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ABSTRACTThis paper describes and compares the oral health status among people with and without diabetes in France, and analyzes the related socioeconomic factors. The study is based on data from the cross‐sectional national health survey conducted in France from 2002 to 2003, which included 19,231 people over 35 years of age, among whom 1,111 reported having diabetes. Data were collected through interviews that inquired about oral health status and use of dental care services, income, educational level, health insurance, place of residence, and birthplace.The prevalence of oral health problems was higher among subjects who had diabetes, compared with those who were nondiabetic (16.4% vs. 13.4%). Dental care utilization during the survey period was reported to be 8.7% among subjects who were diabetic versus 12.9% among those who were nondiabetic. The subjects with diabetes were more likely to have dental problems (OR = 1.47, CI = 1.03–2.08) and wear removable dentures (partial and complete) when their income was lower (OR = 2.17, CI = 1.52–3.10). There were social inequalities in oral health among people with diabetes in France according to income level.

Purpose. To examine the relationship between interactive media use (Internet and video games) and overweight risk in young adults. Design. Prospective cohort study. Setting. France (TEMPO study). Subjects. Community sample of 674 young adults aged 22 to 35 in 2009 (response rate to the original mail out: 44.3%). Measures. Data were collected through mail-based questionnaires from study participants in 1999 (juvenile overweight, juvenile TV use) and 2009 (overweight, Internet and video game use, regular physical activity), and from their parents who participated in the GAZEL study from 1989 to 2009 (parental overweight). Analysis. Logistic regression. Results. Participants who engaged in regular video game use (> 1 time/wk) were more likely to be overweight than those who did not (odds ratio [OR] 2.20, 95% confidence interval [CI] 1.42–3.42). Adjusting for sex, regular athletic activity, juvenile overweight, juvenile TV use, and parental overweight, the OR associated with video game use decreased but remained statistically significant (OR 1.94, 95% CI 1.15–3.28). We found no significant association between Internet use and overweight. Conclusion. Video game use may be a relevant target for interventions aiming to decrease the burden of overweight and associated consequences in young adults.

Un quart des personnes séropositives vivant en France déclarent avoir subi des discriminations au cours des deux années précédentes. Le principal motif de discrimination déclaré est la séropositivité elle-même (13 % des personnes séropositives). Viennent ensuite la couleur de peau, les origines ou la nationalité, ainsi que l'orientation sexuelle (5 % des personnes pour chacun de ces motifs). Les femmes séropositives immigrées d'Afrique subsaharienne et les usagères de drogue sont près de 4 sur 10 à témoigner de discriminations tandis que les hommes séropositifs hétérosexuels non immigrés d'Afrique subsaharienne ne sont qu'un peu plus d'un sur dix dans ce cas. Onze pourcent des personnes séropositives déclarent avoir subi des traitements discriminatoires au sein de la famille et 8 % dans les services de santé. Parmi celles qui travaillaient lors de l'enquête, soit la moitié de l'échantillon, 6 % rapportent des discriminations au travail.

With the increase in asylum-related immigration since 2015, understanding how immigrants settle in a new country is at the centre of social and political debate in European countries. The objective of this study is to determine whether the necessary time to settle for Sub-Saharan Africa immigrants in France depends more on pre-migratory characteristics or on the structural features of the host society. Taking a capability approach, we define settlement as the acquisition of three basic resources: a personal dwelling, a legal permit of a least 1 year and paid work. We use data from the PARCOURS survey, a life-event history survey conducted from 2012 to 2013 that collected 513 life histories of Sub-Saharan African immigrants living in France. Situations regarding housing, legal status and activity were documented year by year since the arrival of the respondent. We use a Kaplan–Meier analysis and chronograms to describe the time needed for settlement, first for each resource (personal dwelling, legal permit and paid work) and then for the combined indicator of settlement. Discrete-time logistic regressions are used to model the determinants of this settlement process. Overall, women and men require 6 and 7 years (medians), respectively, to acquire basic resources in France. This represents a strikingly long period of time in which immigrants lack basic security. The settlement process varies according to gender, but very few sociodemographic factors influence settlement dynamics. Therefore, the length of the settlement process may be due to structural features of the host society. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s10680-017-9463-z) contains supplementary material, which is available to authorized users.

