ABSTRACT
Introduction - The containment measures taken in March 2020 to stop the spread of the Coronavirus strengthened social disparities in populations already vulnerable in terms of physical and mental health and living conditions. Thus, an increase in domestic violence has been observed affecting women and children but also lesbian, gay, bisexual (LGB) people. The objective of this article is to estimate the levels of domestic violence suffered by men who have sex with men (MSM) residing during the eight weeks of the first lockdown of 2020 in a housing with one of their family members, to describe their characteristics and the impacts on health. Methods - ERAS is an anonymous, self-administered online cross-sectional survey based on voluntary. The COVID-19 special edition was conducted from 30 June to 15 July 2020 from Sante publique France. A total of 8,345 MSM residing in France responded to the survey. Results - Among the 8,345 MSM respondents, 2,467 reported living in the same housing as a family member during the eight weeks of the first lockdown. Among the latter, 35.2% (868) reported experiencing domestic violence during this period, mostly psychological verbal violence. The victims of domestic violence were young and in a precarious socio-economic situation. In this context of lockdown, this unfavorable family environment had negative impacts on the mental health of the victims. Conclusion - An action plan was launched by the government to combat anti-LGBT violence, but in light of the successive measures taken to contain the epidemic, innovative initiatives must be implemented to give them all the support they need.
ABSTRACT
Background: On-demand PrEP with TDF/FTC has been recommended as an alternative to daily PrEP for MSM by EACS, WHO and IAS-USA guidelines, but has not been endorsed yet by CDC due to limited real-world experience. Methods: The ANRS Prevenir study is an ongoing prospective cohort study enrolling individuals at high risk for HIV infection on PrEP. MSM could opt for either daily or on-demand PrEP with TDF/FTC. At baseline, month 1 and every 3 months thereafter, subjects were tested for HIV using a 4th generation combined ELISA assay and other STIs and creatinine plasma levels were monitored. At each visit participants provided information regarding sexual behaviour, dosing regimen and drug adherence. Our main objective was to assess the overall HIV incidence in the study and per dosing regimen, as well as incidence of bacterial STIs (including syphilis, gonorrhoea, chlamydia and Mycoplasma genitalium) and viral hepatitis. Safety and study retention were also assessed. This analysis uses data accumulated up to September 30, 2020. Results: From May 3rd 2017 to March 2nd 2019, 3067 subjects were enrolled across 22 sites in the Paris region, 44% being PrEP naive. Median age was 36 years (IQR: 29-43), 98.5% were MSM. At enrolment, PrEP was used daily and on demand by 50.5% and 49.5% of participants, respectively. Median number of partners in the last 3 months was 10 (5-20) and median number of condomless sex events in the prior 4 weeks was 2 (0-5). Median follow-up lasted 22 months and accumulated 5633 person-years (PY) with an overall HIV incidence in the cohort of 0.11 (95% CI: 0.04-0.23) per 100 PY. Six participants (3 daily, 3 on demand) acquired HIV-infection during the study period (P=0.99). Condom use at last sexual intercourse was 19.6%. Overall STIs incidence was 73 (95% CI: 70.7-75.5) per 100 PY which remained stable during follow-up except during the COVID-19 lockdown when it dropped to 32.4 per 100 PY (P<10-4). HCV incidence was 0.69 per 100 PY. Incidence of participants lost to follow-up was 10.3/100 PY and 19 subjects (0.6%) discontinued PrEP for drug-related adverse events (gastrointestinal: 12, e-GFR < 70 ml/mn: 4, other: 3). Conclusion: In this PrEP cohort, enrolling mainly MSM at high risk of HIVacquisition in Paris, HIV incidence was low whether participants used daily or on demand PrEP. There was a high incidence of bacterial STIs and HCV infection despite a drop in STIs incidence during the COVID-19 lockdown.
ABSTRACT
Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) or COVID-19 has undeniably changed the world forever. Capitalism in the United States and Europe can no longer feel immune from the effects of epidemics that were at one point in time the concern of minor countries, such as the recent (2014-2016) Ebola epidemic in Western Africa. This article examines how COVID-19 not only showed that Capitalism has no clothes in its inability to respond effectively to this momentous event, but shows the burgeoning of the impact on its slow-motion decline. This is evident from the still-unresolved healthcare crisis in the United States, which allows runaway contagion, sickness, and death due to a careless governmental attitude that prioritizes capital over human lives;the economic impact, which sidelines millions of workers into unemployment, leaving them without a way to sustain themselves due to a miserly and short-sighted governmental response;and the political and social cost that is yet to be determined. Copyright © 2020 by Koninklijke Brill NV, Leiden.
ABSTRACT
ERAS is a cross-sectional, anonymous, online self-administered and voluntary survey. Its special edition Covid-19 was conducted from 30 June to 15 July 2020. A total of 8,345 MSM residing in France were included in the analysis. Considering their rather favourable living conditions, the lockdown took place for a large part of the respondents in rather good conditions. However, negative impacts were observed at the economic level, with for some respondents a deterioration of their economic situation, and also at the level of consumption of products or mental health. While these last two dimensions are not specific to MSMs, they appear to be more pronounced than in the general population. Regarding the continuity of care for other health problems, 35% of the respondents gave up care, and 28% postponed their HIV/STI screening. Similarly, 34% of HIV-positive respondents postponed an HIV follow-up visit. Finally, 60% of respondents did not have sex with casual partners and 59% of pre-exposure prophylaxis (PrEP) users stopped using PrEP due to a decrease in sexual intercourse, indicating compliance with social distancing measures but also an abrupt interruption of sexual sociability. Thus, the health crisis highlights the specific pre-existing health vulnerabilities of homo- and bisexuals: isolation, mental health, consumption of products to which are added socioeconomic vulnerabilities.