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A stinging AIDS epidemic and missing data. A few days away from World AIDS Day, this Saturday 1st December, it would have been useful to know if the number of new contaminations in France finally drops significantly. But here, the agency Public Health France, in a special issue of the Weekly Epidemiological Bulletin (BEH) made public on Tuesday, was not in a position to give complete results for 2017, which is a bit problematic for our leaders, supposed to drive public policies.
Gays who are infected
Let. There were around 6,300 new HIV infections in 2013 (AIDS represents the last stage of HIV infection), then a slight decrease in 2014 and 2015, a stability around 6,000 in 2016. The latest figures those of 2017 were eagerly awaited, as many experts were hoping for a drop due to the rise in power of new prevention tools such as self-tests, but especially with Prep (Pre-exposure Prophylaxis). This drug treatment given to people at risk to avoid being infected has an efficiency of almost 100% if the person takes it well (in France, there would be today 10 000 "prepeurs", including 3 000 in Paris ). And then there is also the Tasp (treatment of an HIV-positive person as prevention) which consists in treating as soon as possible someone who discovers his / her seropositivity, because once under treatment the person is no more contaminating. "With all its new tools and political will, we can break the epidemic, and go to zero contamination", explain to the World Health Organization (WHO). This is the case, for example, in San Francisco.
In France, the epidemic remains active while the Prep is reimbursed by health insurance. "We do not have the figures for 2017, wrote Public Health France. But it is possible to describe the characteristics of people who discovered their HIV status between January 2017 and September 2018 based on the raw data. " These data are not really encouraging.
Read alsoAIDS: the Prep, it works!
In recent years, it is among gays that the rate of HIV infection remains high. A rate, it may be recalled, which is comparable to that of epidemics in developing countries. "Men who have bad with men (MSM) and heterobaduals born abroad, three-quarters of whom are born in a country in sub-Saharan Africa, are the two most affected groups. They account respectively for 45% and 38% of discoveries in 2017-2018. " That's close to 3,000 gay contaminations a year, which is huge. For heterobaduals born in France and injecting drug users, the epidemic is much lower: 1,000 infections for the first and 60 for the second. Stable proportions since 2015.
The second (and disturbing) fact remains the still high number of late discoveries of seropositivity: 28% of people were diagnosed in 2017-2018 at an advanced stage of infection. And this despite a very strong screening activity that continues to increase, with 5.6 million HIV serologies performed in 2017 in laboratories. Clearly, in France, we detect a lot but we often detect badly, often late, having great difficulty in reaching people at risk.
The old and the AIDS …
Old, beware of AIDS. Contrary to what one might imagine, it is not only young people who are infected. In one of the BEH studies, in 2016, the number of "seniors" (people over 49) who discovered their HIV status was estimated at 1,200, or 20% of all discoveries. This number is not stable, it has even increased regularly between 2008 and 2014. Said seniors are mostly men (72%), contaminated as much by heterobadual bad (51%) as by bad between men (47%) . Logically, older people remain less affected by HIV than the 25- to 49-year-old population, since their rate of HIV-positive discoveries is four times lower. However, this situation is cause for concern.
"We continue to believe that old people have no baduality, and therefore no risk of getting infected. This is a serious mistake, there has never been a prevention campaign turned towards them, irritates Francis Carrier, president of Gray Pride. In fact, we are experiencing a real problem of screening. "This can be explained by an individual perception of the risk of HIV infection lower among seniors, note the BEH. Maybe also [que] health professionals are less comfortable discussing bad with their older patients and are probably less inclined to offer them screening because they consider them to be at low risk for HIV infection. "
Read alsoThe blog of Gray Pride, on the site of Release
In the end, this observation: "The number of seniors who discovered their seropositivity increased between 2008 and 2014 while, at the same time, this number decreased in the 25-49 age group. Among seniors, the increase in the number of HIV-positive discoveries is essentially related to that observed among men who have bad with men. "
Self-tests have a hard time seducing
There was a lot of faith in the advent of self tests to change screening habits, even hoping that it would be as commonplace as a pregnancy test. Their use is ultimately a bit disappointing. Commissioned in September 2015, the sale of HIV tests without prescription in pharmacy does not take off. In 2016, about 75,000 self-tests were sold without really knowing the characteristics of the buyers.
Read alsoAIDS: self-tests, effective but neglected
In fact, by the beginning of 2017, only 5% of gay respondents had used a self test during their last HIV test. "They were men with very different profiles: either young people never detected but interested in demedicalized tools, either men reporting significant badual activity and already familiar with screening, or men reluctant to idea to go to health centers. These results show the interest of this tool and plead for a wider availability. "
To explain the low use of this tool, yet very practical, we can note the sometimes high price (between 20 and 30 euros). It is only in July 2018 that a manufacturer has proposed one to 10 euros. Then, there is a bad disposition in pharmacies where, very frequently, the person must ask the pharmacist. What does this mean for a prevention policy?
Eric Favereau
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