Les hommes ayant des rapports sexuels avec des hommes (HSH) sont les plus touchés par le VIH. La prévention du VIH dans cette population doit aujourd'hui se diversifier grâce à divers outils visant à réduire le risque : traitement des personnes séropositives, traitement préventif chez les personnes séronégatives, et comportements de réduction des risques sexuels. Le dépistage du VIH est alors un enjeu crucial de la prévention.La diversification de l'offre de dépistage en France, notamment grâce au dépistage rapide et communautaire, est un résultat majeur de cette thèse. D'autres problématiques sont également investiguées : le recours au dépistage du VIH chez les HSH vivant au Cameroun et l'intérêt pour la recherche en prévention chez les HSH en France.Tous ces résultats sont confrontés les uns aux autres et sont mis en perspective, en termes de recherches à mener mais aussi en termes de recommandations pour les politiques de prévention à destination des HSH. / Men who have sex with men (MSM) are the most affected by HIV. In this population, HIV prevention must be diversified, using several tools aiming to reduce risks: treatment of HIV positive persons, preventive treatment among HIV negative persons and, sexual risk reduction behaviours. HIV testing thus becomes the cornerstone of HIV prevention.Diversifying HIV testing is one of the most important results of this thesis. Other questions are also addressed: access to HIV testing among MSM living in Cameroon and interest in prevention research among MSM in France.The discussion of all these results leads to several perspectives in terms of researches that should be conducted, but also in terms of recommendations for prevention policies towards MSM.

Introdução: Apesar da abordagem farmacológica multimodal profilática, as náuseas e os vômitos pós-operatórios (NVPO) correspondem a uma das principais queixas dos pacientes após procedimentos laparoscópicos. Em pacientes considerados de alto risco pelo critério de Apfel, a incidência de tais eventos pode chegar a 80%. Neste contexto, os antagonistas dos receptores de NK-1 têm sido recomendados para adultos em adição a outras estratégias antieméticas na tentativa de reduzir essa incidência. Entretanto, o efeito da associação do aprepitanto ao regime dexametasona, ondansetrona e propofol permanece indefinido. Nesta pesquisa, como desfecho principal, estudou-se o efeito da associação do aprepitanto em regime antiemético profilático multimodal para redução de risco de NVPO nas primeiras 24 horas do período pós-operatório em pacientes de alto risco pelo critério de Apfel. Como desfechos secundários, foram estudadas intensidade dos eventos de náuseas, incidência dos eventos de vômitos intensos e ocorrência de consumo de antieméticos de resgate nas primeiras 24 horas do período pós-operatório. Métodos: pacientes adultos, estratificados como alto risco pelo critério de Apfel, submetidos a procedimentos laparoscópicos oncológicos, foram alocados aleatoriamente para receber profilaticamente aprepitanto 80 mg (grupo de tratamento) ou amido (grupo controle) associados à dexametasona (4 mg ou 8 mg), ondansetrona (4 mg ou 8 mg) e anestesia venosa alvo-controlada com propofol. A análise estatística do desfecho principal foi realizada utilizando o Teste Exato de Fisher, e a hipótese nula foi descartada se p < 0,05. Resultados: Sessenta e seis pacientes concluíram o estudo. NVPO ocorreram em 13 (40,6%) pacientes nas primeiras 24 horas após emergência da anestesia no grupo controle. No grupo tratamento, ocorreram náusea em 5 pacientes (14,7%, p = 0,03) e vômito em 1 paciente (2,9%, p = 0,0002). A redução de risco relativo foi de 63,8% (IC 95% 9,9% - 86%) para náusea e de 92,7% (IC 95% 61,2% - 98,8%) para vômito. Episódios de náusea intensa ocorreram em 2 (6,3%) pacientes e de vômitos intensos, em 4 (12,5%) pacientes, no grupo controle. Um paciente apresentou vômito intenso no grupo tratamento. Em relação ao consumo de antieméticos, 9 (28,1%) pacientes solicitaram medicamentos antieméticos de resgate no grupo controle e 3 (8,8%) pacientes, no grupo tratamento, nas primeiras 24 horas pós-operatórias (p = 0,02). Conclusão: O aprepitanto (80 mg), como uma quarta estratégia antiemética profilática, pode contribuir para a redução significativa de NVPO e de consumo de antieméticos de resgate em pacientes de alto risco / Background: Despite the use of multimodal pharmacological approach, postoperative nausea and vomiting (PONV) is one of the most important causes of patients discomfort after laparoscopic surgeries. NK-1 receptor antagonists have recently being recommended for prophylaxis of PONV in adults, but the combination with serotonin (5-HT3) receptor antagonists such as ondansetron, corticosteroids such as dexamethasone and propofol, are not yet well established. The primary aim of this randomized and double-blind study was to assess whether the addition of aprepitant to a multimodal management strategy for PONV prophylaxis in a high-risk patient population would further decrease the incidence of PONV in the first 24 postoperative hours. The secondary aims were the quantification of nausea intensity, number of episodes of vomiting and rescue antiemetic consumption in the same period. Methods: patients classified as Apfel Score 3 or 4, scheduled to laparoscopic surgeries to treat cancer, were randomized to receive either oral aprepitant 80mg (treatment group) or matching placebo (control group) before induction of anesthesia. All patients received intravenous dexamethasone 4 mg or 8 mg at induction of anesthesia, ondansetron 4 mg or 8 mg at the end of the surgery and a standardized total intravenous anesthesia (TIVA) technique. Statistical analysis was performed using Fisher\'s Exact Test and the null hypothesis was ruled out if p < 0.05. Results: Sixty-six patients completed the study. Nausea and vomiting occurred in 13 (40.6%) patients during the first 24 hours in the control group (all patients who presented nausea also vomited). In the treatment group, nausea occurred in 5 patients (14.7%, P = 0.03) and vomiting occurred in 1 patient (2.9%, P = 0.0002). The reduction in the relative risk was 63.8% (95%CI 9.9% - 86%) for nausea and 92.7% (95%CI 61.2% - 98.8%) for vomiting. Severe nausea occurred in 2 (6.3%) patients, and severe vomiting occurred in 4 (12.5%) patients in the control group. One patient presented with severe vomiting in the treatment group in the first 24 postoperative hours. The administration of rescue antiemetics occurred in 9 (28.1%) patients in the control group and in 3 (8.8%) patients in the treatment group in the first 24 postoperative hours (P = 0.02). Conclusion: Eighty milligrams of aprepitant added to a three-drug multimodal prophylaxis strategy can bring benefits to a high-risk population by reducing PONV episodes and rescue antiemetic requirements

