Habilitations |
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Desgrées du Loû, A. (2009). La démographie, une discipline de santé publique ? Habilitation thesis, Université Paris Descartes, Paris.
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Reports |
Desgrées du Loû, A., Brou, H., Tijou-Traoré, A., Djohan, G., Becquet, R., Leroy, V., et al. (2009). From prenatal HIV testing of the mother to prevention of sexual HIV transmission within the couple. Working Papers du CEPED, (01). Paris: CEPED. Retrieved September 3, 2010, from http://www.sciencedirect.com/science?_ob=GatewayURL&_method=citationSearch&_uoikey=B6VBF-4WKH6GY-2&_origin=SDEMFRHTML&_version=1&md5=446b148a89d491ec5442db566187ece5
Résumé: The first step of prevention of mother-to-child HIV-transmission (PMTCT) programmes is offering HIV couselling and testing to pregnant women. In developing countries where HIV-testing remains rare, it represents a unique opportunity for many women to learn their own HIV status. This prenatal HIV testing is not only the entry point to prevention of mother-to-child HIV transmission, but also an occasion for women to sensitize their male partner to sexual risks. We explore here if these women, HIV-tested as mothers, apply the prevention recommendations they also receive as women. In the Ditrame Plus PMTCT program in Abidjan, Côte d’Ivoire, two cohorts of women (475 HIV-infected women and 400 HIV-negative women) were followed-up two years after the pregnancy when they were offered prenatal HIV testing. In each cohort, we compared the proportion of women who communicated with their regular partner on sexual risks, prior to and after prenatal HIV testing. We analysed sociodemographic factors related to this communication. We measured two potential conjugal outcomes of women HIV testing: the level of condom use at sex resumption after delivery and the risk of union break-up. Prenatal HIV testing increased conjugal communication regarding sexual risks, whatever the woman serostatus. This communication was less frequent for women in polygamous union or not residing with their partner. Around 30% of women systematically used condoms at sex resumption. Among HIV infected ones, conjugal talk on sexual risks was related to improved condom use. After HIV testing, HIV-infected women separated more from their partner than HIV-uninfected women, despite very few negative reactions from the notified partners. In conclusion, offering prenatal HIV counselling and testing is an efficient tool to sensitize women and their partners to HIV prevention. But sexual prevention in a conjugal context remains difficult and need to be specifically adressed.
: CEPED
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Memmi, S., Desgrées du Loû, A., & Orne-Gliemann, J. (2010). Stratégies de prévention du VIH/Sida dans les pays à revenu faible et intermédiaire. Working Papers du CEPED, (07). Paris: CEPED.
Résumé: Au cours des deux dernières décennies, seul un petit nombre de pays est parvenu à réduire la prévalence du VIH grâce à d'importants efforts de prévention. Toutefois, le nombre global de personnes nouvellement infectées par le VIH demeure considérable dans les pays à faible et moyen revenus. L’épidémie du VIH influe de façon spectaculaire sur la structure démographique et la situation économique de ces pays. Il y a un besoin urgent de renforcer les stratégies pour prévenir la transmission du VIH. Malgré certains succès, les stratégies de prévention « traditionnelles » n'ont pas été suffisantes pour limiter de façon significative la propagation du VIH. De nouvelles stratégies de prévention ont été explorées. Si certaines se sont montrées efficaces, d'autres sont encore à l’étude. Cet article passe en revue les stratégies traditionnelles de prévention du VIH et présente les nouvelles stratégies de prévention du VIH proposées depuis le début des années 1990, à partir de la littérature scientifique. Pour plus d’efficacité, les efforts de prévention du VIH doivent être adaptés aux contextes socioculturels et économiques, aux caractéristiques de l'épidémie et aux besoins des populations locales.
On trouvera à la fin du présent document la bibliographie annotée sur les stratégies de prévention du VIH/Sida dans les PVD qui a servi de base à cet article, avec le détail des résumés pour chaque référence.
Mots-Clés: VIH/Sida, stratégie, prévention, transmission, efficacité, acceptabilité
: CEPED
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Wade, A. S., Larmarange, J., Diop, A. K., Diop, O., Gueye, K., Marra, A., et al. (2009). Reduction in risk-taking behaviors among MSM in Senegal between 2004 and 2007 and prevalence of HIV and other STIs.
