Sexual risk behaviors and predictors of inconsistent condom use among crack cocaine users in the French overseas territories in the Americas.

The French overseas territories in the Americas are the French territories most affected by HIV. Crack cocaine users are particularly impacted. The objective of this study was to describe sexual risk behaviors and inconsistent condom use among crack cocaine users. A total of 640 crack cocaine users were interviewed. The sampling method was non-probabilistic. An anonymous standardized questionnaire of 110 questions was used. Over a third of persons did not use condoms systematically with casual sex partners (36.2%) or commercial sex partners (32.3%), and 64% did not use condoms systematically with regular sex partners. In a context of multiple sexual partnerships, frequent forced sex, and insufficient HIV testing, the lack of systematic condom use may favor the spread of HIV. Different predictive factors of inconsistent condom use were identified, depending on the type of partner, with a log binomial regression. However, among the predictor variables identified, two predictive factors frequently occur among the different type of sex partners: high perceived risk of HIV and self-perceived capacity to persuade a sex partner to use condom. These results pointed towards interventions improving access to rights and raising perceived self-efficacy.

Transactional sex among men who have sex with men in the French Antilles and French Guiana: frequency and associated factors.

The French Antilles (Martinique, Saint Martin and Guadeloupe) and French Guiana are the French territories most affected by the HIV epidemic. Some population groups such as men who have sex with men (MSM), especially those involved in transactional sex, are thought to be particularly vulnerable to HIV but few data exist to help characterize their health-related needs and thus implement relevant prevention interventions. To fill this knowledge gap, we used data collected from an HIV/AIDS Knowledge, Attitudes, Behaviours and Practices survey conducted in 2012 among MSM living in the French Antilles and French Guiana and recruited through snowball sampling. Our objectives were to compare social and demographic characteristics and sexual behaviours between MSM engaging in transactional sex and MSM not engaging in transactional sex and to identify factors associated with transactional sex involvement using a logistic regression model. A total of 733 MSM were interviewed, 21% of whom reported to undergo transactional sex. Their behaviour and social and demographic characteristics were different from other MSMs' and they were more exposed to factors that are recognized to potentiate HIV vulnerability, at the individual, community, network and structural levels. The variables positively associated with sex trade involvement were having ever consumed drug (OR = 2.84 [1.23-6.52]; p = .002), having a greater number of sex partners than the median (OR = 8.31 [4.84-14.30]; p < .001), having experienced intimate partner violence (OR = 1.72 [0.99-3.00]; p = .053) and having undergone physical aggression because of sexual orientation (OR = 2.84 [1.23-6.52]; p = .014). Variables negatively associated with sex trade involvement were being older (OR = 0.93 [0.90-0.97] per year; p = .001), having a stable administrative situation (OR = 0.10 [0.06-0.19]; p < .001), having a stable housing (OR = 0.29 [0.15-0.55]; p < .001) and being employed full-time (OR = 0.29 [1.23-6.52]; p = .002).

Knowledge, attitudes, behaviors, and practices differences regarding HIV in populations living along the Maroni river: particularities of operational interest for Amerindian and Maroon populations.

The Maroni basin, an isolated region delineating the border between Suriname and French Guiana has been affected by the human immunodeficiency virus (HIV) epidemic 10 years after coastal French Guiana. However, the rise in HIV prevalence was sharp, exceeding 1% within 10 years. The aim of the present study is to compare, using the first quantitative data from the general population in remote villages, the knowledge, attitudes, and behaviors regarding HIV between Maroon and Amerindian populations, the two most frequent populations living along the Maroni. Data were collected in 2012 using a structured questionnaire among a random sample of 896 individuals residing in the remote villages on the Maroni river. Proportions were compared between the Maroni and the coastal general population, and between Maroon and Amerindian populations. The present study shows significant differences between territories and between communities living on the Maroni river: the multiple sexual partnerships, more common among population living on the Maroni river, were more frequently reported in Maroons than in Amerindians. Condom use was more frequently reported among men on the Maroni river than on the coast, but these findings were reversed for women. Moreover, among people living on the Maroni river, condom use was more frequently reported among Maroons than among Amerindians. Regarding genital factors that may affect transmission, penile implant seemed to have no ethnic boundaries, steam baths seemed specific to Maroon women. The present results should help to improve community-based specific interventions.

Prevalence and predictive factors of stigmatizing attitudes towards people living with HIV in the remote villages on the Maroni River in French Guiana.

The Maroni basin, an isolated region which lies between Suriname and French Guiana, has been affected by the HIV epidemic 10 years after coastal French Guiana. However, the rise in HIV prevalence was sharp with a prevalence exceeding 1% within 10 years. Stigma and discrimination towards people living with HIV (PLWHIV) or "suspected to have HIV" is rampant as reported by health professionals or non-governmental organisations. The objective of this article is to present the first quantitative data from the general population of this region on stigma towards people living with HIV. Data were collected in 2012 by a structured questionnaire among a random sample of 896 individuals residing in remote villages on the Maroni River. Proportion comparisons between the Maroni sample and the sample from the general population on the coastline in 2011 were conducted. Simple and multivariate logistic regression models were used to predict stigmatising attitudes. For all situations involving PLWHIV, the proportion of negative attitudes was significantly higher on the Maroni than in coastal French Guiana (p < 0.001). Findings indicate that the different levels of knowledge, erroneous beliefs and poor situation (not having electricity in one's home; not having French health insurance) were associated with stigmatising attitudes. The present data could help both sides coordinate interventions both at the individual level by improving knowledge and at the community level to change norms in order to reduce stigma and discrimination aiming for increased impact.

Incidence and predictive factors of depression among patients with HIV infection in Guadeloupe: 1988-2009.

A retrospective cohort study was conducted to determine the incidence and the predictive factors of depression in a cohort of 2737 HIV/AIDS-infected patients in Guadeloupe followed for a total of 8402 patient-years. The incidence rate of first observed depression was 2.2 per 100 person-years (95% confidence interval [CI], 1.9-2.6). A single failure Cox proportional hazards model showed that the 1997-2000 inclusion period (hazard ratio [HR] = 1.60; 95% CI = 1.10-2.40;p = 0.01), the 2001-2009 inclusion period (HR = 1.50; 95% CI = 1.02-2.40;p = 0.04), the more advanced CDC stage (HR = 2.30; 95% CI = 1.30-3.10;p = 0.000) and the annual frequency of visits > 10 (HR = 2.30; 95% CI = 1.70-3.30;p = 0.000) were associated with an increased risk of depression. Incidence of depression in this HIV cohort was high and the hazard function showed three peaks of depression (2, 7 and 12 years). Physicians should be vigilant to psychological distress throughout life with HIV.

What is AIDS in Guadeloupe? A descriptive and comparative study.

Since the pathogen ecology differs between Caribbean regions, specific differences in the most frequent clinical presentations of acquired immunodeficiency syndrome (AIDS) may be expected. We therefore conducted the present retrospective cohort study in order to describe the main AIDS-defining events in Guadeloupe and to compare them with those observed in Metropolitan France and in French Guiana. We discuss the local pathogen ecology, the diagnostic limitations of hospitals in overseas territories and the drivers of the epidemic.