Mother-to-infant vertical transmission of HIV usually occurs during pregnancy, labor, delivery or breastfeeding. It is the third leading cause of transmission of HIV after sexual intercourse and blood transfusions. In 2008, 12 million women aged 15 years and above were anticipated to be living with HIV in countries within Sub-Saharan Africa. In this study, the association between parental HIV knowledge, attitudes and risk reduction practices, and HIV vertical transmission in Kenya were explored. The health belief model was used to help understand and interpret the findings. For this quantitative study, data were collected via surveys from 212 participants in 3 HIV clinics in Kenya. Data were analyzed using descriptive and inferential statistics. Around 45% of respondents lacked knowledge on key aspects of Prevention of Mother to Child Transmission (PMTCT) of HIV particularly on expressing and heat treating milk from HIV positive mothers to make it safe for their babies. About 65% of Participants had awareness towards Mother to Child Transmission (MTCT) of HIV. Logistic regression showed no association between socioeconomic factors and parental knowledge on MTCT of HIV. Logistic modeling found that there was association between attitude and MTCT, revealing that attitude increased the likelihood to influence MTCT. Being married was associated with reduced risk of MTCT of HIV. The overall results indicated gaps in knowledge and information packaging. The potential positive social change implication of this study is that factors related to HIV vertical transmission identified in this study might be utilized to develop and implement HIV prevention strategies to reduce HIV vertical transmission and decrease associated morbidity and mortality among this vulnerable population.

