Les pays africains au sud du Sahara ont vu leur nombre de patients sous traitement antirétroviral (ARV) croître de façon rapide depuis 2005. Si l’impact individuel et collectif de cette montée en puissance des traitements est positif dans l’ensemble, les défis demeurent nombreux en termes de dépistage, d’observance, d’adhésion aux soins, de résistance aux ARV, de dépendance vis-à-vis des bailleurs de fonds, et de disponibilité des personnels. Dans ce contexte, la question du moment idéal pour proposer le début du traitement ARV doit être abordée de façon médicale individuelle (quel est le rapport bénéfices/risques individuel à débuter à des seuils différents ?), mais également de façon collective en terme de bénéfices et risques pour la communauté, d’organisation des soins, d’analyse médico-économique, de prioritisation et d’équité. Cette thèse, qui est une thèse de recherche clinique, aborde le premier volet de la question, celui des bénéfices et des risques pour l’individu à débuter un traitement plus tôt. Sur ce sujet, le raisonnement a beaucoup évolué au cours des 15 dernières années. Après l’arrivée des multithérapies ARV à la fin des années 1990, la crainte de la toxicité des médicaments a d’abord incité à une approche prudente, et à recommander le seuil de début à 200 CD4/mm3 chez les personnes asymptomatiques. Cette crainte de la toxicité a conduit au début des années 2000 à essayer de pratiquer des « interruptions programmées » d’ARV, pour tenter d’obtenir le maintien au dessus d’un seuil de 200 CD4/mm3, tout en limitant l’exposition aux médicaments. Nous avons participé à un de ces essais d’interruptions programmées en Côte d’Ivoire, au cours duquel nous avons contribué à affiner les connaissances sur la toxicité des ARV (Moh, Antivir Ther 2005). Les essais d’interruptions programmées ont conduit à constater que : (i) les personnes qui interrompaient entre 350 et 250 CD4/mm3 avaient plus de risque de morbidité sévère que celles qui n’interrompaient pas, (ii) les personnes qui débutaient leur premier traitement avant 350 CD4/mm3 avaient moins de risque de morbidité que celles qui débutaient plus tard (Moh, AIDS 2007), et (iii) dans l’essai d’interruption Trivacan réalisé en Côte d’Ivoire, cette morbidité sévère intermédiaire était plus fréquente que dans l’essai SMART réalisé sur d’autres continents, et avait un spectre différent, dominé par la tuberculose et les maladies bactériennes sévères. Les conclusions de ces essais ont donc été que le traitement ARV devait être débuté beaucoup plus tôt que ce qui était auparavant recommandé, et que ceci était probablement encore plus vrai en Afrique sub-Saharienne que dans le reste du monde. En 2008, nous avons lancé en Côte d’Ivoire l’essai Temprano ANRS 12136, dont l’objectif est d’évaluer les bénéfices et risques d’un traitement ARV précoce avec ou sans 6 mois de prophylaxie par isoniazide (INH) chez des adultes infectés par le VIH-1 ayant entre 250 et 800 CD4/mm3. De Mars 2008 à Juillet 2012, 2076 adultes ont été inclus dans l’essai Temprano, dont le suivi se terminera en décembre 2014. L’état du suivi est bon, et les incidences de morbidité et mortalité actuellement constatées sont conformes aux hypothèses du protocole. La pratique de la prophylaxie par INH s’avère bien tolérée, et la procédure choisie par notre équipe (radiographie de thorax systématique et période tampon d’observation de un mois avant le début de l’INH) apporte une grande sécurité de prescription (Moh, Plos One, manuscrit en révision). Notre équipe a traversé une crise politico-militaire au 1er semestre 2011, qui n’a pas eu de retentissement sur la qualité de l’essai en cours. Cette crise a par contre eu des effets délétères pour les patients sous traitement ARV, puisque les échecs virologiques retardés sont significativement associés au fait d’avoir été sous traitement pendant cette période (Moh, manuscrit soumis). . / The African countries situated in the South of the Sahara have seen their number of patients under antiretroviral therapy (ART) grow rapidly since 2005. If the individual and collective impact of this rise of the treatments is positive overall, challenges remain in terms of screening, compliance, accession to care, resistance to ARTs, dependence on donors, and availability of the staff. In this context, the question of the ideal time to propose initiation of ART must be addressed in the individually medical way (what is the individual benefit-harm ratio to start at different thresholds?) but also collectively in terms of benefits and risks for the community, organization of care, medico-economic analysis, prioritization and equity. This thesis, which is a clinical research thesis, addresses the first part of the question, the benefits and risks for the individual to start treatment earlier. On this subject, the rationale has changed considerably over the past 15 years. After the arrival of ART multitherapy at the end of