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Magazine Articles |
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Desgrées du Loû, A. (2008). La santé en Afrique subsaharienne : quels enjeux, quels progrès ? Questions Internationales, (33), 18–20.
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Desgrées du Loû, A., & Andro, A. (2009). La place des hommes dans la santé sexuelle et reproductive : Enjeux et difficultés. Autrepart, 4(52).
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Peer-reviewed Publications |
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Brou, H., Djohan, G., Becquet, R., Allou, G., Ekouevi, D. K., Zanou, B., et al. (2008). Sexual prevention of HIV within the couple after prenatal HIV-testing in West Africa. AIDS Care, 20(4), 413–118.
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Brou, H., Viho, I., Djohan, G., Ekouevi, D. K., Zanou, B., Leroy, V., et al. (2009). Pratiques contraceptives et incidence des grossesses chez des femmes après un dépistage VIH à Abidjan, Côte d’Ivoire. revue épidémiologique de santé publique, (57), 77–86.
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Desgrées du Loû, A., & Orne-Gliemann, J. (2008). Couple-centred testing and counselling for HIV serodiscordant heterosexual couples in sub-Saharan Africa. Reprod Health Matters, 16(32), 151–161.
Résumé: In Africa, a large proportion of HIV infections occur within stable relationships, either because of prior infection of one of the partners or because of infidelity. In five African countries at least two-thirds of couples with at least one HIV-positive partner were HIV serodiscordant; in half of them, the woman was the HIV-positive partner. Hence, there is an urgent need to define strategies to prevent HIV transmission within couple relationships. HIV counselling and testing have largely been organised on an individual and sex-specific basis, for pregnant women in programmes for prevention of mother-to-child transmission of HIV and in STI consultations and recently male circumcision for men. A couple-centred approach to HIV counselling and testing would facilitate communication about HIV status and adoption of preventive behaviours within couples. This paper reviews what is known about HIV serodiscordance in heterosexual couples in sub-Saharan Africa and what has been published about couple-centred initiatives for HIV counselling and testing since the early 1990s. Despite positive outcomes, couple-oriented programmes have not been implemented on a large scale. In order to stimulate and strengthen HIV prevention efforts, increased attention is required to promote prevention and testing and counselling for couples in stable relationships.
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Desgrées du Loû, A., Brou, H., Djohan, G., Becquet, R., Ekouevi, D. K., Zanou, B., et al. (2009). Beneficial Effects of Offering Prenatal HIV Counselling and Testing on Developing a HIV Preventive Attitude among Couples. Abidjan, 2002–2005. AIDS Behav, 13(2), 348–355.
Résumé: Prenatal HIV counselling and testing is mainly an entry-point to the prevention of mother-to-child transmission of HIV, but it may also play an important role in triggering the development of spousal communication about HIV and sexual risks and thus the adoption of a preventive attitude. In Abidjan, Côte d’Ivoire, we investigated couple communication on STIs and HIV, male partner HIV-testing and condom use at sex resumption after delivery among three groups of pregnant women who were offered prenatal counselling and HIV testing: HIV-infected women, uninfected women, and women who refused HIV-testing. The proportion of women who discussed STIs with their regular partner greatly increased after prenatal HIV counselling and testing in all three groups, irrespective of the women’s serostatus and even in the case of test refusal. Spousal communication was related to more frequent male partner HIV-testing and condom use. Prenatal HIV counselling and testing proposal appears to be an efficient tool to sensitize women and their partner to safer sexual practices.
Mots-Clés: Prenatal HIV counselling and testing; Couple; HIV/STIs; Africa; Prevention
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Desgrées-du-Loû, A., Brou, H., Tijou Traore, A., Djohan, G., Becquet, R., & Leroy, V. (2009). From prenatal HIV testing of the mother to prevention of sexual HIV transmission within the couple. Social Science & Medicine, 69(6), 892–899.
Résumé: The first step in preventing mother-to-child HIV transmission (PMTCT) programmes is offering HIV counselling and testing to pregnant women. In developing countries where HIV testing remains rare, it represents a unique opportunity for many women to learn their HIV status. This prenatal HIV testing is not only the entry point to prevention of mother-to-child HIV transmission, but also an occasion for women to sensitize their male partner to sexual risks. Here we explore if these women, HIV-tested as mothers, apply the prevention recommendations they also receive as women.
