Personne : Alary, Michel
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Université Laval. Département de médecine sociale et préventive
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- PublicationAccès libreAcceptability of pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) in Benin : a qualitative study(Taylor & Francis, 2019-05-25) Gning, Ndeye Ndiagna; Guédou, Fernand Aimé; Diabate, Souleymane; Hessou, Septime; Batona, Georges; Béhanzin, Luc; Alary, Michel; Ahouada, Carin; Zannou, Marcel D.In Benin, consistent condom use among men who have sex with men (MSM) is relatively low and providing them with Pre-exposure prophylaxis (PrEP) could be of great relevance. We aimed to describe PrEP knowledge and intention to use it; identify key facilitators and barriers to PrEP; and describe the perceived impact of PrEP on unsafe sexual behavior. MSM, 18 years or older, HIV-negative or of unknown status, were enrolled in five cities of Benin. Intention to use PrEP was assessed through five focus groups (FG). Data were analyzed using manual thematic sorting. Thirty MSM (six per city) participated in the FG. Mean age (standard deviation) was 27.1 (5.0) years. All participants expressed the intention to use PrEP if made available. Facilitators of PrEP use were: availability of medication, safety, absence of constraints as well as freedom to have multiple sex partners and sex with HIV-positive friends. Barriers were: complex procedures for obtaining medication, size and taste of medication, cost of medication, poor PrEP awareness.. Eighteen men admitted that PrEP could lead to decrease in or even abandonment of condom use. In conclusion, MSM showed openness to use PrEP if available, although they recognized that it could lead to risk compensation.
- PublicationAccès libreHIV prevention and treatment cascades among female sex workers in Benin, West Africa(J.B. Lippincott, 2021-02-23) Guédou, Fernand Aimé; Diabate, Souleymane; Béhanzin, Luc; Kêkê, René Kpèmahouton; Morin, Laurianne; Bushman, Lane; Alary, Michel; Anderson, Peter L.; Gangbo, Flore; Nagot, NicolasBackground & Objectives Benin has a long-standing history of HIV prevention programs aimed at female sex workers (FSWs). We used data from a national survey among FSWs (2017) to assess the prevention and care cascades in this population. Methods FSWs were recruited through cluster sampling of sex work sites. A questionnaire was administered, and HIV tested. HIV-positive participants were asked to provide dried-blood spots (DBS), tested for ARV and viral load. We assessed two prevention cascades (HIV testing and safer sex) and the treatment cascade, using a combination of self-reported and biological variables. Results Mean age of the 1086 FSWs was 30 years. Half of them were Beninese and two-thirds had a primary school education level or less. Almost all FSWs had ever heard of HIV/AIDS. 79.1% had ever been tested, and 84.1% of the latter had been tested in the last year. In the previous six months, 90.1% were exposed to prevention messages. Women exposed to any HIV prevention message reported a higher level of consistent condom use in the last month (69.0%) than those who were not (48.5%, p<0.0001). HIV prevalence was 7.7%. Among HIV-positive women, 60.6% knew their status; among those, 90.5% were on ARV and 81.8% of them had a suppressed viral load. Conclusions Despite long-standing HIV prevention programs for FSWs, the prevention indicators were often low. Linkage to care was good, viral suppression was sub-optimal, but knowledge of HIV-positive status was low. Exposing women to prevention messages is necessary, as to increase HIV testing.
- PublicationAccès librePrevalence and factors associated with HIV and sexually transmitted infections among female sex workers in Bamako, Mali(Lippincott Williams & Wilkins, 2020-10-01) Guédou, Fernand Aimé; Téguété, Ibrahima; Alary, Michel; Tounkara, Fatoumata Korika; Keita, BintouBackground: We aimed to (1) estimate the prevalence of HIV and other sexually transmitted infections (STIs) among female sex workers (FSWs) in Bamako, Mali, and (2) identify factors associated with STIs including HIV infection in this population. Methods: We analyzed baseline data from a prospective observational cohort study on cervical cancer screening, human papillomavirus, and HIV infections among FSWs 18 years or older recruited in Bamako. Multivariable log-binomial regression was used to estimate the adjusted prevalence ratios (APRs) with 95% confidence interval (95% CI) for HIV infection and STIs versus associated factors. Results: Among 353 women participating in the study, mean age was 26.8 (±7.6) years. HIV prevalence was 20.4%, whereas 35.1% of the FSWs had at least one STI. Factors significantly associated with HIV were older age (P < 0.0001, test for trend), duration of sex work ≥6 years (APR, 1.92; 95% CI, 1.22-3.02), uneducated status (APR, 2.24; 95% CI, 1.16-4.34), less than 10 clients in the last 7 days (APR, 1.55; 95% CI, 1.02-2.34), and gonococcal (APR, 1.85; 95% CI, 1.21-2.82) and chlamydial (APR, 2.58; 95% CI, 1.44-4.62) infections. Younger age (P = 0.018, test for trend), having ≥10 clients in the last week (APR, 1.47; 95% CI, 1.11-1.94), and HIV infection (APR, 2.00; 95% CI, 1.49-2.69) were significantly associated with STIs. Conclusions: HIV and curable STI prevalence are high among FSWs in Bamako. There is thus a need to enhance the efficiency of interventions toward FSWs in Mali to reduce the burden of HIV and STIs among them and prevent HIV spread to the general population.
- PublicationAccès libreStructural determinants of health : a qualitative study on female sex workers in Benin(Taylor & Francis Online, 2019-03-20) Dugas, Marylène; Guédou, Fernand Aimé; Bédard, Emmanuelle; Kpatchavi, Codjo Adolphe; Béhanzin, Luc; Alary, MichelThe objective of this paper is to expose those socio-structural contexts revealing the social injustice and human rights violations that sub-Saharan women face every day when forced into sex work by unemployment or sickness. Results of a qualitative study highlighting some key structural determinants of sex work and HIV infection among FSWs will be presented and examined through the lens of the WHO conceptual framework for action on the social determinants of health. The results showed that most FSWs had lacked the necessary financial support at some point in their lives. Also, both the socioeconomic and political context failed to provide proper support to prevent involvement in sex work and the consequent risks of HIV. The cultural and societal values placed on the health and well-being of FSWs in Benin appear to depend on the degree to which sexual violence and adultery are perceived as a collective social concern. This portrait of FSWs calls for both long-term interventions through a structural determinant approach to HIV prevention, targeting all the women who could face such a financial situation well before their entry into sex work, while maintaining short and medium-term interventions on the intermediary determinants.