Barebacking and sexual health in the French setting: "NoKondom Zone" workshops.

Barebacking has been, since its emergence in the 1990s, a very controversial issue, and has as many definitions as authors writing about it. In France, sexual risk reduction strategies have been very contentious, and the advent of the bareback phenomenon increased this conflictual situation. This state of affairs has prevented the identification of needs and development of adequate programs for people not using condoms. In December 2008, a peer sexual health workshop, organized on a monthly basis and taking place over 1 year was launched and facilitated by a group of people who declared not using condoms (n approximate = 15). These workshops were hosted and organized by AIDES, the largest French HIV/AIDS community-based organization. The main objective was to create a safe place for exchanging about sexuality and health concerns. Most of the participants, who were mainly HIV positive, referred to being discriminated against in healthcare settings and in the gay community because of prevention policies and stereotypes about barebacking. This experience was extremely challenging for group members, for the facilitator and for the organisation. Main results show that taking part in the groups allowed participants to break their feelings of isolation, to discuss risk reduction strategies and, in some cases, to improve communication with medical staff. Besides, a political dimension related to implementing this kind of intervention was discussed. Participants declared that, in one way or another, they were more in need of this support than people not taking risks. Further interventions are needed in order to compare and contrast the present results.

The "Swiss Statement": who knows about it? How do they know? What are its effects on people living with HIV/AIDS?

The publication of the "Swiss Statement" in 2008 shook the international HIV prevention and advocacy scene. HIV behavioral research has provided us with some studies focusing on the potential changes that new prevention strategies can produce, but results are not conclusive. Besides, there is a lack of data concerning awareness of these kinds of prevention strategies on real-life settings, studying mainly the behavior of people recruited in different types of trials (e.g., circumcision, pre and post-exposure prophylaxis). The present study aims to (1) identify the factors associated with awareness of the "Swiss Statement" among PLWHA, (2) determine in which setting they became aware of it, and (3) look for potential, behavioral, and/or emotional changes as a consequence of this awareness. In order to achieve these three objectives, we used the data collected by a community-based survey called "HIV, Hepatitis and you." In order to determine the factors associated with the awareness of the Swiss Statement, univariate and multivariate logistic regression were performed. Main results show that among the 997 HIV-positive people answering the questionnaire, 57% knew about the Swiss Statement, and that their main source of information was the associative setting, while 30% declared having found out about it from their doctor. As for the factors associated with the awareness of the Swiss Statement, we found that the following variables were significantly associated with such awareness: living in stable housing, having a CD4 count above 350 cell/mm(3), having an undetectable viral load, being in contact with a HIV-solidarity network, feeling of belonging to the LGBT community, and filling out the questionnaire online. The results of this study point out that interventions addressed to improve access to health-related information for PLWHA facing socioeconomical difficulties and isolation are strongly needed.

Stigma, discrimination, and sexual (dis)satisfaction among people living with HIV: results from the "AIDES et toi" survey.

The effects of HIV-related stigma and discrimination have been studied in several areas, such as access to testing, quality of care quality, and access to work. Nevertheless, the effects of stigma and discrimination on the sexual life of people living with HIV/AIDS (PLWHA) have not been studied enough. AIDES, a French community-based organization, has developed a biannual survey which assesses several socioeconomical and psychosocial dimensions of the people in contact with this organization. A focus on the results concerning sexual (dis)satisfaction and the factors associated are presented here. A convenience sample of 521 HIV-positive men having sex with men, heterosexual men and women was analyzed. A logistic regression was performed to examine which factors were significantly associated with sexual dissatisfaction. Results showed that being older, not having a full-time job, not having a steady sexual partner, lower frequency of sexual intercourse, discrimination in the sexual relationship setting, and the perception of loneliness were independently associated with sexual dissatisfaction. A quality health approach must include the aspects linked to sexual life and sexual satisfaction. Given the potentially harmful effects that HIV-related stigma and discrimination have on PLWHA's well-being, more specific actions and advocacy in this direction should be developed and implemented.