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Aborder la problématique du genre dans la cyber-radicalisation terroriste revient à s’interroger principalement sur le processus de recrutement et de radicalisation des hommes et des femmes sur l’internet. Cet article tente de répondre à ces interrogations dans un contexte où Internet est devenu l’arme de prédilection de plusieurs groupes terroristes, notamment l’État islamique, pour toucher et sensibiliser de nouvelles recrues. Le Sénégal et le Mali, présentant deux contextes sécuritaires différents, seront ciblés. Le Sénégal et le Mali étant de plus en plus connectés à Internet, leurs populations deviennent accessibles aux messages propices au radicalisme terroriste, qui sont facilement véhiculés par ce canal, prenant pour cibles hommes et femmes. C’est en cela que la croissance exponentielle du taux de pénétration dans ces pays provoque un contexte de vulnérabilité. Les terroristes entrent en contact avec les potentielles cibles à travers les réseaux sociaux en utilisant la manipulation, voire le chantage. Ils parviennent à convaincre la plupart de leurs cibles qui sont surtout des jeunes (H/F) et des femmes. Il demeure ainsi crucial aujourd’hui de mettre l’accent sur la dimension genre dans les processus de recrutement et de radicalisation terroristes en raison des impacts variables sur les femmes et les hommes.

Background Persistent infection with high-risk human papillomavirus (HPV) is associated with development of invasive cervical cancer. Methods Longitudinal data was collected from 174 Senegalese women. We employed marginal Cox proportional hazards models to examine the effect of human immunodeficiency virus (HIV) status (HIV positive vs HIV negative) and HIV type (HIV-1 vs HIV-2 vs dual HIV-1/HIV-2) on clearance of type-specific HPV infection. Analyses were stratified by incident versus prevalent HPV infection. Results Incident HPV infections in HIV-positive women were less likely to clear than those in HIV-negative women (adjusted hazard ratio [HR] = 0.60; 95% confidence interval [CI], .38–.94). Among HIV-positive women, HIV-2–infected women and HIV-1/2 dually infected women were more likely to clear HPV incident infections than HIV-1–infected women (HR = 1.66; 95% CI, .95–2.92 and HR = 2.17; 95% CI, 1.12–4.22, respectively). Incident HPV infections in HIV-positive women with CD4 cell count ≤500 cells/μL were less likely to clear than those in HIV-positive women with CD4 cell count >500 cells/μL (HR = 0.65; 95% CI, .42–1.01). No significant associations were observed for prevalent HPV infections. Conclusions HIV infection reduced the likelihood of clearance of incident HPV infection. Furthermore, among HIV-positive women, low CD4 cell count and dual HIV infection were each associated with reduced likelihood of clearance.

HIV/AIDS is a serious health problem among prisoners and constitutes a big challenge for prison administration services, public health services and governments. Aims: Determine the prevalence of HIV infection among prisoners and describe associated factors. Population and Methods: This was a descriptive and analytical cross-sectional study conducted from December 2015 to October 2016. A sample of 600 prisoners was randomly interviewed nationwide. They were selected directly from the sample frame from across the country and proportionally from all sites. Pre-established questionnaires providing information on the sociodemographic and biological characteristics of prisoners were used for the collection of data. Data entry and analysis were performed using EXCEL and SPSS 18 software. Results: The survey was based on a randomised sample of 600 prisoners, 593 of whom accepted blood extraction for the HIV testing. The series was mainly composed of males (89%). The median age was 33 years (18 - 69). The level of education among respondents was 60%. Regarding marital status, the proportion of married prisoners was 51.8%. Almost three-quarters (71.5%) were at their first imprisonment and 51.8% were on preventive detention. The reasons for imprisonment varied and were dominated by drug use (35.3%), while only 4.6% confessed that they continued using drugs while in prison. 97.8% of prisoners have had a sexual experience. Their median age was 19 years at their first sexual intercourse. 20.5% reported using a condom during their first intercourse. Multi partnership was estimated at 17.8%. The prevalence of HIV infection was high among prisoners (2%), the quadruple of the national rate. This prevalence was associated with female sex (4.5%) (p = 0.012) and housewives (12.5%) (p = 0.002). Conclusion: Prisoners are very vulnerable to HIV infection with a high prevalence compared to the national rate, hence the need for the enforcement of effective HIV prevention and care measures in prisons.

