To describe the circumstances of the first HIV-positive test and to study the determinants of a delayed diagnosis of HIV infection.
In a retrospective study among adult AIDS patients diagnosed ...between July 1993 and May 1995 in two French districts, data on socioeconomic characteristics, circumstances of first HIV-positive test and attitudes and behaviours regarding medical care were collected in a confidential interview and analysed for potential association with a late test, defined as a first HIV-positive test within 6 months of AIDS diagnosis.
Of the 359 AIDS patients studied, 69 (19.2%) had a late test. Late testers were more likely than other patients to have had an HIV-positive test because of clinical symptoms (89.7 versus 38.9%, P < 0.001) and not to perceive themselves as being at risk of infection with HIV (53.6 versus 39.3%, P < 0.05). The proportion of late testers was 34.6% among heterosexually infected patients, 12.7% among homo-/ bisexual men and 9.6% among injecting drug users. Factors independently associated with a late test were male gender adjusted odds ratio (aOR), 5.6; 95% confidence interval (CI), 1.7-18.9 and absence of earned income (aOR, 5.2; 95% CI, 1.4-19) among heterosexually infected patients; high education (aOR, 3.1; 95% CI, 1.0-9.6) and having consulted a person practising alternative medicine (aOR, 3.4; 95% CI, 1.2-10) in homo-/bisexual men.
Despite incentives to be tested for HIV, many individuals in France are still tested too late, even if they are in known high-risk groups. Efforts to test HIV-infected people as early as possible should be made by increasing the perception of HIV risk and decreasing the level of missed opportunities for testing. Current case management approaches make this recommendation critically important from both public health and an individual perspective.
En France, la population des usagers de drogues est majoritairement masculine. Parmi ceux-ci, les profils et les pratiques des femmes sont mal connus. Entre 2004 et 2007, l'enquête Anrs-Coquelicot, ...alliant épidémiologie et socio-anthropologie, a permis de décrire les profils des usagers de drogues et d'analyser les situations à risque vis-à-vis du VIH et du VHC, en prenant en compte la problématique du genre. Les entretiens montrent que les femmes ont fréquemment connu des événements marquants durant l'enfance et l'adolescence (violences). C'est généralement dans ce contexte qu'elles s'initient aux drogues par le biais de rencontres amoureuses. Elles adoptent globalement plus de comportements à risque que les hommes et ont davantage recours à la prostitution. Ainsi, ces femmes ont des trajectoires encore plus chaotiques que celles des hommes. Elles sont confrontées à une double fragilité vis-à-vis du VIH et du VHC liée au contexte de leur consommation de drogues et de leur sexualité.
To assess trends in HIV infection among sexually transmitted disease (STD) patients.
Repeated unlinked anonymous survey, 1991-1993.
STD clinics in Paris, France.
Patients (n = 4354) with a new ...suspected STD.
HIV antibody testing, using blood from syphilis samples.
HIV prevalences were stable over time in all transmission groups. One-third of homo-/bisexual men were HIV-positive. Prevalence was 2.5 times higher among heterosexual patients from Africa or the Caribbean than among those from other countries. Among patients under 25 years of age prevalence significantly decreased from 4.3% in 1991 to 0.8% in 1993 (P = 0.01). Among homo-/bisexual men, despite a 50% reduction in the incidence of STD, the absolute number of those newly HIV-infected remained stable; median age increased from 28 years in 1991 to 32 years in 1993 (P = 0.02). Among heterosexuals, trends in HIV incidence were difficult to assess: recently infected patients were more likely to be identified in 1993 than in 1991, since the proportion of patients who reported a recent HIV-negative test increased over time.
Prevalence studies contribute to define specific subgroups which should be targeted for prevention (HIV-positive or older homosexuals, heterosexuals from Africa and the Caribbean). Despite a decrease in both overall STD incidence and HIV prevalence among patients aged under 25 years, overall HIV incidence has not decreased, at least among homo-/bisexual men in whom recent HIV infections occurred at a high rate overall, and increased in those aged 35 years or more. Sentinel site-based HIV seroprevalence studies are best interpreted in the light of results obtained from different populations and through routine surveillance of STD.
