Rates of HIV infection continue to climb among minority populations and men who have sex with men (MSM), with African American/Black MSM being especially impacted. Numerous studies have found HIV transmission risk to be associated with many health and social disparities resulting from larger environmental and structural forces. Using anthropological and social environment-based theories of resilience that focus on individual agency and larger social and environmental structures, this dissertation employed a mixed methods design to investigate resilience processes among African American/Black MSM. Quantitative analyses compared African American/Black (N=108) and Caucasian/White (N=250) MSM who participated in a previously conducted randomized controlled trial (RCT) of sexual and substance use risk reduction interventions. At RCT study entry, using past 90 day recall periods, there were no differences in unprotected sex frequency, however African American/Black MSM reported higher frequencies of days high (P Qualitative data collected among a sub-sample of African American/Black MSM from the RCT (N=21) described the men’s experiences of living with multiple health and social disparities and the importance of RCT study assessments in facilitating reductions in risk behaviors. A cross-case analysis showed different resilience processes undertaken by men who experienced low socioeconomic status, little family support, and homophobia (N=16) compared to those who did not (N=5). The dissertation concludes that resilience processes to HIV transmission risk and related health and social disparities among African American/Black MSM varies and are dependent on specific social environmental factors, including social relationships, structural homophobia, and access to social, economic, and cultural capital. Men define for themselves what it means to be resilient within their social environment. These conclusions suggest that both individual and structural-level resilience-based HIV prevention interventions are needed.

The evaluation of the feasibility and clinical utility of liquid based cytology, human papillomavirus testing and high-resolution anoscopy to screen for anal intraepithelial neoplasia in high-risk groups. Dr Alice Martha Schofield: The University of Manchester for the degree of Doctor of Medicine, January 2016. Background: The increased incidence and natural history of anal cancer in high-risk groups, provides a screening opportunity to detect precancerous lesions, anal intraepithelial neoplasia (AIN), as well as early invasive lesions. The ANALOGY study was performed to strengthen the evidence base required to determine the case for anal screening in terms of the feasibility and clinical utility of liquid based cytology (LBC), high-risk human papillomavirus (HR-HPV) testing and high-resolution anoscopy (HRA) in high-risk groups. Methods: This prospective study offered screening to four cohorts aged over 25 at varying but elevated risk; human immunodeficiency virus (HIV) positive and negative men who have sex with men (MSM), HIV positive women with prior history of abnormal cervical cytology or anogenital warts, HIV negative women who practice anoreceptive sex and transplant recipients (TR). Recruitment commenced in March 2013 and concluded in December 2014, with follow-up until March 2015. All participants underwent testing for HR-HPV, LBC and had HRA performed, sites of abnormality were biopsied. Participants were seen at initial consultation and at a second visit six months later. Immunostaining with Ki67 and p16 antibody was performed on 100 anal tissue biopsies. The cellular positivity of each biomarker were scored by automated and manual methods. H-SCORES of p16 biomarker and block positive staining of AIN2 were quantified and analysed. Results: 409 participants were recruited; 284 MSM (203 HIV positive, 81 HIV negative), nine HIV positive women, four HIV negative women and 112 TR. HR-HPV was highly prevalent in anal samples from MSM (HIV positive 88.0% and HIV negative, 77.8%) and much less so in HIV positive and negative women and TR (19.3%). Despite the high prevalence of cytological abnormality in MSM, almost half of AIN of all grades was associated with negative cytology. AIN3+ on biopsy was found in 4.4% (18/409) of participants; three HIV positive MSM had cancer. One new case of AIN3 was identified at the second visit. Low-grade disease (AIN1/2) was highly prevalent in all groups. Ki67 and p16 biomarker expression increase as the grade of anal disease increased when scored manually. AIN2 histology samples, which demonstrate block positive p16 staining, have an association with an increased H-SCORE.Conclusions: Anal screening in some high-risk groups is clinically feasible in terms of diagnostics with evidence of significant disease prevalence particularly amongst MSM. The high prevalence of HR-HPV infection and frequency of false negative cytology indicates that in terms of sensitivity and specificity, HRA would be the best primary screening tool. The use of Ki67 and p16 in the identification of anal disease appears to have clinical utility, especially in the detection of AIN2; with the majority of samples displaying block p16 staining that corresponded with an increased H-SCORE. The prevalence of AIN3+ in HIV positive MSM lends support for a policy of screening in this group, however limitations of treatment, as well as highly prevalent low-grade lesions of dubious significance, require careful consideration.