Background: Optimizing antiretroviral therapy is an essential step to reach the 90 - 90 - 90 targets. Despite tremendous progress made for antiretroviral treatment (ART) to be accessible in countries with limited resources, health care providers continue to face challenges due to the under-optimization of ART due to therapeutic failures and poor retention. Objectives: To determine the prevalence of adverse therapeutic outcomes in a decentralized health care center and to determine associated factors. Patients and Methods: This is a cross-sectional descriptive and analytical study targeting PLHIV, aged 18 years and over, on first line antiretroviral treatment (ART), monitored onsite from February 1st to December 31st, 2018. A data collection form was completed from medical records (clinical, immuno-virological, therapeutic and evolutionary). Data were also collected from interviews with patients for additional socio-demographic information including the level of HIV knowledge. Data were captured and analyzed using EPI 2002 and R software. Proportions were compared using the chi -square and Fisher tests and logistic regression. A value of p Results: 331 patients were enrolled with HIV-1 profile in 89% of the cases. A proportion of 55% was married and 98% came from the rural area. 80% were either not or poorly educated. The median of age was 44 ± 11 years with a F/M ratio of 3.5. 30% that had not shared their HIV status, and more than half had a low knowledge of HIV transmission. At baseline, 56% were symptomatic at WHO stage 3 or 4. They had severe immunosuppression with a median CD4 count of 217 ± 187 cells/mm3; the viral load was detectable in half of the patients with a median viral load (VL) of 97,000 ± 70,569 cp/ml. The antiretroviral regimens combined 2 nucleoside reverse transcriptase inhibitor (NRTI) with 1 no nucleoside reverse transcriptase inhibitor (NNRTI) in 88% of the cases. The median duration of follow-up was estimated at 60 ± 43 months. The prevalence of adverse therapeutic outcomes was 36% (119 patients). The proportion of virological failure was 19%, lost follow up was 20% and the mortality was 4%. The adverse therapeutic outcomes were associated with the age less than 25 years (p = 0.007) and with a late diagnosis (CD4 T cells at baseline less than 200 cell/mm3, p = 0.02). Conclusion: These results suggest the need to make new therapeutic classes available for first-line treatment and to promote actions improving retention in care.

Introduction: In Senegal, the decentralization of Health Care Centers has contributed significantly to the intensification of antiretroviral treatment. However, Care providers are still facing the treatment optimizing challenge. Objectives: To determine the prevalence of virologic failures of PLHIV monitored in a decentralized Health care center and to determine associated factors. Patients and Methods: This is a cross-sectional descriptive and analytical study of PLHIV, aged 18 years and over, on first-line treatment, monitored onsite from February 1st to December 31st, 2018. A data collection form was completed from medical records (clinical, immuno-virologic and evolutionary). Any VL > 1000 cp/ml after 6 months of antiretroviral therapy (ART) was considered as virologic failure. Data were captured and analysed using the EPI INFO 2002software. Chi-square test and the Fisher test were used to compare the proportions; a value of p ≤ 0.05 was considered significant. Results: 331 patients were treated with HIV-1 profile in 89% of cases. A proportion of 55% was married and 97% came from rural areas. 80% were either not or poorly educated. The median of age was 44 ± 11 years with a F/M ratio of 3.4. At baseline, 56% were symptomatic at stage 3 or 4 of WHO. They had severe immunosuppression with a median CD4 count of 217 ± 187 cells/mm3, the viral load was detectable in half of the patients with a median VL of 97,000 cp/ml ± 70,569. The antiretroviral regimen combined 2 NRTIs with 1 NNRTI in 88% of cases. The median of follow-up was estimated at 60 ± 43 months. The prevalence of virologic failure was 19%. This prevalence was associated with age less than 25 years (p = 0.04), late diagnosis (CD4 at baseline less than 200 cel/mm3 (p = 0.002), stage 3 or 4 WHO (p = 0.04) High viral load greater than 10,000 (p = 0.04) at baseline. Conclusion: These results suggest making the new therapeutic classes accessible for first-line treatment.