Syphilis, new epidemiologic features Dupin, Nicolas; Couturier, Elisabeth
La revue du praticien,
2004-Feb-29, Volume:
54, Issue:
4
Magazine Article
The epidemiologic survey by the InVS from data from voluntary sites shows an increase of the cases of syphilis from 2000 to 2002 in France. Most of patients with early syphilis are men having sex ...with men and more than half of cases is HIV infected patients. Resurgence of syphilis reflects the relapse of high-risk sexual practices and the most sexual practice evocated is unprotected oral sex. The same situation has been reported in countries from the west of Europe. In east of Europe, the epidemiology is a little bit different with an increase of cases since the early 90's mostly in sex workers and in relation to the rapid increase in the number of injecting drug users. In United States, although increases in syphilis rates among men who have sex with men have been documented since 1997, the majority of cases have been reported in the South affecting disproportionately blacks, reflecting low access to medical care but also racial segregation in sexual activity. The resurgence of syphilis while it is limited highlights the need for more health promotion initiatives especially in the most affected population.
Viral hepatitis A is a vaccine preventable disease. It frequently occurs in France at the end of the summer among individuals back from high endemic countries. It is a notificable disease with an ...incidence threefold higher among children below fifteen years of age. Prevention is based on personal and collective hygiene and contacts' vaccination around a case. In France viral hepatitis E cases are more likely autochthonous than imported. In most of autochthonous cases, the source of infection and the transmission route remain unexplained. Following the implementation of mandatory notification in 2003, over 750 cases of acute symptomatic hepatitis B have been notified between 2005 and 2009. Half of them could have been avoided, if current immunisation recommendations would have been applied adequately. In France, more than 500,000 individuals are living with chronic hepatitis B or C, with 4000 deaths attributable to these hepatitis. Improved and reinforced HBV and HCV screening for individuals at risks are priority issues to better access to care and application of prevention measures around a case.
Significant efforts have recently been undertaken to develop highly efficient solid oxide cells for high-temperature steam electrolysis (SOEC). Implementing new materials and microstructures that ...would improve the performance and durability of this technology remains a major issue. For this purpose, a nano-structured PrO1.833 material coated by the electrostatic spray deposition (ESD) technique was studied as a promising active oxygen electrode for SOEC application. The study was performed considering the PrOx as the functional layer and strontium-doped lanthanum manganite (LSM) as the current collecting layer on a standard half-cell supported by a typical Ni-YSZ cermet, a YSZ electrolyte, and a gadolinium-doped ceria (GDC) barrier layer. The electrochemical characterizations showed promising initial performance at 700 °C in SOEC mode (− 1 A cm−2 at 1.4 V with H2O/H2 = 90 vol%/10 vol%). In addition, a reasonable degradation rate of ∼5.8% kh−1 was obtained at 700 °C within 1000 h of SOEC operation. The structural and elemental evolutions were analyzed with micrometer size resolution all along the functional layer thickness using synchrotron μ-X-ray diffraction and fluorescence. The electrode degradation was primarily attributed to the phase transitions of PrO1.833. In particular, the structural analyses of the sample aged under applied current revealed a small quantity of PrO1.5≤x≤1.7 phase at the GDC/AFL (active functional layer) interface which is expected to be less conductive than PrO1.833, along with PrO1.714 and GDC phases. Finally, additional structural characterizations were performed on samples annealed at different temperatures and dwell times: 700 °C for 1000 h and 800 °C for 700 h, respectively. The results are discussed to provide a better understanding of the stability of the praseodymium oxide.
•SOEC long-term test of a nanostructured PrOx electrode.•No significant interdiffusion of the chemical elements detected by SEM-EDX.•Phase decomposition characterized by synchrotron μ-XRD and μ-XRF.•Only ∼5.8% kh−1 degradation rate obtained at 700 °C for 1000 h of SOEC operation.•A better understanding of the aging of nanostructured PrOx for electrolysis.
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