In the Ditrame Plus PMTCT program in Abidjan, Côte d'Ivoire, two cohorts of women (475 HIV-infected women and 400 HIV-negative women) were followed up two years after the pregnancy when they were offered prenatal HIV testing. In each cohort, we compared the proportion of women who communicated with their regular partner on sexual risks, prior to and after prenatal HIV testing. We analysed socio-demographic factors related to this communication. We measured two potential conjugal outcomes of women HIV testing: the level of condom use at sex resumption after delivery and the risk of union break-up.
Prenatal HIV testing increased conjugal communication regarding sexual risks, whatever the woman's serostatus. This communication was less frequent for women in a polygamous union or not residing with their partner. Around 30% of women systematically used condoms at sex resumption. Among HIV infected ones, conjugal talk on sexual risks was related to improved condom use. After HIV testing, more HIV-infected women separated from their partners than HIV-uninfected women, despite very few negative reactions from the notified partners.
In conclusion, offering prenatal HIV counselling and testing is an efficient tool for sensitizing women and their partners to HIV prevention. But sexual prevention in a conjugal context remains difficult and need to be specifically addressed.
Mots-Clés: Prenatal; HIV testing; Sexual transmission; Couple; Communication; Prevention; Mothers; Ivory coast
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Larmarange, J., Desgrées du Loû, A., Enel, C., Wade, A. S., & ELIHoS Group,. (2010). Homosexuality and Bisexuality in Senegal: a Multiform Reality. Population (English), 64(4), 635–666.
Résumé: Homosexuality and Bisexuality in Senegal: a Multiform Reality
The first surveys on men who have sex with men (MSM) carried out in Senegal in the context of the fight against AIDS, revealed high rates of bisexuality. In 2007, a new epidemiological and behavioural survey (ELIHoS) approached the question of bisexual practices in greater depth. That survey is used here to depict the plurality of forms that bisexuality may take in Senegal. A six-group typology of current modes of sexual activity was constructed based on the characteristics of sexual partners over the past year and at the time of the survey. Various factors in the respondents’ social and sexual life event histories were then analysed according to their current mode of sexual activity. It showed that these modes correspond to different sexual practices and characteristics of first sexual intercourse with a man. However, the systematic use of a condom for similar sexual practices did not depend on the mode of sexual activity. Fewer men who engaged in regular intercourse with women and only occasionally with men were infected with HIV because they less frequently engaged in high-risk anal intercourse.
Homosexualité et bisexualité au Sénégal : une réalité multiforme
Les premières enquêtes menées au Sénégal auprès d’hommes ayant des rapports sexuels avec d’autres hommes,dans le cadre de la lutte contre le sida, révèlent des taux élevés de bisexualité. En 2007, une nouvelle enquête épidémiologique et comportementale (ELIHoS) a été réalisée, dans laquelle la question des pratiques bisexuelles a été abordée de façon approfondie. Cette enquête est utilisée ici pour décrire la pluralité de formes que peut recouvrir la bisexualité au Sénégal. Une typologie du pôle d’activité sexuelle actuel en six classes est construite à partir des caractéristiques des partenaires sexuels sur l’année et au moment de l’enquête. Différents éléments de la sociobiographie sexuelle des individus sont ensuite analysés selon leur pôle d’activité sexuelle actuel. Il apparaît que ces pôles correspondent à des pratiques sexuelles et à des caractéristiques différentes d’entrée en vie sexuelle avec un homme. En revanche, l’utilisation systématique d’un préservatif, à pratiques égales, ne dépend pas du pôle d’activité sexuelle. Les hommes engagés dans des relations régulières avec des femmes et ayant des partenaires masculins seulement occasionnellement sont moins souvent infectés par le VIH, car ils ont moins fréquemment des rapports anaux à risque.
Homosexualidad y bisexualidad en Senegal: una realidad multiforme
Las primeras encuestas realizadas en Senegal, en el marco de la lucha contra el sida, sobre hombres que mantienen relaciones sexuales con otros hombres, revelan tasas de bisexualidad elevadas. En 2007 se ha realizado una nueva encuesta epidemiológica y comportamental (HELIHoS) que aborda en profundidad la cuestión de las prácticas bisexuales. Esta encuesta se utiliza aquí para describir la multitud de formas que la bisexualidad puede adoptar en Senegal. A partir de las características de los compañeros sexuales en el momento de la encuesta y durante el año que la precede, se ha construido una tipología del polo actual de actividad sexual en seis clases. Diferentes elementos de la sociobiografía sexual de los individuos han sido analizados según el polo actual de actividad sexual. Se observa que estos polos corresponden a prácticas sexuales y a características diferentes de la entrada en la vida sexual con un hombre. Sin embargo, la utilización sistemática del preservativo, a práctica igual, no depende del polo de actividad sexual. Los hombres implicados en relaciones regulares con mujeres y que han tenido ocasionalmente compañeros sexuales masculinos, están menos frecuentemente infectados por el VIH, a causa de relaciones anales con riesgo menos frecuentes.