Background Programmatic treatment outcome data for people living with human immunodeficiency virus type 2 (HIV-2) in West Africa, where the virus is most prevalent, are scarce. Methods Adults with HIV-2 initiating or receiving antiretroviral therapy (ART) through the Senegalese national AIDS program were invited to participate in this prospective, longitudinal observational cohort study. We analyzed HIV-2 viral loads, CD4 cell counts, antiretroviral drug resistance, loss to follow-up, and mortality. We also examined changes in treatment guidelines over time and assessed progress toward the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 targets for HIV-2. Results We enrolled 291 participants at 2 sites for 926.0 person-years of follow-up over 13 years. Median follow-up time was 2.2 years per participant. There were 21 deaths reported (7.2%), and 117 individuals (40.2%) were lost to follow-up, including 43 (14.7%) who had an initial visit but never returned for follow-up. CD4 counts and HIV-2 viral suppression ( Conclusions Participants in the Senegalese national AIDS program are initiating ART earlier in the course of disease, and more modern therapeutic regimens have improved outcomes among those receiving therapy. Despite these achievements, HIV-2 treatment remains suboptimal, and significant challenges to improving care remain.

Female genital mutilation or cutting (FGM/C) is a traditional practice that affects a significant portion of women in sub-Saharan Africa, Egypt, areas of the Middle East and some countries in Asia. While clinical and epidemiological studies have established a close association between inflammation and carcinogenesis, particularly in epithelial cancers, the relationship between FGM/C and cervical cancer is not well known. We performed a secondary analysis using combined data from six research studies conducted in and around Dakar, Senegal from 1994 to 2012. Study subjects included both asymptomatic women who presented to outpatient clinics but were screened for cervical cancer, and women with cancer symptoms who were referred for cervical cancer treatment. We used unconditional logistic regression to estimate adjusted pooled odds ratios (ORs) and 95% confidence intervals (CI) for associations between FGM/C and (1) Invasive cervical cancer (ICC) and (2) noninvasive cervical abnormalities. After adjusting for confounding, women with ICC were 2.50 times more likely to have undergone FGM/C than women without cervical abnormalities (95% CI, 1.28-4.91). Restricting to HPV-positive women increased the strength of the association (OR = 4.23; 95% CI 1.73-10.32). No significant associations between FGM/C and noninvasive cervical abnormalities were observed, except in commercial sex workers with FGM/C (OR = 2.01; 95% CI 1.19-3.40). The potential increased risk for ICC suggested by our study warrants further examination. Study results may impact cancer prevention efforts in populations where FGM/C is practiced and draw awareness to the additional health risks associated with FGM/C.

BACKGROUND: There is an urgent need for safe and effective antiretroviral therapy (ART) for human immunodeficiency virus type 2 (HIV-2) infection. We undertook the first clinical trial of a single-tablet regimen containing elvitegravir, cobicistat, emtricitabine, and tenofovir disoproxil fumarate (E/C/F/TDF) to assess its effectiveness in HIV-2–infected individuals in Senegal, West Africa. METHODS: HIV-2–infected, ART-naive adults with World Health Organization stage 3–4 disease or CD4 count

Background The Alere q HIV-1/2 Detect test (Alere Detect) is a rapid point-of-care (POC) nucleic acid test (NAT) that can detect and differentiate HIV-1 and HIV-2 in 25-μL whole blood or plasma samples. The Alere Detect test has been validated for early infant diagnosis of HIV-1 infection, and it is the only POC NAT device currently known to detect HIV-2, which is endemic in West Africa. Objectives To evaluate the sensitivity detecting HIV-2 RNA and the differential performance of the Alere Detect. Study design Plasma samples from non-HIV (n = 4), HIV-1 (n = 22), HIV-2 (n = 111; 29 Group A, 2 Group B) and HIV-1/HIV-2 dually-seropositive (n = 8) participants in Senegal and the United States and HIV-2 reference strains (3 Group A, 1 Group B) were tested by Alere Detect, Abbott RealTime HIV-1 and the University of Washington HIV-2 RNA quantitative (UW HIV-2) assays. Results The Alere Detect correctly differentiated between HIV-1 and HIV-2 in all 80 (100%) patient samples with detectable HIV RNA (n = 20 HIV-1, 60 HIV-2). The overall HIV-2 detection concordance between Alere Detect and the UW HIV-2 assay was 68% (54/80); the concordance improved to 100% (30/30) for samples with HIV-2 RNA >300copies/mL. Neither assay detected HIV-2 RNA in 31 of 111 HIV-2 seropositive samples. Conclusions The Alere Detect test is a novel device detecting HIV RNA in clinical samples, and differentiating HIV-1 and HIV-2 with a high level of specificity. It has the potential for use as a rapid HIV-2 NAT-based diagnosis tool in resource-limited settings and to confirm HIV-2 infection for the CDC 4th generation HIV-1/2 diagnostic algorithm.