As international travel is rapidly increasing, more people are being exposed to potentially more antibiotic resistant bacteria, a changed infectious disease epidemiology, and an increased risk of accidents and crime. Research-based advice is needed to adequately inform travellers about these risks. We studied travellers who sought advice from the Travel Medicine Clinic at the Department of Infectious Diseases, Umeå University Hospital, as well as university students from Umeå, Stockholm, and Gothenburg travelling abroad for study, research, and clinical exchange programs. From retrospective data at the Travel Medicine Clinic, we found that pre-existing health problems were rare among travellers from Umeå seeking pre- travel health advice and vaccinations. In addition, we found that the travel destination and the sex of the traveller affected vaccination levels. Although hepatitis A is endemic to both Thailand and Turkey, compared to travellers to Thailand few travellers to Turkey visited the clinic for hepatitis A vaccination. The data also revealed that more women than men were vaccinated against Japanese encephalitis despite comparable trips. A prospective survey study showed that travellers felt that the pre-travel health advice they received was helpful. Two-thirds of the travellers followed the advice given although they still fell ill to the same extent as those who were not compliant with the advice. Factors outside the control of travellers likely affect the travel-related morbidity. Compared to older travellers, younger travellers were less compliant with advice, fell ill to a greater extent, and took greater risks during travel. In a prospective survey study, we found that healthcare students had higher illness rates and risk exposure when abroad compared to students from other disciplines. This difference was mainly due to the fact that healthcare students more often travelled to developing regions during their study period abroad. When abroad, half of all students increased their alcohol consumption and this was linked to an increased risk of theft and higher likelihood of meeting a new sex partner. The healthcare students participating in the survey study also submitted stool samples before and after travel. These samples were tested for the presence of antibiotic resistance, both by selective culturing for ESBL-PE (Extended-Spectrum Beta-Lactamase Producing Enterobacteriaceae) as well as by metagenomic sequencing. About one-third (35%) of the students became colonised by ESBL-PE following their study abroad. The strongest risk factor for colonisation was travel destination; for example, 70% of students who had travelled to India became colonised. Antibiotic treatment during travel was also a significant risk factor for colonisation. The stool samples from a subset of study subjects were analysed using metagenomic sequencing. From this we learned that although the majority of resistance genes in the gut microbiome remained unchanged following travel, several clinically important resistance genes increased, most prominently genes encoding resistance to sulphonamide, trimethoprim, and beta-lactams. Overall, taxonomic changes associated with travel were small but the proportion of Proteobacteria, which includes several clinically important bacteria (e.g., Enterobacteriaceae), increased in a majority of the study subjects. Clearly, there are risks associated with international travel and these risks include outside factors as well as the personal behaviour of travellers. We believe our results can be used to develop better pre-travel advice for tourists as well as university students studying abroad resulting in safer travel.

Since 1994 fundamental transformation has taken place in South Africa in terms of disaster risk management. The transformation process gave rise to the promulgation of the Disaster Management Act (57/2002) that heralded a new era for disaster risk management in South Africa. Consequently the National Disaster Management Framework, published in 2005, set clear guidelines for the implementing of the mentioned act. The National Disaster Management Framework emphasises the importance of the integration and coordination of disaster risk management activities in all spheres of government. Die Disaster Management Act (57/2002) calls for the establishment or certain disaster risk management structures like interdepartmental commitees, disaster management centers, disaster management frameworks, and disaster management advisory forums. Furthermore the National Disaster Management Framework sets certain guidelines in compliance with the Disaster Management Act (57/2002). Municipalities in South Africa have had time since the promulgation of the act in 2003 to get all the mentioned structures in place. This study tried to deretmine the degree in which municipalities complied with the requirements of the Disaster Management Act (57/2002). The municipalities were handles per procvince and the research is based on a 20% representative sample of all the municipalities in South Africa. A mixed method of research was followed. That means that qualitative (telephonic and semi-structured interviews) and quantitative (questionnaires with Likert scale questions) research was used. The result of this research is that there are big failings in terms of the implementing of the Disaster Management Act (57/2002) across the country. In certain provinces the situation is better than in others, but of none of the provinces it can be said that they comply with all the recuirements of the act. / M. Development and Management, North-West University, Potchefstroom Campus, 2013

The history of the mining industry indicates a lack of understanding among the decision-makers of the impact the closure of mines has on the industry and the associated effects on the society and surrounding environment. The policies of the mining industry do make provision for a planned mine closure, but not for an unexpected closure. This detrimental aspect of closures in the mining industry is highlighted in the present study. The present study investigates how mineworkers’ dependency on their employment at a mine affects their ability to sustain their livelihoods. Vulnerable livelihoods leave the community at a greater risk to be affected by a disaster, than the livelihoods of a community that is resilient and has sustainable resources. Even though mineworkers are not considered as poor at the time of their employment, a mine closure could render them into a status called ‘transitional poverty’. This study also highlights that mineworkers who are skilled for mining operations only do not overcome the status of ‘transitional poverty’ and hence enter a phase called ‘chronic poverty’. This stage constitutes their inability to negotiate livelihood strategies and livelihood outcomes that could sustain a household. Thus humanitarian assistance would be needed from outside sources. Planning for unexpected mine closures should also be on the agenda of the mining industry due to the extreme consequences such an event holds for the mining community experiencing the event. In the case under investigation, the unexpected mine closures occurred in the Grootvlei mine in Springs and the Orkney mine owned by the Aurora Empowerment Systems Ltd. at the time of this study. These closures left the surrounding communities in need of food, shelter and clean water. The inhabitants gradually lost their livelihood assets. A contingency planning model is proposed at the end of this study to address the short-term and long-term consequences of an unexpected mine closure. / M Development and Management, North-West University, Potchefstroom Campus, 2014

