Santé des personnes LGBTI+ : enjeux scientifiques et perspectives de santé publique.

Despite advances in recent decades, health inequalities faced by sexual, gender and gendered minorities remain poorly recognized. Yet the barriers to accessing prevention and care encountered by these populations are widely documented in international literature. The health of LGBTI+ people is still largely understood and structured as a sexual health issue related to sexually transmitted infections, leaving other crucial issues in the background. Some questions remain hidden, in particular the realities experienced by bisexual, lesbian, intersex people, as well as the diversity of transidentities. This issue is a first on several levels. It is indeed the first time that a scientific journal publishes a collection of this scope in the French-speaking world. Moreover, the issue brings together contributions that reflect the diversity of actors and actresses in this field. Finally, the issue's French-speaking focus allows for diversified geographical insights. This issue is structured around three main parts: 1) Thinking, categorizing: from research to health promotion; 2) Describing health realities: apprehending needs and understanding obstacles; 3) Intervening in the field of sexual, gender and gendered minorities health.

Les lesbiennes se droguent-elles davantage ? Les effets de l'(hétéro)sexualité sur la consommation de produits psychoactifs.

INTRODUCTION: Most of the data addressing LGBT populations are adressing gay men's health and focuses on the heterosexual/homosexual alterity without considering their practices nor their trajectories. PURPOSE OF RESEARCH: In this article, we are looking into psychoactive substances use among lesbian and bisexual women. Based on an analysis of the Lesbian and Gay Press Survey (INVS, 2011), this paper aims to analyze the substance use of these populations, while discussing the categories used to describe them. RESULTS: Our results show that sexuality with male partners is associated with increased levels of consumption of illegal psychoactive products. However, this is not true for prescripted drugs. With regard to alcohol, consumption levels follow a gradient corresponding to the number of partners, regardless of their sex. However, sexual identification is not a relevant indicator for interpreting substance use, whatever the product consumed which suggest bisexuality is not associated, per se, with increased levels of substance abuse. CONCLUSIONS: These results suggest that the links commonly made between sexual orientation and increased consumption of psychoactive products should be discussed. Not only are consumption levels different for different products, but they also depend on gender and sexuality indicators. Because of the weight of heterosexist structures, sexuality with men is an important determinant of psychoactive product use among sexual minorities. Particularly with regard to bisexual women, this leads to discuss the link between a double discrimination, from their male and female partners, and their level of consumption of psychoactive products.

Investigating health services for sexual and gender minorities in France: a qualitative study protocol.

INTRODUCTION: Discrimination and structural violence experienced by sexual and gender minorities are the source of social inequalities in health. The last decade has been marked by major developments in the provision of sexual health services for these minorities in France. This paper presents the research protocol of the Services for Minorities-Lesbian Gays Bisexuals Transgender Intersex+ (SeSAM-LGBTI+) study, which aims to document the health, social and professional challenges in the organisation of current health services for sexual and gender minorities in France. METHODS AND ANALYSIS: The SeSAM-LGBTI+ study relies on a multidisciplinary qualitative study. It has two objectives: (1) to analyse the history of the development of LGBTI+ health services in France, through interviews with key informants and rights activists and through a study of archives and (2) to study the functioning and challenges of a sample of health services currently offered to LGBTI+ people in France, through a multiple case study, using a multilevel and multisited ethnography. The study will rely on approximately 100 interviews. The analysis will be based on an inductive and iterative approach, combining sociohistorical data and the cross-sectional analysis of the case studies. ETHICS AND DISSEMINATION: The study protocol has undergone a peer review by the Institut de Recherche En santé Publique's scientific committee and has been approved by the research ethical committee of Aix-Marseille University (registration number: 2022-05-12-010). The project has received funding from December 2021 to November 2024. The results of the research will be disseminated from 2023 onwards to researchers, health professionals and community health organisations.

Union break-up after HIV diagnosis among sub-Saharan African migrants in France: disclosing HIV status is linked with staying in union.

Sub-Saharan African migrants living in France are particularly affected by HIV. Due to the fear of sexual transmission of the virus, those in a relationship could experience a union break-up after an HIV diagnosis. Based on data from the time-event ANRS-Parcours survey that was conducted among a representative sample of sub-Saharan migrants living with HIV (France, 2012-2013), we studied union break-ups after HIV diagnosis among people who were in a relationship at the time of their diagnosis. Women experienced a more rapid union break-up after HIV diagnosis than did men. The living conditions of men were not correlated to their risk of union break-up while among women, having a personal dwelling reduced the risk of union break-up. For both sexes, less established relationships were more likely to break up after HIV diagnosis. Having disclosed the HIV status to a partner was associated with a reduced risk of separation between partners, after adjustment on socio-economic conditions and migration characteristics.