The 2014 CDC 4th generation HIV screening algorithm includes an orthogonal immunoassay to confirm and discriminate HIV-1 and HIV-2 antibodies. Additional nucleic acid testing (NAT) is recommended to resolve indeterminate or undifferentiated HIV seroreactivity. HIV-2 NAT requires a second-line assay to detect HIV-2 total nucleic acid (TNA) in patients' blood cells, as a third of untreated patients have undetectable plasma HIV-2 RNA.To validate a qualitative HIV-2 TNA assay using peripheral blood mononuclear cells (PBMC) from HIV-2-infected Senegalese study participants.We evaluated the assay precision, sensitivity, specificity, and diagnostic performance of an HIV-2 TNA assay. Matched plasma and PBMC samples were collected from 25 HIV-1, 30 HIV-2, 8 HIV-1/-2 dual-seropositive and 25 HIV seronegative individuals. Diagnostic performance was evaluated by comparing the outcome of the TNA assay to the results obtained by the 4th generation HIV screening and confirmatory immunoassays.All PBMC from 30 HIV-2 seropositive participants tested positive for HIV-2 TNA including 23 patients with undetectable plasma RNA. Of the 30 matched plasma specimens, one was HIV non-reactive. Samples from 50 non-HIV-2 infected individuals were confirmed as non-reactive for HIV-2 Ab and negative for HIV-2 TNA. The agreement between HIV-2 TNA and the combined immunoassay results was 98.8% (79/80). Furthermore, HIV-2 TNA was detected in 7 of 8 PBMC specimens from HIV-1/HIV-2 dual-seropositive participants.Our TNA assay detected HIV-2 DNA/RNA in PBMC from serologically HIV-2 reactive, HIV indeterminate or HIV undifferentiated individuals with undetectable plasma RNA, and is suitable for confirming HIV-2 infection in the HIV testing algorithm.

We examined the antiviral activity of the integrase inhibitor (INI) cabotegravir against HIV-2 isolates from INI-naive individuals. HIV-2 was sensitive to cabotegravir in single-cycle and spreading-infection assays, with 50% effective concentrations (EC(50)s) in the low to subnanomolar range; comparable results were obtained for HIV-1 in both assay formats. Our findings suggest that cabotegravir should be evaluated in clinical trials as a potential option for antiretroviral therapy and preexposure prophylaxis in HIV-2-prevalent settings.

Introduction Le VIH-2, endémique en Afrique de l'Ouest, est naturellement résistant aux inhibiteurs non nucléosidiques de la rétro transcriptase (INNRTI), ce qui rend difficile la prise en charge dans les pays en développement. L’objectif ici était de déterminer la prévalence de l'échec virologique au 12éme et 24éme mois (M12 et M24) de traitement antirétroviral de première ligne chez les patients infectés par le VIH-2 et d'en décrire les résistances génotypiques associées. Méthodes Il s'agit d'une étude descriptive longitudinale et prospective, durant la période de novembre 2005 à juin 2017. L'échec virologique a été défini comme toute charge virale supérieure à 50 copies/ml après 6 mois de traitement ARV à deux reprises. La recherche de mutations de résistance a été réalisée dans les régions codantes de la protéase et de la transcriptase inverse. Résultats Au total 110 patients ont été colligés, d'âge médian de 46 ans (Extrêmes 18-67) avec un ratio F/H de 2,54. À l'inclusion, la charge virale était détectable dans 44% des cas avec une médiane de 935cp/ml (Extrêmes 17-144038). Le schéma antirétroviral associait 2 INTI à 1IP dans 94% des cas. La durée médiane de suivi était estimée à 1200 jours (Extrêmes 1-3840). 94 puis 76 patients ont respectivement complété leur bilan à M12 et M24. Au suivi M24, 39 patients étaient en échec virologique soit une prévalence de 39% estimée à 33% à M12 et 11% à M24. 45% des patients avaient des résistances aux inhibiteurs nucléosidiques de la transcriptase inverse (INTI), 41% des résistances aux IP et 30% des multi résistances aux INTI et IP. Conclusion Il est impératif de rendre accessible les nouvelles classes thérapeutiques pour le traitement de sauvetage des patients infectés par le VIH-2 dans les pays à ressources limitées.