the 1990s, the fear of drug toxicity first prompted a cautious approach, and to recommend the threshold from beginning to 200 CD4/mm3 in the asymptomatic people. This fear of toxicity led in the early 2000s to try to practice "scheduled interruptions" of ARTs, to try to get the maintenance above a threshold of 200 CD4/mm3, in limiting exposure to the drug. We have participated in one of these trials of interruptions programmed in Côte d'Ivoire, in which we have helped to refine the knowledge on the toxicity of ARTs (Moh, Antivir Ther 2005). Testing scheduled interruptions led to see that: (i) persons who interrupted between 350 and 250 CD4/mm3 had greater risk of severe diseases than those who didn’t interrupt, (ii) persons who started their first treatment prior to 350 CD4/mm3 had less risk of morbidity than those who started later (Moh, 2007 AIDS), and (iii) in trial interruption Trivacan launched in Côte d'Ivoire, this intermediate severe morbidity was more frequent than in the SMART trial carried out on other continents, and had a different spectrum dominated by tuberculosis and severe bacterial diseases. The findings of these trials were that the ART should be started much earlier than was previously recommended, and that this was probably even truer in sub-Saharan Africa than in the rest of the world. In 2008, we launched in Ivory Coast the clinical trial, Temprano ANRS 12136, whose objective is to assess the benefits and risks of early ART with or without 6 months of prophylactic isoniazid (INH) in HIV-1 infected adults with CD4 250 and 800/mm3. From March 2008 to July 2012, 2076 adults were included in the trial Temprano, which follow-up will be completed by December 2014. The state of the follow-up is good, and the impact of morbidity and mortality currently observed are consistent with the assumptions of the Protocol. The practice of INH prophylaxis is well tolerated, and the procedure chosen by our team (systematic chest x-ray and period buffer observation of one month before the beginning of the INH) brings a prescription safety (Moh, Plos One manuscript in review). Our team went through a crisis politico-military 1St half 2011, which had no impact on the quality of the ongoing trial. This crisis has however had deleterious effects for patients under ART, since delayed virological failure are significantly related to the fact of having been under treatment during this period (Moh, submitted manuscript).

Alors que la question du « vivre ensemble » demeure dans le débat public de la société française, cette thèse retrace la formation en région bordelaise des sociabilités corporelles et sportives des immigrés africains subsahariens en période post-coloniale. Ces dernières connaissent une dynamique effective au fil du temps. Si la décennie des années 1960 reste relativement atone en la matière, dès les années 1970, se constituent plusieurs types de sociabilités fondées sur une pluralité de frontières ethno-nationales, nationales, ethniques et générationnelles. Les différents projets migratoires relatifs aux diverses vagues et types d’immigrations, associés à l’influence des liens transnationaux entre les pays d’émigration et la France expliquent prioritairement cette configuration historique. Ce résultat de recherche vient enrichir l’historiographie française de l’objet étudié. Il montre que des logiques communautaires impriment leurs marques aux pratiques corporelles et sportives à l’exception de la descendance qui tend à s’en extraire et atteste que la relation « sport et immigration » n’est en rien linéaire, mais soumise à la complexité des flux migratoires contemporains et à l’implantation durable des populations en présence. / While the question of "living together" is still a central issue in French society, this thesis recounts the creation in the Bordeaux region of social and professional sporting activities among sub-Saharan African immigrants in the post-colonial period. The dynamic of this activity has changed over time. While the 1960s were a relatively quiet period in this respect, several types of sociability based on many ethno-national, national, ethnic and generational interfaces have come to exist since the 1970s. The various projects for immigration associated with several types of immigration waves, together with the influence of transnational links between countries from which the immigrants came and France, primarily explain this historical trend. This research project adds to the French historiography of the subject under study. It shows that the logic of the community has a strong impact on sports and physical practices, with the exception of the descendants of the immigrants who tend to shun this tendency. The findings show that that the relationship between sport andimmigration is by no means linear but is subject to the complexity of contemporary migration flows and to the sustainable settlement of the populations involved.

