December 1st remains the unmissable event in the fight against AIDS. Especially in this “anniversary” year of the 40th anniversary of the discovery of the virus. Like every year, this world day is also the highly anticipated moment when Public Health France (SPF) provides epidemiological data from the previous year on infection by HIV and other sexually transmitted infections (STIs).
First observation, the account is still not there. First, the number of infections is not decreasing fast enough in our country. In 2022, 5,738 new cases of HIV seropositivity were discovered, compared to 6,213 in 2019. The decline (according to the two corrected calculation methods, of -11% or a maximum of -21%) was much greater in London (-44%) or San Francisco (-65%) over the same period. Even if it is difficult to compare cities to a country, France is not sufficiently meeting the WHO 2030 objectives: zero new contamination.
However, the figures are more contrasted if we look at the transmission groups. The largest drop is observed among men who have sex with men (MSM) born in France: – 32% between 2012 and 2022, and -12% since 2019. On the other hand, we observe significant increases in the group of MSM born abroad (+ 96%), precisely at a time when State medical aid (AME) is being put in danger and even more so among trans people contaminated by sexual intercourse (+ 153%) since 2012.
The mandatory declaration system (DO) – highlighted in its recent report by the National AIDS Council – is not sufficiently deployed with only 23% completeness in the city and 77% in hospitals. SPF requested an audit from the European Center for Disease Prevention and Control (ECDC, European Center for Disease Prevention and Control) on this system which is struggling to produce reliable figures. Even more worrying is this other figure which corresponds to the reality on the ground: 43% of new diagnoses are at too late a stage of the disease, or even 28% at the most advanced stage of AIDS disease or profound immunosuppression. This glass ceiling of delay in diagnosis, which weighs on healthcare systems and actively participates in the circulation of HIV, has been constant in recent years.
These figures show that our HIV prevention and screening tools are not sufficiently reaching their targets. They once again point out the glaring deficit in public health policy in our country. Public Health France lacks resources while its field of competence has continued to expand, from Covid to the health reserve with the sending of caregivers to Mayotte, including the monitoring of cannabis consumption or mental health . All this with an employment ceiling and a budget that is said to be planned to decline.
We also see to what extent the time factor weighs on public health actions. While Covid data was available day every evening with incidence data, hospitalization rates, new diagnoses, the SIDEP database, now Labo-e-si, still does not include real-time accounting of the HIV and STIs, which would nevertheless make it possible to adapt public policies in terms of prevention.
Let us nevertheless note two elements of satisfaction. First, the information campaign of December 1st which, under the leadership of Public Health France, will finally communicate on prevention tools. Today these are in fact used too little, in particular PREP (pre-exposure prophylaxis). Only 4.6% of initiations of this preventive treatment concern women, who nevertheless represent 31% of new HIV diagnoses, a caricature example of gender inequality in health. And half of eligible MSM do not have access to it either, according to a recent survey. Another element of satisfaction, the initiation of Prep by private medicine which represents 27% of the 52,800 people on Prep in France (Epiphare Study). Enough to give hope until December 1st.
Pr Gilles PIALOUX Infectious disease specialist, Vice-president of the French Society for the Fight against AIDS, www.vih.org