Treatment options for individuals infected with human immunodeficiency virus type 2 (HIV-2) are restricted by the intrinsic resistance of the virus to nonnucleoside reverse transcriptase inhibitors (NNRTIs) and the reduced susceptibility of HIV-2 to several protease inhibitors (PIs) used in antiretroviral therapy (ART). In an effort to identify new antiretrovirals for HIV-2 treatment, we evaluated thein vitroactivity of the investigational nucleoside analog BMS-986001 (2′,3′-didehydro-3′-deoxy-4′-ethynylthymidine; also known as censavudine, festinavir, OBP-601, 4′-ethynyl stavudine, or 4′-ethynyl-d4T). In single-cycle assays, BMS-986001 inhibited HIV-2 isolates from treatment-naive individuals, with 50% effective concentrations (EC50s) ranging from 30 to 81 nM. In contrast, EC50s for group M and O isolates of HIV-1 ranged from 450 to 890 nM. Across all isolates tested, the average EC50for HIV-2 was 9.5-fold lower than that for HIV-1 (64 ± 18 nM versus 610 ± 200 nM, respectively; mean ± standard deviation). BMS-986001 also exhibited full activity against HIV-2 variants whose genomes encoded the single amino acid changes K65R and Q151M in reverse transcriptase, whereas the M184V mutant was 15-fold more resistant to the drug than the parental HIV-2ROD9strain. Taken together, our findings show that BMS-986001 is an effective inhibitor of HIV-2 replication. To our knowledge, BMS-986001 is the first nucleoside analog that, when tested against a diverse collection of HIV-1 and HIV-2 isolates, exhibits more potent activity against HIV-2 than against HIV-1 in culture.

Female genital mutilation or cutting (FGM/C) is a traditional practice that affects a significant portion of women in sub-Saharan Africa, Egypt, areas of the Middle East and some countries in Asia. While clinical and epidemiological studies have established a close association between inflammation and carcinogenesis, particularly in epithelial cancers, the relationship between FGM/C and cervical cancer is not well known. We performed a secondary analysis using combined data from six research studies conducted in and around Dakar, Senegal from 1994 to 2012. Study subjects included both asymptomatic women who presented to outpatient clinics but were screened for cervical cancer, and women with cancer symptoms who were referred for cervical cancer treatment. We used unconditional logistic regression to estimate adjusted pooled odds ratios (ORs) and 95% confidence intervals (CI) for associations between FGM/C and (1) Invasive cervical cancer (ICC) and (2) noninvasive cervical abnormalities. After adjusting for confounding, women with ICC were 2.50 times more likely to have undergone FGM/C than women without cervical abnormalities (95% CI, 1.28-4.91). Restricting to HPV-positive women increased the strength of the association (OR = 4.23; 95% CI 1.73-10.32). No significant associations between FGM/C and noninvasive cervical abnormalities were observed, except in commercial sex workers with FGM/C (OR = 2.01; 95% CI 1.19-3.40). The potential increased risk for ICC suggested by our study warrants further examination. Study results may impact cancer prevention efforts in populations where FGM/C is practiced and draw awareness to the additional health risks associated with FGM/C.