Since 1994 fundamental transformation has taken place in South Africa in terms of disaster risk management. The transformation process gave rise to the promulgation of the Disaster Management Act (57/2002) that heralded a new era for disaster risk management in South Africa. Consequently the National Disaster Management Framework, published in 2005, set clear guidelines for the implementing of the mentioned act. The National Disaster Management Framework emphasises the importance of the integration and coordination of disaster risk management activities in all spheres of government. Die Disaster Management Act (57/2002) calls for the establishment or certain disaster risk management structures like interdepartmental commitees, disaster management centers, disaster management frameworks, and disaster management advisory forums. Furthermore the National Disaster Management Framework sets certain guidelines in compliance with the Disaster Management Act (57/2002). Municipalities in South Africa have had time since the promulgation of the act in 2003 to get all the mentioned structures in place. This study tried to deretmine the degree in which municipalities complied with the requirements of the Disaster Management Act (57/2002). The municipalities were handles per procvince and the research is based on a 20% representative sample of all the municipalities in South Africa. A mixed method of research was followed. That means that qualitative (telephonic and semi-structured interviews) and quantitative (questionnaires with Likert scale questions) research was used. The result of this research is that there are big failings in terms of the implementing of the Disaster Management Act (57/2002) across the country. In certain provinces the situation is better than in others, but of none of the provinces it can be said that they comply with all the recuirements of the act. / M. Development and Management, North-West University, Potchefstroom Campus, 2013

Although disaster risk reduction is still not considered a priority by many countries and organisations, there is significant progress made towards the reduction of disaster risk. The experience of the International Decade for Natural Disaster Reduction (IDNDR, 1990–1999) prompted a major conceptual shift from disaster response to disaster reduction underscoring the crucial role of human action (UNISDR, 2001:03). This circumstance led to the adoption of an International Strategy for Disaster Risk Reduction (ISDR) in 1999 by the participants of the IDNDR Programme Forum. The adoption gave emphasis to the importance of a global strategy that encourages and facilitates concerted action to reduce risk and vulnerability to natural and related technological and environmental hazards. This research then focuses on the disaster risk reduction phenomenon and major or international initiatives and forums aimed at improving or raising the disaster risk reduction profile. It also focuses on disaster risk management in the South African context. In recent years, disaster risk reduction has grown in importance on the international agenda. This followed the prevalence of natural hazards such as floods, drought, earthquakes, tsunamis, as well as epidemics, which have had an increasing impact on humans, due to population growth, urbanization, rising poverty and the onset of global environmental changes. Aspects of environmental change include climate change, land degradation and deforestation. Practitioners and researchers widely acknowledge that poor planning, poverty and a range of other underlying factors create conditions of vulnerability that result in insufficient capacity or measures to reduce hazards‘ potentially negative consequences (IISD/UN/ISDR, 2007:01). It is in this light that in 2005 many governments around the world committed themselves to take action to reduce disaster risk, and thereby adopted a guiding document to reduce vulnerabilities to natural hazards, called the Hyogo Framework for Action (HFA). The HFA was adopted in January 2005 at the World Conference on Disaster Reduction, in Kobe Hyogo, Japan by 168 States. The aim of the HFA is to assist the efforts of nations and communities to become more resilient to, and cope better, with the hazards that threaten their development gains with the overriding goal of achieving a substantial reduction in global disaster risk. It also emphasizes that disaster risk reduction is a central issue for development policies, in addition to being of interest to various science, humanitarian and environmental fields. To help attain the expected outcome, the HFA identified five specific priorities for action (PFAs) which are: (i) making disaster risk reduction a priority; (ii) improving risk information and early warning; (iii) building a culture of safety and resilience; (iv) reducing the risks in key sectors; and (v) strengthening preparedness for response. The Global Network of Civil Society Organisation for Disaster Risk Reduction (GNDR) which was launched in 2007 in Geneva, is a major international network of civil society organisations working to influence and implement disaster risk reduction policies and practice around the world. The major programme of the global network is to collect perspective for the local level as to how the HFA is progressing. The Views from the Frontline (VFL) is the first independent assessment project undertaken towards the implementation of the HFA at the local level and is led by the Global Network. The aim of this project is to measure the gap between policy formulation at international level with the realities of policy execution at local level and to deepen the communication and coordination between different stakeholders on disaster risk reduction by involving government organisation and communities at the local level. The VFL perspective is that nationally formulated policies are not generating widespread systematic changes in local practices. There is a concern that the current approach is top–down and engages minimally with affected communities and fails to address their needs and capacities (GNDR, 2008:01). The main objective of this research was to provide an overview of progress made in the implementation of the HFA at local level particularly in the Kabokweni Location. The approach adopted in this study is called 'the Views from the Frontline', and explores the extent of the actual progress made toward the implementation and impact of the HFA priorities at local level, namely the Kabokweni community in the Mbombela Local Municipality (MLM) situated in the Mpumalanga Province of South Africa. / Thesis (M. Development and management)--North-West University, Potchefstroom Campus, 2011.