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Larmarange, J., Desgrées du Loû, A., Enel, C., Wade, A. S., & Groupe ELIHoS,. (2010). Homosexualité et bisexualité au Sénégal : une réalité multiforme. Population, 64(4), 723–756.
Résumé: Homosexualité et bisexualité au Sénégal : une réalité multiforme
Les premières enquêtes menées au Sénégal auprès d’hommes ayant des rapports sexuels avec d’autres hommes,dans le cadre de la lutte contre le sida, révèlent des taux élevés de bisexualité. En 2007, une nouvelle enquête épidémiologique et comportementale (ELIHoS) a été réalisée, dans laquelle la question des pratiques bisexuelles a été abordée de façon approfondie. Cette enquête est utilisée ici pour décrire la pluralité de formes que peut recouvrir la bisexualité au Sénégal. Une typologie du pôle d’activité sexuelle actuel en six classes est construite
à partir des caractéristiques des partenaires sexuels sur l’année et au moment de l’enquête. Différents éléments de la sociobiographie sexuelle des individus sont ensuite analysés selon leur pôle d’activité sexuelle actuel. Il apparaît que ces pôles correspondent à des pratiques sexuelles et à des caractéristiques différentes d’entrée en vie sexuelle avec un homme. En revanche, l’utilisation systématique d’un préservatif, à pratiques égales, ne dépend pas du pôle d’activité sexuelle. Les hommes engagés dans des relations régulières avec des femmes et ayant des partenaires masculins seulement occasionnellement sont moins souvent infectés par le VIH, car ils ont moins fréquemment des rapports anaux à risque.
Homosexuality and Bisexuality in Senegal: a Multiform Reality
The first surveys on men who have sex with men (MSM) carried out in Senegal in the context of the fight against AIDS, revealed high rates of bisexuality. In 2007, a new epidemiological and behavioural survey (ELIHoS) approached the question of bisexual practices in greater depth. That survey is used here to depict the plurality of forms that bisexuality may take in Senegal. A six-group typology of current modes of sexual activity was constructed based on the characteristics of sexual partners over the past year and at the time of the survey. Various factors in the respondents’ social and sexual life event histories were then analysed according to their current mode of sexual activity. It showed that these modes correspond to different sexual practices and characteristics of first sexual intercourse with a man. However, the systematic use of a condom for similar
sexual practices did not depend on the mode of sexual activity. Fewer men who engaged in regular intercourse with women and only occasionally with men were infected with HIV because they less frequently engaged in high-risk anal intercourse.
Homosexualidad y bisexualidad en Senegal: una realidad multiforme
Las primeras encuestas realizadas en Senegal, en el marco de la lucha contra el sida, sobre hombres que mantienen relaciones sexuales con otros hombres, revelan tasas de bisexualidad elevadas. En 2007 se ha realizado una nueva encuesta epidemiológica y comportamental (HELIHoS) que aborda en profundidad la cuestión de las prácticas bisexuales. Esta encuesta se utiliza aquí para describir la multitud de formas que la bisexualidad puede adoptar en Senegal. A partir de las características de los compañeros sexuales en el momento de la encuesta y durante el año que la precede, se ha construido una tipología del polo actual de actividad
sexual en seis clases. Diferentes elementos de la sociobiografía sexual de los individuos han sido analizados según el polo actual de actividad sexual. Se observa que estos polos corresponden a prácticas sexuales y a características diferentes de la entrada en la vida sexual con un hombre. Sin embargo, la utilización sistemática del preservativo, a práctica igual, no depende del polo de actividad sexual. Los hombres implicados en relaciones regulares con mujeres y que han tenido ocasionalmente compañeros sexuales masculinos, están menos frecuentemente infectados por el VIH, a causa de relaciones anales con riesgo menos frecuentes.
