French public health monitoring center Baromètre de Santé publique France. RESULTS: Among the persons aged 18-75 having consulted a GP over the last 12 months (82.5%), 36.7% stated that smoking had been discussed in consultation while 16.8% had talked about alcohol use. For both substances, being a man, a smoker, an excessive alcohol user and having a chronic illness were not only independently associated with being questioned by one's doctor, but also with more frequent patient initiative. About 87% considered it normal to be asked by their GP about their alcohol intake, this proportion being higher among men and people with high incomes. CONCLUSION: Even though a large portion of the population would deem it normal to discuss smoking and alcohol intake in consultation with a GP, the subjects are rarely broached. Our results underline the need to bolster efforts at systematic screening for substance use by GPs.

Lessons learned from the experiences of informal PrEP users in France: results from the ANRS-PrEPage study.

Before January 2016, Pre-Exposure Prophylaxis (PrEP), a new biomedical HIV-prevention tool, was only available in France via ANRS-Ipergay clinical study but informal use was reported outside this setting. PrEPage qualitative study reports profiles and experiences of participants who used PrEP outside of a biomedical trial before this prevention method was authorized. Between March 2015 and February 2016, a cross-section of twenty-four informal PrEP users, mostly MSM, was recruited to complete in-depth semi-structured interviews. While ANRS-Ipergay was still ongoing (2012-2016), participants described their initiation to PrEP, the way they used it and the difficulties they faced to acquire antiretroviral drugs in an environment where PrEP was still not widely known and often criticized . Through the testimonies, different user profiles and motivation toward informal PrEP use emerged: (a) participants who have increasing difficulties using condoms, (b) "opportunists" who tried PrEP without the intention of using it regularly and (c) participants with a risk aversion who sought additional protection against HIV. Participants chose to use PrEP and/or their usual prevention strategies depending on available supplies, type of partners and individual attitudes toward risk. The feeling of living a safer sex life helped participants to outweigh the fear of possible toxicity and drug resistance. Participants' needs and expectations about PrEP implementation in France were also presented.

[Community-Based Testing and Factors Associated with HIV among Men Who Have Sex with Men (MSM) in Haiti between 2015 and 2018]. / Dépistage communautaire et facteurs associés au VIH d'hommes ayant des relations sexuelles avec des hommes (HSH) en Haïti entre 2015 et 2018.

Men who have sex with men (MSM) are an HIV key population in Haiti. However, little data exists on that population and on factors associated with this infection. Our study carried out the factors associated with HIV-positive screening among MSM in a community-based rapid testing program in Haiti between 2015 and 2018. Among the 1416 MSM screened, a third reported that it was their very first HIV test and 7.0% had an HIV-positive test. With a median age of 25 years old [21-29], over half of them were living in urban areas (60.7%) and were in financial precarious conditions (68.6%). Multivariate analysis showed that two factors were significantly associated with an HIVpositive result: having had an STI in the last 12 months, strengthened by psychoactive drug use; transactional sex practice in the last 12 months, strengthened by the age between 18 and 20 years old. These results should be taken into account when developing and implementing targeted and comprehensive HIV prevention programs and services for young MSM in Haiti.

Les hommes ayant des relations sexuelles avec des hommes (HSH) constituent une population clé du virus de l'immunodéficience humaine (VIH) en Haïti. Cependant, peu de données existent sur cette population et les facteurs associés à cette infection. Notre étude s'intéresse aux facteurs liés à un test rapide positif au VIH chez les HSH dans le cadre d'un dispositif de dépistage communautaire en Haïti entre 2015 et 2018. Parmi les 1 416 HSH dépistés, un tiers déclaraient leur premier test VIH et 7,0 % avaient un résultat positif. Avec un âge médian de 25 ans [21­29], plus de la moitié d'entre eux vivaient en milieu urbain (60,7 %) et étaient en situation de précarité financière (68,6 %). Une analyse multivariée a montré que deux facteurs étaient significativement associés à un résultat positif au VIH : avoir eu une infection sexuellement transmissible dans les 12 derniers mois, facteur accentué lorsqu'il est combiné à une consommation de produits psychoactifs ; la pratique du sexe transactionnel dans les 12 derniers mois, facteur accentué par l'appartenance à la classe d'âge des 18­20 ans. Ces résultats doivent se traduire dans la mise en place de futurs programmes et services de prévention du VIH vers les jeunes HSH en Haïti.