There is a pressing need to identify more effective antiretroviral drugs for HIV-2 treatment. Here, we show that the investigational compound MK-8591 (4′-ethynyl-2-fluoro-2′-deoxyadenosine [EFdA]) is highly active against group A and B isolates of HIV-2; 50% effective concentrations [EC50] for HIV-2 were, on average, 4.8-fold lower than those observed for HIV-1. MK-8591 also retains potent activity against multinucleoside-resistant HIV-2 mutants (EC50≤ 11 nM). These data suggest that MK-8591 may have antiviral activity in HIV-2-infected individuals.

An understanding of the factors contributing to food insecurity and malnutrition among people living with HIV (PLHIV) in Senegal is urgently needed in order to develop effective interventions. The goals of this study were to identify differences in the dimensions of food security among PLHIV in Dakar versus Ziguinchor, Senegal, to determine which of these dimensions are most predictive of severe food insecurity, and to identify factors associated with malnutrition. We conducted a cross-sectional study at outpatient clinics in Dakar and Ziguinchor, Senegal. Data were collected using participant interviews, anthropometry, the Household Food Insecurity Access Scale, the Individual Dietary Diversity Scale, and chart review. Interviews were conducted with ninety-five food insecure, HIV-infected subjects. Daily household income and daily food expenditure per household member were the strongest predictors of severe food insecurity. The practice of agriculture, livestock ownership, nutritional status, and HIV outcomes were not predictive of severe food insecurity. CD4 count

Background Malnutrition and food insecurity are associated with increased mortality and poor clinical outcomes among people living with HIV/AIDS; however, the prevalence of malnutrition and food insecurity among people living with HIV/AIDS in Senegal, West Africa is unknown. The objective of this study was to determine the prevalence and severity of food insecurity and malnutrition among HIV-infected adults in Senegal, and to identify associations between food insecurity, malnutrition, and HIV outcomes. Methods We conducted a cross-sectional study at outpatient clinics in Dakar and Ziguinchor, Senegal. Data were collected using participant interviews, anthropometry, the Household Food Insecurity Access Scale, the Individual Dietary Diversity Scale, and chart review. Results One hundred and nine HIV-1 and/or HIV-2 participants were enrolled. The prevalence of food insecurity was 84.6% in Dakar and 89.5% in Ziguinchor. The prevalence of severe food insecurity was 59.6% in Dakar and 75.4% in Ziguinchor. The prevalence of malnutrition (BMI

Protease inhibitor (PI)-based antiretroviral therapy (ART) can effectively suppress HIV-2 plasma load and increase CD4 counts; however, not all PIs are equally active against HIV-2, and few data exist to support second-line therapy decisions. To identify therapeutic options for HIV-2 patients failing ART, we evaluated the frequency of PI resistance-associated amino acid changes in HIV-2 sequences from a cohort of 43 Senegalese individuals receiving unboosted indinavir ( n = 18 subjects)-, lopinavir/ritonavir ( n = 4)-, or indinavir and then lopinavir/ritonavir ( n = 21)-containing ART. Common protease substitutions included V10I, V47A, I54M, V71I, I82F, I84V, L90M, and L99F, and most patients harbored viruses containing multiple changes. Based on genotypic data, we constructed a panel of 15 site-directed mutants of HIV-2 ROD9 containing single- or multiple-treatment-associated amino acid changes in the protease-encoding region of pol . We then quantified the susceptibilities of the mutants to the HIV-2 “active” PIs saquinavir, lopinavir, and darunavir using a single-cycle assay. Relative to wild-type HIV-2, the V47A mutant was resistant to lopinavir (6.3-fold increase in the mean 50% effective concentration [EC 50 ]), the I54M variant was resistant to darunavir and lopinavir (6.2- and 2.7-fold increases, respectively), and the L90M mutant was resistant to saquinavir (3.6-fold increase). In addition, the triple mutant that included I54M plus I84V plus L90M was resistant to all three PIs (31-, 10-, and 3.8-fold increases in the mean EC 50 for darunavir, saquinavir, and lopinavir, respectively). Taken together, our data demonstrate that PI-treated HIV-2 patients frequently harbor viruses that exhibit complex patterns of PI cross-resistance. These findings suggest that sequential PI-based regimens for HIV-2 treatment may be ineffective.