Six à sept ans après leur arrivée en France, la moitié des migrants d'Afrique subsaharienne n'ont toujours pas les trois éléments d'installation que sont un titre de séjour d'au moins un an, un logement personnel, et un travail. Au bout de onze à douze ans, c'est encore le cas d'un quart d'entre eux. Cette longue période de précarité après l'arrivée en France tient plus aux conditions d'accueil (longueur du processus de régularisation, marché du travail segmenté, discriminations) qu'aux caractéristiques individuelles des arrivants. La situation des migrants subsahariens finit par se stabiliser, mais pour beaucoup d'entre eux, c'est au prix du passage par une longue période d'insécurité.

AbstractIntroductionIn France, oral pre‐exposure prophylaxis (PrEP) for HIV prevention has been publicly available since 2016, mainly targeting at men who have sex with men (MSM). Reliable and robust estimations of the actual PrEP uptake among MSM on a localized level can provide additional insights to identify and better reach marginalized MSM within current HIV prevention service provision. This study used national pharmaco‐epidemiology surveillance data and regional MSM population estimations to model the spatio‐temporal distribution of PrEP uptake among MSM in France 2016–2021 to identify marginalized MSM at risk for HIV and increase their PrEP uptake.MethodsWe first applied Bayesian spatial analyses with survey‐surveillance‐based HIV incidence data as a spatial proxy to estimate the size of (1) regional HIV‐negative MSM populations and (2) MSM who could be eligible for PrEP use according to French PrEP guidelines. We then applied Bayesian spatio‐temporal ecological regression modelling to estimate the regional prevalence and relative probability of the overall‐ and new‐PrEP uptake from 2016 to 2021 across France.ResultsHIV‐negative and PrEP‐eligible MSM populations vary regionally across France. Île‐de‐France was estimated to have the highest MSM density compared to other French regions. According to the final spatio‐temporal model, the relative probability of overall PrEP uptake was heterogeneous across France but remained stable over time. Urban areas have higher‐than‐average probabilities of PrEP uptake. The prevalence of PrEP use increased steadily (ranging from 8.8% [95% credible interval 8.5%;9.0%] in Nouvelle‐Aquitaine to 38.2% [36.5%;39.9%] in Centre‐Val‐de‐Loire in 2021).ConclusionsOur results show that using Bayesian spatial analysis as a novel methodology to estimate the localized HIV‐negative MSM population is feasible and applicable. Spatio‐temporal models showed that despite the increasing prevalence of PrEP use in all regions, geographical disparities and inequalities of PrEP uptake continued to exist over time. We identified regions that would benefit from greater tailoring and delivery efforts. Based on our findings, public health policies and HIV prevention strategies could be adjusted to better combat HIV infections and to accelerate ending the HIV epidemic.

IntroductionPeople living with HIV (PLHIV) on antiretroviral therapy (ART), with sustained undetectable viral load (sUVL) and no history of sexually transmitted infections for at least six months, are considered to have a low risk of HIV transmission (LRT). We aimed to characterize, in a representative sample of French PLHIV, the sexual behaviour of LRT PLHIV compared with non‐LRT PLHIV.MethodsThe cross‐sectional ANRS‐VESPA2 survey was conducted on adult PLHIV attending French hospitals in 2011. The LRT PLHIV group included participants with sUVL and no sexually transmitted infection for at least 12 months. Socio‐behavioural and medical data were collected. Chi‐square tests helped compare sexual risk indicators between LRT and non‐LRT PLHIV. The survey's retrospective nature allowed us to perform complementary category‐based analyses of LRT PLHIV according to whether they had sUVL for at least 18, 24 or 36 months in three socio‐epidemiological groups: men who have sex with men (MSM), other men and women.ResultsAnalysis included 2638 PLHIV diagnosed >12 months with available viral load data. The proportion of LRT PLHIV varied from 58% (≥12 months sUVL) to 38% (≥36 months sUVL). Irrespective of sUVL duration, we found the following: 1) LRT men (MSM and other men) were more likely to report having no sexual partner than their non‐LRT counterparts. Among men having sexual partners in the previous 12 months, no significant difference was seen between LRT and non‐LRT men in the number of sexual partners. LRT women were less likely to report having more than one sexual partner than non‐LRT women; 2) LRT MSM were more likely to report being in sexually inactive couples than their non‐LRT counterparts; 3) among sexually active participants, no difference was observed between LRT and non‐LRT PLHIV concerning condom use with their serodiscordant steady partner or with their most recent casual sexual partners.ConclusionsLRT PLHIV with sUVL ≥12 months did not report more sexual risk behaviours than their non‐LRT counterparts. Because the same result was obtained for those having a sUVL ≥36 months, the hypothesis of increased sexual risk behaviour over time in PLHIV meeting non‐transmission biomedical criteria is not supported.

