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International audience; Understanding the dynamics of HIV infection in men who have sex with men (MSM) can help improve efficiency in existing prevention strategies. We aimed to identify and describe the sexual behaviors of MSM most at risk of HIV infection in West Africa. HIV-negative MSM were provided a quarterly preventive follow-up package in the community-based cohort CohMSM. They completed face-to-face sociobehavioral questionnaires every 6 months. This sub-study on 520 participants used a baseline, 6-, 12- and 18-month data cluster analysis to categorize two profiles (high risk [HRE] and moderate risk [MRE] of exposure to HIV) based on three risky sexual practices over the previous 6 months. HRE-MSM (61%) were more engaged in receptive practices, had a higher proportion of inconsistent condom use during anal sex, and reported more sexual partners than MRE-MSM (39%). The proportion of HIV seroconversions observed during the first 18 months of follow-up using sexual behavioral profiles (92% are HRE-MSM) was higher than using the three risky sexual practices separately. Factors associated with the HRE-MSM profile were being younger (18-21 years), reporting stigma, and having had no female partner while being attracted only to men. Our findings suggest that in order to identify MSM most at risk of HIV infection, several risky sexual practices need to be evaluated in a combined approach. Prevention programs should pay particular attention to younger MSM, and implement activities addressing questions of MSM identity and stigma in order to reduce the dynamic of HIV infection in Western African MSM.

International audience; OBJECTIVE:To explore the interest in taking PrEP among Western African men who have sex with men (MSM).METHODS:A cross-sectional survey was implemented at enrolment of HIV-negative MSM in a multiple centre community-based cohort study in four West African countries (Mali, Côte d'Ivoire, Burkina Faso, Togo). A standardised face-to-face questionnaire collected data on socio-demographic and behavioural characteristics over the previous 6 months. Descriptive analysis and multivariate logistic regression helped identify factors associated with the interest in taking PrEP.RESULTS:Of 564 participants, 87% were interested in taking PrEP. Interest in PrEP was associated with inconsistent condom use for anal sex (adjusted odds ratio (aOR): 2.11; 95% confidence interval (CI) 1.21-3.67), transactional sex (aOR: 2.02; 95% CI 1.11-3.71), searching for male sexual partners on the Internet in the previous month (aOR: 1.86; 95% CI 1.01-3.43), having a high level of self-esteem (aOR: 1.20; 95% CI 1.06-1.36), having at least one sexually transmitted infections at enrolment (aOR: 5.08; 95% CI 1.40-18.4) and not being aware of PrEP (aOR: 2.03; 95% CI 1.04-3.96). Participants having sex with HIV-positive male partners (aOR: 0.28; 95% CI 0.11-0.74), those being more sexually attracted to women than to men (aOR: 0.20; 95% CI 0.07-0.89) and those reporting psychological and material support from close friends (aOR: 0.33; 95% CI 0.15-0.73) were less interested in taking PreP.CONCLUSIONS:Western African HIV-negative MSM appear very interested in taking PrEP, especially those most at risk of HIV infection. PrEP implementation in a comprehensive prevention package should be considered urgently.

ObjectivesTo investigate whether adherence to antiretroviral treatment (ART) can be explained not only by individual factors but also by health care facilities' characteristics, among a sample of people living with HIV (PLWH) treated with PI-based regimens in Cambodia. MethodsThe ANRS 12276 2PICAM cross-sectional survey was conducted between February 2013 and April 2014 among PLWH followed up in 13 health care facilities. The 1316 patients in this analysis corresponded to 90% of the total number of adult patients treated with 2nd-line PI-based regimens in Cambodia in the study period. A variable indicating whether patients were non-adherent (=1) or completely adherent (=0) was constructed. Health care facilities and individual characteristics were included in a two-level logistic model to investigate their influence on patients' adherence to ART. ResultsA total of 17% of participants did not adhere to ART. Patients in health care facilities outside the capital Phnom Penh were six times more likely to be non-adherent than those treated in health care facilities in the capital (OR: 6.15, 95% CI [1.47, 25.79]). Providing psychosocial care (provided by psychologist counsellors and/or full-time coaches) was found to be a structural facilitator of adherence, as the probability of non-adherence fell by 38.5% per each additional psychological worker present in health care facilities (OR: 0.62, 95% CI [0.43, 0.89]). Financial constraints were the main individual factor preventing adherence. ConclusionsOur results suggest that inefficiencies in health care delivery are detrimental to PLWH health and to the exceptional progress currently being made by Cambodia in response to HIV. Policy makers should focus on increasing the number of psychosocial workers, especially in areas outside the capital. ObjectifsInvestiguer si l'adhesion au traitement antiretroviral (ART) peut etre expliquee non seulement par des facteurs individuels mais aussi par les caracteristiques des etablissements de sante, dans un echantillon de personnes vivant avec le VIH (PVVIH), traitees par des schemas a base d'IP au Cambodge. MethodesL'enquete transversale ANRS 12276 2PICAM a ete menee entre fevrier 2013 et avril 2014 chez des PLWH suivies dans 13 etablissements de sante. Les 1316 patients dans cette analyse correspondaient a 90% du nombre total des patients adultes traites par des schemas de 2(e) ligne a base d'IP au Cambodge durant la periode d'etude. Une variable indiquant si les patients etaient non adherents (= 1) ou totalement adherents (= 0) a ete construite. Les caracteristiques des etablissements de soins de sante et individuels ont ete incluses dans un modele logistique a deux niveaux afin d'etudier leur influence sur l'adhesion des patients a l'ART. Resultats17% des participants n'on pas adhere a l'ART. Les patients dans les etablissements de soins de sante en dehors de la capitale Phnom Penh etaient six fois plus susceptibles d'etre non-adherents que ceux traites dans les etablissements de sante dans la capitale (OR: 6,15; IC95%: 1,47-25,79). La fourniture de soins psychosociaux (par des psychologues et/ou des coaches a temps plein) a ete trouve comme etant un facilitateur structurel de l'adhesion, vu que la probabilite de non-adhesion a chute de 38,5% par chaque agent psychologique supplementaire present dans les etablissements de sante (OR: 0,62; IC95%: 0,43-0,89). Les contraintes financieres etaient le principal facteur individuel empechant l'adhesion. ConclusionsNos resultats suggerent que l'inefficacite dans la prestation des soins de sante est prejudiciable a la sante des PLWH et aux progres exceptionnels realises actuellement par le Cambodge en reponse au VIH. Les decideurs devraient se concentrer sur l'augmentation du nombre des agents psychosociaux, en particulier dans les zones situees a l'exterieur de la capitale.