Multiple discriminations experienced by people living with HIV in France: results from the ANRS-Vespa2 study.

Since the advent of AIDS, discrimination has remained at the core of the experience of people living with HIV (PLHIV). PLHIV who belong to minority groups are exposed to discrimination not only on the grounds of their HIV infection but also because of rejecting attitudes towards drug users, homosexuals and black people. This article aimed to measure the frequency of discrimination and assess its correlates among PLHIV in France. We used data from a national representative survey, the ANRS-Vespa2 study, conducted in France in 2011 among 3022 male and female HIV-positive patients followed at hospitals. Respondents answered a face-to-face questionnaire documenting their health status and living conditions. Discrimination was documented during the previous two years on the grounds of HIV infection, gender, country of birth, skin colour, sexual orientation, place of residence, and substance abuse in a variety of contexts. For each context, we performed logistic regressions on discrimination, controlling for socio-epidemiological group, age, education level and employment status. Discrimination is frequently experienced by PLHIV in France (26%), particularly when applying for a job (24%), interacting with family (11%) or seeking health services (8%). Women from sub-Saharan Africa reported the highest levels of discrimination, whereas heterosexual non-African men reported the lowest. Men who have sex with men experienced levels of discrimination that fell between those of these two groups. The major perceived reason for discrimination was HIV status (13%). Nationality, skin colour and sexual orientation were cited by 5% each, whereas gender was cited by 1% of respondents. Our analyses show that discrimination is a frequent and cross-cutting experience with differences across the various contexts and among the diverse subpopulations. The intertwining of HIV-related stigma with sexism, racism and homophobia needs to be addressed to understand why discrimination against PLHIV persists when the disease itself has greatly evolved.

'Migrants from over there' or 'racial minority here'? Sexual networks and prevention practices among sub-Saharan African migrants in France.

Migrants from sub-Saharan Africa bear a disproportionate burden of HIV infection in Europe, with an increasing proportion of them acquiring HIV after migration. This transformation in the epidemic pattern has raised concerns about the sexual mixing and preventive behaviours of migrants. This paper aims at exploring how racial boundaries shape sexual networks and structure prevention practices among migrants from sub-Saharan Africa. Analyses are based on a French survey carried out among 1874 individuals born in sub-Saharan Africa, aged 18-49 and living in Paris and its surroundings. Our results provide evidence of the existence of African sexual networks, over and beyond those of national origin. The intra-African segregation of these sexual networks leads to sexual contacts between migrants from low- and high-HIV prevalence countries, which probably contribute to the development of the epidemic amongst these migrants. Moreover, racially-based perceptions of HIV-related risk seem to produce a specific attitude toward prevention practices as shown by higher rates of condom use among migrant women from sub-Saharan Africa with a partner born outside sub-Saharan Africa. As a consequence, community-based approaches to HIV prevention should take into account the identification of migrants from sub-Saharan Africa as a racial minority and not only focus on national borders.

Class, gender and culture in the experience of menopause. A comparative survey in Tunisia and France.

The experience of menopause can vary strongly from one society to another: frequency of hot flushes, other somatic and psychological symptoms, and changes in family and social relations. Several studies have shown that country of residence, country of birth, ethnicity, and social class all play roles in these variations. But few comparative anthropological studies have analysed the social processes that construct the experience of menopause or considered menopausal women's social and financial autonomy. To study the impact of the social status accorded to menopausal women and their social resources, during 2007 and 2008 we conducted a series of 75 in-depth interviews with women in different sociocultural settings: Tunisian women in Tunisia, Tunisian women in France, and French women in France, all aged from 45 to 70 years. Our methodological approach to the data included content analysis, typology development and socio-demographic analysis. Quite substantial differences appeared, as a function of social class and cultural environment. We identified three principal experiences of menopause. Tunisian working class women, in Tunisia and France, experience menopause with intense symptoms and strong feelings of social degradation. Among Tunisian middle-class women in both countries, menopause was most often accompanied by a severe decline in aesthetic and social value but few symptoms. For most of the French women, menopause involved few symptoms and little change in their social value. The distribution of types of experiences according to social but not geographic or national factors indicates that, in the populations studied here, the differences in symptoms are not biologically determined. Different experiences of menopause are linked to social class and to the degree of male domination. A given level of independence and emancipation allows women an identity beyond their reproductive function and a status unimpaired by menopause.