Amal Bernoussi

Unprotected Sex and Internalized Homophobia

During recent years in France, the number of HIV infections in the gay community has been constantly increasing. How can we explain the number of transmissions being still so prevalent? Since the arrival effective therapies, HIV may no longer be perceived as a fatal disease, and therefore it may have become trivialized. This paper will merge variables linked to homophobia and interiorized homophobia in order to bring a new insight in understanding to the motivations of gay men having non protected sex, whether it is systematic or episodic. Interiorized homophobia appears to be an essential element of the construction of the identity among gay men. A real “coping strategy”, it allows firstly a protection from the surrounding environment, but in a second step becomes harmful to the development of healthy self-esteem. Gay men partially construct their identity from elements such as heterosexism and insults targeting gays as feminine, submissive individuals. We suggest that unprotected sex between men answers a quest for identity. On the one hand, there is an act of virility with unprotected sex and transmission of seminal fluids and exposure to a risk, reinforcing the masculine side. On the other hand, we can see identification with homophobic rejection, and becoming the carrier of a contagious, chronic, rejected disease. It is in this status of rejection—the transfer from homophobia to the disease—that gay men may find themselves. This paper proposes to approach the phenomenon in a replay of previous contributions on this topic.

Nalmefene Phase IV Study: A Seeding Flying in the Face of Evidence?

Barrio et al. [1] concluded ‘‘data provided by this phase IV study (110 patients included, 88 reporting data at the 1-month visit) suggest nalmefene is an effective, welltolerated treatment for alcohol dependence in real-world, clinical settings’’. This deserves robust comment. First, psychological interventions (delivered by appropriately trained and competent staff, based on a relevant evidence-based treatment manual) are the recommended treatment [2]. Second, flawed marketing claims about the effectiveness of nalmefene were seen as early as 2014 and the ineffectiveness of nalmefene has been confirmed by two metaanalyses showing evidence that the reduction in drinking with nalmefene is not different from placebo [3–10]. Pharmacologically assisted treatment for alcohol use disorder is only evidence based for acamprosate, naltrexone and disulfiram, for the maintenance of abstinence. However, long-term multi-factorial life-style interventions, the cornerstone for treatment, are effective [2, 11]. The paradigm of a reduction in drinking, assuming that vulnerable and dependent individuals could reduce their consumption over the long term, is not logical because the duration of the intoxication is a critical issue and alcohol is a human carcinogen (Class 1) with dose-related increases in cancer prevalence being either exponential (e.g. oral cavity, pharynx) or linear (e.g. oesophagus, breast) beginning at one to two drinks per day [12]. This alternative to abstinence, based on an old short-term study with surrogate endpoints, was rapidly dismissed when considering data 1 year after discharge from the study [13]. Long-term phase III studies must use relevant health outcomes (quality of life, accidents/injuries, morbidity), not declarative subjective surrogates. Abstinence remains the appropriate goal for people with alcohol dependence or with psychiatric/physical co-morbidity. Nevertheless, when a patient prefers another approach, he/she should be advised strongly that abstinence is most appropriate, but should not be refused access to care. Third, Barrio et al. stated ‘‘satisfaction was globally high for both professionals and patients, and overall nalmefene was well tolerated, with no serious adverse events reported’’. However, the lack of detailed information on adverse event screening and monitoring suggest a poor method that may explain the discrepancy with a meta-analysis reporting the threefold increased risk of withdrawal from treatment on nalmefene and an elevated (Peto odds ratio = 1.32) risk of psychiatric serious adverse events, albeit not statistically significant [14]. Four, psychoactive substances are usually used in conjunction, in this instance especially tobacco, the first avoidable cause of premature death. Tobacco cessation treatment improves other substance use, predicting more favourable long-term outcomes [15]. The lack of data about this issue is a major limitation. This comment refers to the article available at https://doi.org/10.1007/ s40261-017-0590-4.

From the Influence of Traumas to Therapeutic Letting Go: The Contribution of Hypnosis and EMDR

Abstract The development of new psychotherapies such as Eye Movement Desensitization and Reprocessing (EDMR) has led to numerous fresh approaches to both the treatment of trauma and to the understanding of underlying psychopathology. A unified view appears to be slowly emerging in an attempt to corroborate clinical practice with neurobiological data. This article attempts to demonstrate links between alternate psychotherapies by highlighting what appears to be an invariant among these approaches, namely “letting go.” This concept refers to a psycho-physical dynamic that combines psychological dissociation and reassociation, as well as the body’s vagotonic mechanisms. Following an explanation of this process, it is demonstrated how letting go can manifest itself physiologically and why this may be significant in the study of trauma.

Conduites addictives des enfants en situation de rue : interculturation et résilience

UNLABELLED This research belongs to a more comprehensive study on the care of street children in Cameroon. The idea is to develop an analysis of the street pathology where symptoms such as addictive behavior and drug addiction can be found. Beside HIV AIDS, addictive behaviors are the main risk factors that many professionals have to face with while dealing with the street problems today. AIM Through an intercultural approach, we examined the practices of addictive typology, their initiatory role and their function in the integration of the street system. We also analysed their importance in the survival strategies. After an overview of theoretical controversies that feed the debate on addictions, we questioned the impact of these practices on the street career through the prism of general theory of addictions, particularly the hedonic management model. Addiction helps to resist adversity, it helps to desist and then to begin a harmonious neo development despite the horrors of the street experience. METHODOLOGY We undertook a quantitative and qualitative study on a sample of 148 street children. We proposed to 128 of them a questionnaire focused on addictive behaviors and survival strategies in the street context. We notably evaluated the street career of 24 of them, using interviews and standardized tests to assess self-esteem (Coopersmiths SEI) frustration tolerance (Rosenweigs P-F) and self-efficacy (Sherers SE Scale) in order to measure the impact of addictive behaviors on the resilience process. RESULTS We found that the street career is essentially traumatic, and that addictive behaviors involving various integration strategies are strongly linked to the interculturation process through the identity strategies and the intercultural competences. Addiction itself is not significantly related to self-esteem issues but strongly impacts on self-efficacy and the ability to tolerate frustration. They allow the street children to withstand the street adversity but are a real obstacle to their resilience process.