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Approche psychosociale de la gestion du risque VIH des Hommes ayant des rapports Sexuels avec des Hommes (HSH) dans un essai de prévention biomédicale communautaire (ANRS-IPERGAY)

Abstract : HIV prevention remains a public health issue throughout France and the world. In 2017, of an estimated 1.8 million new HIV infections worldwide (ONUSIDA, 2018), 6400 were in France (Santé publique France, 2019). Men who have sex with men (MSM) constitute the population most affected by the epidemic in France, representing 41% of new infections in 2017 (Santé publique France, 2019).Given this alarming public health situation, the community-based clinical trial ANRS-IPERGAY recently evaluated the use of one of the newest HIV prevention tools – on-demand pre-exposure prophylaxis (PrEP) – in MSM in France. Results showed a relative reduction of 97% in HIV incidence in this population using on-demand PrEP (Molina et al., 2017).The aim of this thesis is to study psychosocial issues linked to PrEP integration into existing risk management strategies by MSM enrolled in ANRS-IPERGAY.Methods:The French community-based ANRS-IPERGAY trial comprised two phases: i) a double-blind placebo-controlled randomised phase (DBP) (2012-2014) and ii) an open-label extension (OLE) study without placebo (2014-2016) among HIV-negative MSM (n=428). A mixed methods approach was implemented during the study in order to meet the thesis objectives, whilst maintaining a comprehensive and psychosocial view. We conducted 5 studies, as follows:- 1) Both sexual and preventive behaviours of MSM in different contexts of risk exposure (i.e., DBP versus OLE) were studied through a longitudinal, quantitative analysis.- 2) Risk perception and associated factors were examined through a longitudinal, quantitative analysis. The level of risk perception was then compared with both the levels of PrEP and condom use.- 3) The participant-physician relationship was explored in the specific context of prevention support as part of risk management, using a qualitative analysis focused on physicians.- 4) The perception of combined medical and community-based support was studied using a qualitative analysis involving both physicians and participants.- 5) Factors associated with condomless anal sex without PrEP were analysed using a quantitative, longitudinal analysis.Results:The quantitative studies highlighted that PrEP use was higher than condom use. Risk perception was a major factor in predicting PrEP use, but not condom use. Results also showed that 19% of anal intercourses by MSM in ANRS-IPERGAY were unprotected (i.e., no condom or PrEP). Factors associated with this show that risk taking do not have a distinctive "profile". Indeed, associated factors were dynamic, dependent of the social and relational contexts of the sexual intercourses. Furthermore, qualitative studies highlighted that participant-physician relationships were based on listening and support. Moreover, physicians positively perceived the relational dynamic with community-based peer counsellors (PC) in the trial. They highlighted the complementary nature of using both approaches. Participants also viewed this combined approach as a strong point. They positively compared physicians participating in the trial with other physicians, yet were less positive when comparing the trial’s physicians with PC.Conclusions:The work carried out in this thesis provides a global view of sexual behaviours, risk management and associated psychosocial determinants in the HIV-negative population in France. Quantitative results showed that sexual and preventive behaviours are more influenced by contextual and relational factors than personal characteristics. This finding provides concrete indications for future HIV prevention programs targeting MSM.Furthermore, with regard to PrEP implementation, PrEP use may be positively influenced by the support system surrounding the MSM, being the relationship with the physicians and the counselling associated.
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Marion Di Ciaccio. Approche psychosociale de la gestion du risque VIH des Hommes ayant des rapports Sexuels avec des Hommes (HSH) dans un essai de prévention biomédicale communautaire (ANRS-IPERGAY). Psychologie. Université de Lyon, 2019. Français. ⟨NNT : 2019LYSE2081⟩. ⟨tel-02493209⟩

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