Cette thèse se centre sur trois sources importantes d'inégalité de genre sur le marché du travail en Afrique : (i) les salaires, (ii) l'allocation du temps entre travail marchand et travail domestique, et (iii) les revenus de l'emploi informel. Le Chapitre 2 montre que, en Ethiopie, les progrès en matière d'égalité de genre dans l'éducation sont nécessaires pour accroitre le salaire des femmes, mais pas suffisants pour enrayer l'écart de salaire avec les hommes. D'autres interventions seraient nécessaires, telles que des campagnes d'information et d'autres efforts de sensibilisation sur les dispositions antidiscriminatoires de la législation nationale, afin de compenser l'effet adverse de facteurs non-observables (pratiques discriminatoires, normes culturelles et sociales…) qui contribuent directement au différentiel de salaire entre les sexes et indirectement, à travers la sélection dans l'emploi. Le Chapitre 3 met en lumière la coexistence de deux phénomènes en Ethiopie, une forte division du travail selon le genre et une double charge de travail des femmes. Le pays gagnerait à poursuivre et intensifier ses efforts pour un meilleur accès des femmes à tous les niveaux d'éducation, et pour une meilleure diffusion et application de la loi en faveur du bien-être économique et social des femmes, car cela contribuerait au changement des mentalités et attitudes qui empêchent les femmes d'exploiter pleinement leur potentiel et les subordonnent aux hommes. Finalement, dans le Chapitre 4 nous observons que les femmes occupant un emploi informel en Tanzanie subissent une pénalité salariale bien plus élevée que celle des hommes. Pour expliquer ce résultat, nous conjecturons que l'hypothèse d'exclusion, selon laquelle les individus n'ont pas accès à l'emploi formel en raison des contraintes disproportionnées auxquelles ils font face (fardeau des tâches domestiques, manque d'infrastructures adéquates…), est plus forte parmi les femmes.Classification JEL : J16, J22, J24, J31, J42, J71 / The main objective of this thesis is to contribute to our better understanding of the main factors behind large and persistent gender disparities in Africa's labour markets. This work looks at three key dimensions of labour market gender inequality in Africa: (i) the gender wage gap, (ii) gender inequalities in allocating time to market and household work, and (iii) the gender-differentiated income effect of informality. Chapter 2 shows that, in Ethiopia, progress towards gender equity in education is important to improve women's wages but not enough to close most of the gender wage differential. Other interventions would be needed as, for instance, information campaigns and other awareness-raising efforts in support of the anti-discriminatory provisions of Ethiopia's own constitution and legislation, to compensate for the adverse impact of unobservable factors (discriminatory practices, social and cultural norms…), that directly contribute to the gender wage gap and indirectly, through job selection. Chapter 3 highlights the coexistence of two phenomena in Ethiopia, a strong gender-based division of labour and a double work burden on women. The country would benefit from pursuing and intensifying its efforts to ensure better access to education at all levels for women, and from providing better information and enforcement of the law in support of women's economic and social well-being, as it would help changing mentalities and attitudes that impede women to take full advantage of their abilities and that keep them subordinated to men. Finally, in Chapter 4 we observe that, in Tanzania, women face a significantly higher informal employment wage penalty than men. To explain this result, we conjecture that the exclusion hypothesis, according to which individuals are denied access to formal jobs due to the disproportionate constraints they face (burden of household responsibilities, lack of adequate infrastructure…), is more acute among women.JEL classification : J16, J22, J24, J31, J42, J71

