BackgroundA large proportion of the 2.5 million new adult HIV infections that occurred worldwide in 2007 were in stable couples. Feasible and acceptable strategies to improve HIV prevention in a conjugal context are scarce. In the preparatory phase of the ANRS 12127 Prenahtest multi-site HIV prevention trial, we assessed the acceptability of couple-oriented post-test HIV counseling (COC) and men's involvement within prenatal care services, among pregnant women, male partners and health care workers in Cameroon, Dominican Republic, Georgia and India.MethodsQuantitative and qualitative research methods were used: direct observations of health services; in-depth interviews with women, men and health care workers; monitoring of the COC intervention and exit interviews with COC participants.ResultsIn-depth interviews conducted with 92 key informants across the four sites indicated that men rarely participated in antenatal care (ANC) services, mainly because these are traditionally and programmatically a woman's domain. However men's involvement was reported to be acceptable and needed in order to improve ANC and HIV prevention services. COC was considered by the respondents to be a feasible and acceptable strategy to actively encourage men to participate in prenatal HIV counseling and testing and overall in reproductive health services.ConclusionsOne of the keys to men's involvement within prenatal HIV counseling and testing is the better understanding of couple relationships, attitudes and communication patterns between men and women, in terms of HIV and sexual and reproductive health; this conjugal context should be taken into account in the provision of quality prenatal HIV counseling, which aims at integrated PMTCT and primary prevention of HIV.

Success in scaling-up access to ART in Cameroon has been facilitated by decentralization of the healthcare system. Long-term sustainability urgently implies better integration of this HIV-targeted programme in the global healthcare reform of financing mechanisms, management of human resources and drug procurement systems.

A simple prenatal intervention taking into account the couple relationship increases the uptake of HIV testing among men in different socio-cultural settings. COC could contribute to the efforts towards eliminating mother-to-child transmission of HIV.

Objectives Research on men who have sex with men (MSM) in sub-Saharan Africa was neglected for a long time. The objective of this study was to understand factors associated with unprotected anal intercourse (UAI) with male partners among a group of MSM living in the city of Douala, Cameroon. Methods In 2008, a survey on the sexual activity and practices of MSM was set up in Douala in collaboration with a local community-based organisation. Data were collected among a convenience sample of 168 MSM during face-to-face interviews with trained interviewers. Results A total of 142 individuals reported sexual activity during the previous 6 months, among whom 80 (57%) reported UAI with male partners. In a multivariate logistic regression model adjusted for the frequency of sexual intercourse, not having had access to prevention interventions and not knowing any HIV-infected person were both independently associated with a higher risk of UAI. Other factors associated with this higher risk included having had a stable male partnership at some point in one's life and not having been out of Douala for more than 4 weeks during the previous year. Conclusions This community-based research is the first study of MSM in Cameroon and the HIV transmission risks they face. Results show the importance of HIV prevention interventions from peers, and underline the need to maintain efforts to develop specific interventions targeting MSM more efficiently in the African context.

In low- and middle-income countries, men who have sex with men (MSM) are 19 times more likely to be HIV positive compared with background populations. Criminalisation and social rejection of homosexuality in most sub-Saharan African countries reinforce stigma and exclude MSM from prevention activities, including HIV testing. This paper's purpose is to identify factors associated with never having been HIV tested (NHT), among a sample of Cameroonian MSM. In 2008, a community-based study was conducted in Douala, the economic capital city of Cameroon, by a local NGO Alternatives-Cameroun, recruiting participants through the snowball technique and administering a questionnaire during face-to-face interviews. Proximity to HIV was investigated according to the following criteria: knowing at least one person living with HIV and having been exposed to HIV prevention interventions. NHT was defined as reporting to have never been HIV tested. A logistic regression was used to identify factors associated with NHT. Among the 165 MSM of our study group who reported that they were not HIV positive, 19% reported NHT. Factors independently associated with NHT were as follows: being younger, being Muslim, not having a steady male partner, not knowing any person living with HIV and never having been exposed to HIV prevention interventions. In this MSM population, a small proportion reported that they had never been HIV tested and among these, the percentage was higher among individuals not in proximity to HIV. Despite the hostile context of sub-Saharan African countries towards MSM, local and national HIV testing campaigns to date may have played a substantial role in raising HIV awareness in the MSM population living in Douala, and peer-based counselling may have educated those in contact with Alternatives-Cameroun regarding the positive value of HIV testing. This result is a further argument for continuing community-based prevention and extending it to difficult-to-reach MSM.

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L'idée selon laquelle les questions de genre et de sexualité méritent d'être pensées ensemble n'est pas nouvelle. Pour autant, elle a mis du temps à s'imposer et ne va toujours pas de soi. Dans un texte phare publié au moment où la notion de genre émerge au coeur de la théorie féministe, Gayle Rubin développe le concept de «système sexe/genre» qu'elle définit comme «l'ensemble des dispositions par lesquelles une société transforme la sexualité biologique en produits del' activité humaine et dans lesquelles ces besoins sexuels transformés sont satisfaits » [Rubin, 1998 (1975): 6]. En même temps que le sexe social, le genre traduit l'orientation sexuelle: «Le genre n'est pas seulement l'identification à un sexe; il entraîne aussi que le désir sexuel soit orienté vers l'autre sexe » [Rubin, 1998 (1975): 33]. Genre et sexualité se trouvent ici indissociablement liés dans le cadre d'une théorie visant notamment à souligner la liaison entre l'oppression des femmes et celle des homosexuel-le-s. Dans un texte publié neuf ans plus tard, en 1984, alors que le contexte des luttes et des productions intellectuelles féministes a changé, Gayle Rubin revient sur ses premières positions : « Le genre affecte la façon dont fonctionne le système sexuel, et le système sexuel a des manifestations spécifiques en fonction du genre. Mais bien que le sexe et le genre soient reliés, ils ne sont pas la même chose, et ils forment le fondement de deux aires différentes d'interaction sociale. Par opposition à ma prise de position de The Traffic in Women, je soutiens aujourd'hui qu'il est essentiel de séparer analytiquement le genre et la sexualité pour mieux refléter leur existence sociale séparée » [Rubin, 2001 (1984) : 128]. De fait, les deux domaines de recherche se développent séparément pendant longtemps, avec heureusement des exceptions [Ortner & Whitehead, 1981 ]. À partir des années 1980, l'essor des recherches consacrées aux femmes ou aux minorités sexuelles entraîne un certain renouvellement des approches de la sexualité et du genre dans les pays occidentaux. La pensée constructionniste domine, procédant à une dénaturalisation non seulement du genre mais aussi du sexe, également analysé comme une construction historiquement située [Laqueur, 1992 (1990)]. Au début des années 1990, apparaît aux États-Unis une nouvelle génération de travaux rassemblés plus tard sous le label de théorie queer, dont

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