IntroductionWe aimed to quantify and identify associated factors of linkage to HIV care following home‐based HIV counselling and testing (HBHCT) in the ongoing ANRS 12249 treatment‐as‐prevention (TasP) cluster‐randomized trial in rural KwaZulu‐Natal, South Africa.MethodsIndividuals ≥16 years were offered HBHCT; those who were identified HIV positive were referred to cluster‐based TasP clinics and offered antiretroviral treatment (ART) immediately (five clusters) or according to national guidelines (five clusters). HIV care was also available in the local Department of Health (DoH) clinics. Linkage to HIV care was defined as TasP or DoH clinic attendance within three months of referral among adults not in HIV care at referral. Associated factors were identified using multivariable logistic regression adjusted for trial arm.ResultsOverall, 1323 HIV‐positive adults (72.9% women) not in HIV care at referral were included, of whom 36.9% (n=488) linked to care <3 months of referral (similar by sex). In adjusted analyses (n=1222), individuals who had never been in HIV care before referral were significantly less likely to link to care than those who had previously been in care (<33% vs. >42%, p<0.001). Linkage to care was lower in students (adjusted odds‐ratio [aOR]=0.47; 95% confidence interval [CI] 0.24–0.92) than in employed adults, in adults who completed secondary school (aOR=0.68; CI 0.49–0.96) or at least some secondary school (aOR=0.59; CI 0.41–0.84) versus ≤ primary school, in those who lived at 1 to 2 km (aOR=0.58; CI 0.44–0.78) or 2–5 km from the nearest TasP clinic (aOR=0.57; CI 0.41–0.77) versus <1 km, and in those who were referred to clinic after ≥2 contacts (aOR=0.75; CI 0.58–0.97) versus those referred at the first contact. Linkage to care was higher in adults who reported knowing an HIV‐positive family member (aOR=1.45; CI 1.12–1.86) versus not, and in those who said that they would take ART as soon as possible if they were diagnosed HIV positive (aOR=2.16; CI 1.13–4.10) versus not.ConclusionsFewer than 40% of HIV‐positive adults not in care at referral were linked to HIV care within three months of HBHCT in the TasP trial. Achieving universal test and treat coverage will require innovative interventions to support linkage to HIV care.

IntroductionWhether early antiretroviral therapy (ART) initiation could impact sexual risk behaviours remains to be documented. We aimed to investigate changes in sexual behaviours within the 24 months following an early versus standard ART initiation in HIV‐positive adults with high CD4 counts.MethodsWe used data from a prospective behavioural study nested in a randomized controlled trial of early ART (Temprano‐ANRS12136). Time trends in sexual behaviours from enrolment in the trial (M0) to 12‐month (M12) and 24‐month (M24) visits were measured and compared, using Generalized Estimating Equations models, between participants randomly assigned either to initiate ART immediately (early ART) or to defer ART initiation until on‐going WHO starting criteria are met (standard ART). Indicators of sexual behaviours included 1) sexual activity in the past year, 2) multiple partnership in the past year, 3) unprotected sex at last intercourse and 4) risky sex (i.e. unprotected sex with a partner of HIV negative/unknown status) at last intercourse.ResultsAnalyses included 1952 participants (975 with early ART and 977 with standard ART; overall median baseline CD4 count: 469/mm3). Among participants with early ART, significant decreases were found between M0 and M24 in sexual activity (Odds Ratio [OR] 0.72, 95% Confidence Interval [95% CI] 0.57–0.92), multiple partnership (OR 0.57, 95% CI 0.41–0.79), unprotected sex (OR 0.59, 95% CI 0.47–0.75) and risky sex (OR 0.58, 95% CI 0.45–0.76). Among participants with standard ART, sexual behaviours showed similar trends over time. These decreases mostly occurred within the 12 months following enrolment in the trial in both groups and prior to ART initiation in participants with standard ART. For unprotected sex and risky sex, decreases were or tended to be more pronounced among patients reporting that their last sexual partner was non‐cohabiting.ConclusionsIn these sub‐Saharan adults with high CD4 counts, entry into HIV care, rather than ART initiation, resulted in decreased sexual activity and risky sexual behaviours. We did not observe any evidence of a risk compensation phenomenon associated with early ART initiation. These results illustrate the potential behavioural preventive effect of early entry into care, which goes hand in hand with early ART initiation.