Sub-Saharan Africa is the poorest region in the world suffering from social, political and economic problems. The study focuses on investigation of relationship of capital flight and external debt to long-term economic growth in this region. Firstly the magnitude of capital flight is computed. Using fixed effects model and random effects model we estimate the impact of external debt and capital flight on long-term growth. Moreover the time structure of debt and its source is integrated into model. Our sample consists of 24 countries from sub-Saharan Africa over the period 1989-2008. We have found that external debt has statistically significant negative impact on growth. On the other hand this impact is economically negligible. The long-term growth is also slowed down by long-term debt and by multilateral borrowing. Concerning capital flight its effect on growth is harmful as well. JEL klasifikace: F34, O47, O55, Klíčová slova: zahraniční dluh, únik kapitálu, Subsaharská Afrika, růst

Nous soutenons la thèse que la sécurité alimentaire des pays d'Afrique sub-saharienne peut être renforcée par une meilleure maitrise de l'instabilité des prix des matières premières agricoles constituant leur panier alimentaire de base. A cet effet, nous évoquons dans un premier temps les mécanismes de fonctionnement des marchés agricoles, le rôle qu'y joue la notion de prix ainsi que le lien existant entre l'évolution instable des prix et l'insécurité alimentaire. Nous nous intéressons ensuite au lien existant entre l'insécurité alimentaire et la régulation du secteur agricole, en particulier dans le cadre des échanges internationaux et régionaux. Nous procédons enfin au traitement formalisé de l'insécurité alimentaire. En ayant recours aux outils économétriques, nous mettons en évidence le caractère instable des prix au niveau individuel des pays ainsi que les interdépendances entre les prix des différentes denrées alimentaires et des différents pays. Des mesures de sécurisation alimentaire sont suggérées tout au long de la thèse pour les pays d'Afrique sub-saharienne étudiés. Nous estimons que ces mesures peuvent servir de pistes de réflexion pour l'établissement de politiques économiques agricoles nationales et régionales. Ces politiques auraient pour but final de garantir la sécurité alimentaire des populations des pays de l'Afrique sub-saharienne par une meilleure maitrise de l'instabilité des prix alimentaires. / In our thesis, we assume that African Sub-saharan countries' food security status can be enhanced through a better management of agricultural commodities prices instability, which constitutes the basic food basket of local populations. To this aim, we initially review the dynamics of agricultural markets and the role played by “prices” in this mechanism as well as the existing linkages between unstable price trends and the notion of food insecurity. Focus is then directed to the relationship between “food insecurity” and the regulation of the agricultural sector, in particular within international trade theory frameworks.Finally, we proceed to the assessment of “food insecurity” through the empirical analysis of the instabilities affecting food prices of the region, and also that of price transmission and linkages within and between countries. We then highlight prices instabilities at individual (country) level, as well as the linkage of these prices (therefore of their unstable components) between the various constituents of the basic food basket of a given country, or that of neighboring countries.All along our thesis, food insecurity resilience measures for these countries are suggested. These measures are believed to potentially serve as initial steps in the establishment of national and regional agricultural policies aiming at attaining/safeguarding food security in African sub-Saharan countries.