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Orne-Gliemann, J., & Desgrées du Loû, A. (2008). The involvment of men within prenatal HIV counselling and testing. Facts, constraints and hopes. (Correspondance.). AIDS, 22(18), 2555–2557.
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Tijou Traoré, A., Querre, M., Brou, H., Leroy, V., Desclaux, A., & Desgrées-du-Loû, A. (2009). Couples, PMTCT programs and infant feeding decision-making in Ivory Coast. Social Science & Medicine, 69(6), 830–837.
Résumé: In Sub-Saharan Africa, prevention of HIV pediatric infection due to breastfeeding requires turning to alternatives to prolonged breastfeeding: artificial feeding or exclusive breastfeeding with early weaning. Choosing a preventive option and applying it does not only depend upon the mother but also on the father and more specifically on couple interactions. To date, not enough studies have considered this question. In Abidjan, Ivory Coast, HIV-positive women and their infants were followed over two years in Ditrame Plus, a prevention of mother-to-child transmission (PMTCT) project. Using data from this project and from interviews conducted with couples and women, we analyzed the construction of decisions and practices concerning the application of preventive infant feeding options.
Differences may be found between women and men in discourses regarding their attitudes, which are in part related to their conceptions of motherhood and fatherhood. We found that when men know their wife is HIV positive and are involved in the PMTCT project, they play an active role in applying the advice received. However, women do not always need the support of their spouse to undertake preventative behaviour. The project team also plays an important role in the adoption of such by women and men. The implementation of preventive options is a complex process in which three groups of actors (women, men and the project team) interact. In order to optimize PMTCT programs for couples, it is essential that this dynamic be taken into account.
Mots-Clés: Côte d'Ivoire; Couple; HIV; Breastfeeding; Mother; Father; Infant feeding
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Wade, A. S., Larmarange, J., Diop, A. K., Diop, O., Gueye, K., Marra, A., et al. (2010). Reduction in risk-taking behaviors among MSM in Senegal between 2004 and 2007 and prevalence of HIV and other STIs. ELIHoS Project, ANRS 12139. AIDS Care, 22(4), 409–414.
Résumé: An epidemiological survey conducted in Senegal in 2004 among men having sex with men (MSM) revealed high HIV prevalence and a high rate of risky behaviors within this population. Consequently, several prevention campaigns targeting MSM were implemented. A second survey was carried out in 2007 to assess the impact of these measures. This paper aims to examine trends in HIV and STI prevalence and in sexual behaviors between 2004 and 2007. The two surveys were conducted in four urban sites among 440 and 501 MSM – recruited using the snowball sampling method – in 2004 and 2007, respectively. A similar methodology was applied for both surveys. This consisted of a closed-ended questionnaire concerning socio-demographic, behavioral, and biomedical information plus a clinical examination including urine and blood tests to detect STIs and HIV infection. Between 2004 and 2007, the frequency of different sexual practices reported by MSM remained stable, but condom use for each type of sexual practice rose. The percentage of men who reported consistent condom use during previous-month anal sex has increased by about 35% (p<0.01). The percentage of men who reported consistent condom use during previous-month non-commercial sex with women has increased by 14% (p<0.01). HIV prevalence remained stable from 22.4% [95% CI: 18.6-26.8] in 2004 to 21.8% [95% CI: 18.3-25.7] in 2007 (adjusted OR = 1.05, p=0.8). Gonorrhea prevalence decreased from 5.5% [95% CI: 3.6-8.3] in 2004 to 2.6% [95% CI: 1.5-4.5] in 2007 (adjusted OR = 0.5, p=0.07). The prevention campaigns, STI and HIV care and support programs conducted in Senegal among MSM have been followed by a reduction of risk-taking behaviors and STI prevalence among this population. Specific targeting of this group within HIV/STI prevention programs seems to be effective in decreasing sexual infections.
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Conference Proceedings |
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Enel, C., Larmarange, J., Desgrées du Loû, A., & Wade, A. S. (2008). Les identités sexuelles des HSH et de leurs partenaires : une grande complexité de situations, au Sénégal. Communication au XVIIIème Congrès International des Sociologues de Langue Française, Istanbul, 7-11 juillet 2008..
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Book Contributions |
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Desgrées du Loû, A. (2009). Le couple à l’épreuve du sida en Afrique sub-saharienne. In Jacques Vallin (Ed.), Du genre et de l'Afrique. Hommage à Thérèse Locoh (pp. 519–529). Paris: INED.
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