Although disaster risk reduction is still not considered a priority by many countries and organisations, there is significant progress made towards the reduction of disaster risk. The experience of the International Decade for Natural Disaster Reduction (IDNDR, 1990–1999) prompted a major conceptual shift from disaster response to disaster reduction underscoring the crucial role of human action (UNISDR, 2001:03). This circumstance led to the adoption of an International Strategy for Disaster Risk Reduction (ISDR) in 1999 by the participants of the IDNDR Programme Forum. The adoption gave emphasis to the importance of a global strategy that encourages and facilitates concerted action to reduce risk and vulnerability to natural and related technological and environmental hazards. This research then focuses on the disaster risk reduction phenomenon and major or international initiatives and forums aimed at improving or raising the disaster risk reduction profile. It also focuses on disaster risk management in the South African context. In recent years, disaster risk reduction has grown in importance on the international agenda. This followed the prevalence of natural hazards such as floods, drought, earthquakes, tsunamis, as well as epidemics, which have had an increasing impact on humans, due to population growth, urbanization, rising poverty and the onset of global environmental changes. Aspects of environmental change include climate change, land degradation and deforestation. Practitioners and researchers widely acknowledge that poor planning, poverty and a range of other underlying factors create conditions of vulnerability that result in insufficient capacity or measures to reduce hazards‘ potentially negative consequences (IISD/UN/ISDR, 2007:01). It is in this light that in 2005 many governments around the world committed themselves to take action to reduce disaster risk, and thereby adopted a guiding document to reduce vulnerabilities to natural hazards, called the Hyogo Framework for Action (HFA). The HFA was adopted in January 2005 at the World Conference on Disaster Reduction, in Kobe Hyogo, Japan by 168 States. The aim of the HFA is to assist the efforts of nations and communities to become more resilient to, and cope better, with the hazards that threaten their development gains with the overriding goal of achieving a substantial reduction in global disaster risk. It also emphasizes that disaster risk reduction is a central issue for development policies, in addition to being of interest to various science, humanitarian and environmental fields. To help attain the expected outcome, the HFA identified five specific priorities for action (PFAs) which are: (i) making disaster risk reduction a priority; (ii) improving risk information and early warning; (iii) building a culture of safety and resilience; (iv) reducing the risks in key sectors; and (v) strengthening preparedness for response. The Global Network of Civil Society Organisation for Disaster Risk Reduction (GNDR) which was launched in 2007 in Geneva, is a major international network of civil society organisations working to influence and implement disaster risk reduction policies and practice around the world. The major programme of the global network is to collect perspective for the local level as to how the HFA is progressing. The Views from the Frontline (VFL) is the first independent assessment project undertaken towards the implementation of the HFA at the local level and is led by the Global Network. The aim of this project is to measure the gap between policy formulation at international level with the realities of policy execution at local level and to deepen the communication and coordination between different stakeholders on disaster risk reduction by involving government organisation and communities at the local level. The VFL perspective is that nationally formulated policies are not generating widespread systematic changes in local practices. There is a concern that the current approach is top–down and engages minimally with affected communities and fails to address their needs and capacities (GNDR, 2008:01). The main objective of this research was to provide an overview of progress made in the implementation of the HFA at local level particularly in the Kabokweni Location. The approach adopted in this study is called 'the Views from the Frontline', and explores the extent of the actual progress made toward the implementation and impact of the HFA priorities at local level, namely the Kabokweni community in the Mbombela Local Municipality (MLM) situated in the Mpumalanga Province of South Africa. / Thesis (M. Development and management)--North-West University, Potchefstroom Campus, 2011.

Diss. (sammanfattning) Umeå : Umeå universitet, 2010.