Background: The current global refugee crisis requires attention from the public health community to improve the health and wellbeing of forcibly displaced groups. Eighty-six percent of refugees are hosted in developing countries, while 58% migrate to urban centers in search of opportunities. Although there are benefits to urban migration, refugees residing in Nairobi, Kenya are vulnerable to police extortion, arrests, deportations, and social exclusion as a result of anti-refugee policies. Despite threats to psychosocial wellbeing, many refugees successfully cope with acute and cumulative stressors to exhibit positive mental health outcomes in the context of adversity. This dissertation explores the ways urban Congolese refugees in Nairobi negotiate and navigate personal, social, and environmental resources to mitigate stress and promote psychosocial wellbeing. Research Aims: The dissertation included the following three aims: (1) document stressors experienced by urban Congolese refugees in Nairobi; (2) describe the range of coping supports available to Congolese refugees; identify how individuals, families, and groups navigate and negotiate these resources; and (3) explore relationships that exist among stressors, supportive resources, and reported mental health status of urban Congolese refugees. Methods: Mixed-methods exploratory research took place over a 12-month period in Nairobi. Preliminary research was conducted between May and August 2012, and dissertation fieldwork occurred between January and August 2014. Qualitative research included ethnographic participant observation, semi-structured in-depth interviews, and small group discussions with Congolese refugees (n=70). Additional interviews were conducted in Kenya with academics (n=3), intergovernmental employees (n=4), representatives from government agencies (n=2), and refugee service providers (n=18). Quantitative research was comprised of two surveys administered to Congolese refugees (N=244) in 150 households. The Self-Reporting Questionnaire (SRQ-20) assessed mental health functioning, and a survey developed in-field inventoried perceived stressors and supports. Results: The results by aim were: (1) stressors fell within three primary domains: inadequate material resources, political and personal insecurity, and emotional distress; (2) Congolese refugees utilized three salient coping strategies, comprised of reliance on religious communities and faith in God, participation in borrowing networks, and managing memories; and (3) isolation was associated with poor mental health functioning, while perceived support from religious communities enhanced mental health outcomes. Recommendations: Organizations should bolster community-based programs and strengthen partnerships with religious communities to improve the psychosocial wellbeing of urban Congolese refugees. Conclusions: Shifting the paradigm with refugee populations from a deficits-centric to resilience-focused framework recognizes the inherent strengths of individuals, families and communities with refugee status, and has the potential to mold future research and praxis that aims to enhance the wellbeing of displaced populations.

Student Number : 9903082V - MSc (Med) dissertation - Faculty of Health Sciences / Chronic infection with the hepatitis B virus (HBV) is endemic to sub-Saharan Africa and south-east Asia where it is a major risk factor for the development of cirrhosis and hepatocellular carcinoma (HCC). Currently available therapy is only effective in a small subset of chronic carriers. The development of novel treatment modalities for the management of HBV therefore remains an important global medical objective. Sequence plasticity of the HBV genome is limited by its small size and the overlapping nature of its open reading frames (ORFs). These features make HBV an ideal target for therapy based on nucleic acid hybridization. The use of ribozymes (RNA enzymes) and antisense molecules to inhibit gene expression is well documented. The recent discovery of RNA interference (RNAi) has added to the arsenal of therapy based on nucleic acid hybridization. RNAi is the process whereby short RNA duplexes (called short interfering RNA or siRNA) mediate the sequence-specific post-transcriptional silencing of genes homologous in sequence to the siRNA. siRNA function by guiding a protein complex (RNA Induced Silencing Complex or RISC) to target mRNA for degradation or translational repression. The protein X ORF (HBx ORF) is a conserved region of the HBV genome and is common to all viral transcripts. HBx is required for infection by the virus and plays an important role in the establishment of chronic infections in vivo as well as in the development of HCC. RNAi targeted against the HBx ORF may therefore prove useful as treatment of chronic HBV infection. Plasmid based expression cassettes capable of endogenously generating short hairpin RNA (shRNA) targeted to the HBx ORF were constructed. The shRNA function as substrates for the RNAi machinery and are processed into siRNA. The ability of the expression cassettes to knockdown markers of HBV gene expression was tested in a human hepatoma cell line. A panel of 10 U6 promoter-driven shRNA expression vectors was generated. The U6 promoter (an RNA polymerase III promoter) is normally involved in the transcription of small nuclear RNA and as such is ideal for the generation of shRNA of precisely defined length. Three cytomegalovirus (CMV) promoter-driven shRNA expression cassettes incorporating ribozymes that produce defined hairpin sequences were also generated. The CMV promoter (an RNA polymerase II) promoter is involved in the transcription of large messenger RNA. Two hammerhead ribozymes lying 5’ and 3’ of the shRNA encoding sequence were incorporated into the cassette. Cis-cleavage by the ribozymes releases a shRNA of defined length thereby overcoming the limitations imposed by extraneous sequences from CMV promoter-driven transcription. U6 promoter-driven shRNA expression vectors efficiently knocked down markers of HBV replication in liver cells. The CMV promoter-driven expression vectors were incapable of inhibiting HBV gene expression; however shRNA generated in vitro from these vectors mediated efficient knockdown of HBV replication. shRNA-mediated inhibition of gene expression therefore holds promise as a novel treatment strategy for the management of HBV and other mobile genetic elements.