Les hommes ayant des relations sexuelles avec des hommes (HSH) sont particulièrement touchés par le VIH depuis le début de l’épidémie. En France, le taux annuel d’incidence du VIH est le plus élevé, estimé en 2008 à 1% dans cette population. Dans ce contexte, il est primordial de disposer de données comportementales efficientes sur les pratiques sexuelles et préventives ainsi que sur les modes de vie afin de mettre en œuvre des programmes de prévention au plus proche des habitudes de vie des HSH et d’évaluer leurs impacts sur les comportements. Mais appréhender la population HSH dans sa globalité est complexe de par sa diversité est difficile. Depuis leur création en 1985, les Enquêtes Presse Gay (EPG) se sont attachées à comprendre l’impact des progrès médicaux, des modes de socialisation et les modifications des représentations de l’homosexualité sur les pratiques sexuelles préventives.La dernière édition de l’Enquête Presse Gays et Lesbiennes réalisée, en 2011, a recruté 10 448 HSH sur la base du volontariat. Grâce à la diversification des modes de recrutement incluant les sites internet communautaires, de nouveaux profils socio-démographiques et sexuels sont décrits à côté de ceux habituellement recrutés. L’actualisation des indicateurs de prises de risque sexuel qui prennent en compte les avancées thérapeutiques et les pratiques profanes de prévention permet de constater que le niveau d’exposition au VIH des HSH reste toujours élevé. Il varie selon le statut sérologique VIH et le niveau d’étude de ces HSH. L’analyse longitudinale des sept dernières EPG, a mis en évidence, l’impact des dynamiques sociales structurant les comportements sexuels et préventifs des HSH ayant débuté leur sexualité entre 1960 et 2011.Dans l’optique, d’enrayer la dynamique de l’épidémie de VIH, il est essentiel de poursuivre les dispositifs d’observation des comportements sexuels et préventifs des HSH via des enquêtes ad hoc. Ces enquêtes doivent être en adéquation avec les évolutions rapides et soutenues qui caractérisent la lutte contre le VIH. Elles devront faire preuve d’innovation. / Men who have sex with men (MSM) have been greatly affected by HIV infection. Indeed in France, the highest HIV incidence rate was estimated in 2008 at 1% in this population. In this context, it is essential, more than ever, to have in-depth knowledge of the sexual behavior and lifestyles of the MSM population in order to implement efficient prevention programs. Obtaining such data is not easy because of the difficulty in understanding and describing the MSM population both as a whole and in all its diversity.Since its creation in 1985, the Gay Press Surveys (EPG) have focused on the comprehensive approach of the impact of HIV medical advances, patterns of socialization and changes in the homosexuality’s representations on preventive sexual practices. In the last Gays and Lesbians Press Survey conducted in 2011, 10,448 MSM were recruited on a voluntary basis. With the diversification of recruitment methods including community websites, new socio-demographic and sexual profiles were described in addition to those usually recruited. The updating of the at-risk sexual indicators took into account the HIV therapeutic advances and the profane practices of prevention. A high level of HIV exposure among MSM was still observed, depending on the respondents’ HIV serological status and level of education. A generational approach of the last seven EPGs highlighted a strong period effect suggesting that sexual behaviors in MSM are influenced more by contextual than generational factors.To progress in ending the HIV epidemic, it is essential to continue to monitor sexual and preventive behaviors among MSM. Behavioral surveillance has to maintain consistency in methods and measures over time but needs to successfully adapt to follow new and emerging practices.

A conductive atomic force microscopy (c-AFM) investigation of GaN nanostructures is reported for strain engineering optoelectronic and piezotronic devices. The use of AFM enables the simultaneous correlation between the surface morphology and charge carrier transport through the nanostructures. The samples under investigation are molecular beam epitaxy (MBE) grown InGaN/GaN nanowires on Ti coated Mo substrate and GaN nanowires on ITO. The metal-semiconductor interface between the metallic substrates and the GaN nanostructures form the bottom contact. A Pt-Ir coated AFM probe is used to create a Schottky top nano-contact. The two interfaces form a metal-semiconductor-metal (MSM) structure. Force and temperature-dependent IV curves are obtained and analyzed, and the MSM structure parameters are extracted. Modulation of both the conductivity and Schottky barrier height (SBH) is revealed. Drastic reduction of the barrier is observed to drive the junctions to ideal MSM under a combination of force and temperature, revealing a dynamic and controlled two-way switching of the devices from rectifying to ideal linear IV properties. Through compressive force modulation by AFM tip, a symmetric 80 meV reduction in SBH at ±0.7 V is realized for the sample grown on Mo. By a combination of temperature and force modulation, a 40 meV increase in SBH is achieved at 0.53 V for the sample on ITO. These results show that the formed structure is ideal for applications in optoelectronics, sensing, piezotronic, piezo-phototronic, and nano-energy harvesting devices.

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Previous research on HIV stigma and the use of spirituality by people living with HIV/AIDS is scarce. Moreover, the research with older Black men who have sex with men (BMSM) is scant. The focus of this qualitative transcendental phenomenological study was to examine the lived experiences of BMSM living with HIV aged 50 and older with encounters of HIV stigma on the use of spirituality. The research questions were designed to explore the lived experiences of aging, HIV stigma, and spirituality. Conceptually, this study was framed within the minority stress theory and the HIV stigma framework. Data were collected through in-depth individual interviews, which provided detailed descriptions of the participants' experiences and created a basis for analysis. Ten participants from an HIV service organization in the Mid-Atlantic United States were selected for participation. Semi-structured interviews were digitally recorded, and data were coded and thematized using a modified vam Kaam data analysis method, which lead to the disclosure of 8 critical themes that illuminated the participants' lived experiences of living with HIV, aging, stigma, and spirituality. Older BMSM identified stigma as a stressor that reinforced the use of their spirituality. The results of this study may provide social workers, community organizations, and policymakers with data that inform a deeper understanding of the challenges older BMSM face due to HIV stigma. This study contributes to positive social change by providing practical information for social workers to inform intervention strategies that might reduce stigma and increase coping resources.

Les marchés financiers occupent, depuis des décennies, une place importante dans notre société. Pourtant, ils présentent des risques accrus auxquels font face la majorité des institutions financières. Les crises, les krachs, les bulles et les turbulences financières jalonnent l’histoire de ces marchés et les déstabilisent fréquemment. En effet, l’existence des anomalies et des biais psychologiques, allant à l’encontre de l’hypothèse d’efficience, remettent en question la théorie financière et révèlent de façon rigoureuse les inefficacités des mécanismes de gestion financière et de contrôle du risque du marché. Confrontés à ces évolutions, le comité de Bâle II recommande la Value at Risk comme une nouvelle vision réglementaire des risques. Ce processus d’innovation financière, introduite par la banque JP Morgan dans les années 90, a connu une grande reconnaissance en finance, mais elle est aussi sujette à des controverses continuelles. Pour surmonter les limites de la VaR, nous proposons un nouveau cadre d’analyse de la VaR basé sur des processus fractals. Tenant compte des anomalies et des facteurs de risques du marché financier, qui induisent des rendements par nature non-gaussiens, nous introduisons la VaR en fonction du modèle multifractal à changements de régime markovien de Calvet et Fisher. L’approche VaR-MSM qui modélise la volatilité multifractale à différentes fréquences constitue un aperçu différent d’évaluation du risque du marché. En appliquant ce modèle sur l’indice boursier français le CAC 40, les résultats obtenus révèlent que la VaR-MSM a surpassé assez nettement les autres modèles d’évaluation de la VaR. / Financial markets occupy an important place in our society. However, they present increased risks to financial institutions. Crises, crashes, bubbles and financial turbulence often destabilize these markets. Indeed, the existence of different anomalies and psychological bias, going against the hypothesis of efficiency, put into question financial theory and present an inefficiency of financial and risk management. Faced with these effects, Bale II committee recommended Value at risk as a new financial instrument of risk management. Value at Risk, introduced by JP Morgan Bank in the 90, have a great recognition in finance, but it is also a subject of controversy. To overcome the VaR limits, we propose a new framework based on fractal process. Taking into account abnormalities and risk factors of financial markets, which induce non-Gaussian returns, we introduce the VaR with a Markov-switching multifractal model proposed by Calvet and Fisher. The VaR-MSM approach presents multifractal volatility at different frequencies. We apply this model to the France CAC 40 stock market index. The results clearly show the advantages of VaR-MSM compared with other models of VaR evaluation.

Syfte: Syftet var att beskriva och diskutera forskningen avseende partnervåld i samkönade relationer mellan män samt att undersöka faktorer som påverkade våldet, och analysera våldsutsatta mäns upplevelser av hjälpsökande. Metod: För att besvara syftet genomfördes en litteraturöversikt utifrån scoping-review metodik. Femton artiklar inkluderades och analyserades med innehållsanalys. Resultat: Resultatet visade att forskningsfältet avseende våldsutsatta homo -och bisexuella män var framskridande. Fem teman identifierades; emotionellt våld, hjälpsökande, samhällsnormer och centrala begrepp, våldets processer, risk -och skyddsfaktorer. Emotionellt våld var vanligast, samhällsnormer såsom heteronormativitet och homofobi skapade stigma. Internaliserad homofobi och inlärda könsnormer skapade ytterligare hinder för män att ”komma ut” som homosexuella och som våldsoffer. Droger förekom, liksom andra riskfaktorer, såsom ålder och hiv-status. Slutsats: Genom tillämpande av ett systemteoretiskt perspektiv och nivåindelning, kunde växelverkan mellan olika faktorer belysas på ett sätt som klargjorde behovet av och betydelsen i tillämpandet av ett helhetsperspektiv i arbetet med våldsutsatta homo -och bisexuella män. / Purpose: The aim was to describe and discuss research about partner violence in same-sex relationships between men, together with exploring factors that influenced violence, and analyze the experiences of help-seeking. Method: a literature review was conducted based on scoping-review methodology. Fifteen articles were included and analyzed with content analysis. Results: Research on gay and bisexual men exposed to violence was progressing. Five themes were identified: emotional violence, help-seeking, societal norms and key concepts, processes of violence, risk -and protection factors. Emotional violence was most common, societal heteronormativity and homophobia created stigma. Internalized homophobia and gender norms created barriers for openness as gay and victim. Drugs, age, and HIV was mentioned as risk factors. Conclusion: Through a system theoretical perspective and level arrangement, interaction between factors could be highlighted in a way that clarified the need for and importance in the application of a holistic perspective in the violence preventive work.