Thesis advisor: David A. Deese / Throughout the last fifteen years, the phenomenon of International Election Monitoring (IEM) has become increasingly widespread. IEM works to enhance the credibility and transparency of elections; over time, as the outcome of one election (and the success of IEM) conditions the electoral context of future elections, IEM can encourage internal political reform. In a number of states, particularly in Latin America, monitoring efforts have succeeded in steadily improving domestic political conditions and facilitating democratic consolidation. Yet, IEM effectiveness is conditioned not only by the characteristics of the monitoring groups involved, but also by the domestic context of a state. Hence, the unique structural conditions in Sub-Saharan Africa present distinct challenges and opportunities for IEM. This thesis investigates the relationship between IEM and internal political reform in four Sub-Saharan African states. While IEM can encourage the progress of reform through a feedback mechanism, the extent of such reforms is greatly affected not only by domestic structural conditions, but by additional and often overlooked intervening variables. / Thesis (BA) — Boston College, 2007. / Submitted to: Boston College. College of Arts and Sciences. / Discipline: International Studies. / Discipline: College Honors Program.

In 2015, the United Nations developed 17 goals to work towards sustainable development by 2030. Among these goals, goal number seven focuses on providing clean and affordable energy for all, to solve problems such as poverty and to reduce greenhouse gas emissions around the world. In Sub-Saharan Africa, 600 million people live without access to electricity. Furthermore, millions of people in Sub-Sharan Africa die each year because of indoor air pollution that comes from combustible and inefficient energy solutions. Because of these issues, social enterprises are a vital component to be able to work towards providing renewable energy solutions and efficient cooking solutions to households in Sub-Saharan Africa. This thesis analyses social enterprises working within the renewable energy sector in Sub-Saharan Africa, and investigates what a social enterprise must do to succeed. To answer this question, the authors carried out interviews to identify the factors that contribute to success and barriers that prevent the success of social enterprises active within the mentioned sector and region. The answers from the interviews were later on compared with findings from existing literature discussed in a literature review. Social enterprises in Sub-Saharan Africa that works within the renewable energy sector must work together with local employees to access knowledge about external factors that could engender barriers. Other barriers that a social enterprise might encounter are linked to profitability and affordability, and what the business is primarily focusing on achieving.    Social networks and financial institutions are of importance for social enterprises to succeed in Sub-Saharan Africa. Furthermore, by providing excellent customer service together with having the right abilities and knowledge, a social enterprise will have a higher chance of success. One of the most critical variables when aiming for success in the renewable energy sector in Sub-Saharan Africa is to have a well thought out business model before entering a new target market. This thesis concludes that the identified success factors and barriers, along with the explanation behind them, can be used as guidelines for future social enterprises that want to establish in the renewable energy sector in Sub-Sharan Africa.

Thesis advisor: Brian Gareau / In the past causation theories concerning conflict have centered upon differences between civilizations, ethnicities, religions, and several other dividing social factors. While such factors can increase the likelihood of conflict, this paper discusses the effects of environmental degradation and resource scarcity on conflict in sub-Saharan Africa, with a specific focus on the effects of climate change. Sustainable development practices, especially the use of renewable energy technologies, are identified as potential tools with which to mitigate conflict stemming from the effects of climate change, and current energy initiatives in Tanzania and Kenya are discussed. New energy initiatives in sub- Saharan Africa must look to the future of energy development; they cannot attempt to reproduce the status quo. This paper seeks to qualify why the Occidental world has a stake in the future of sub-Saharan Africa and proposes that developed nations give financial assistance to communities in sub-Saharan Africa so that they may invest in sustainable development. / Thesis (BA) — Boston College, 2013. / Submitted to: Boston College. College of Arts and Sciences. / Discipline: International Studies Honors Program. / Discipline: College Honors Program. / Discipline: International Studies.