“We are in the last kilometer,” notes Sandrine Fournier, spokesperson for Sidaction, “but to defeat this epidemic, we need a final push. We don’t have time to relax.” More than forty years after the discovery of the virus, it is today possible to live a normal life when you are HIV positive, provided you know your serological status and are under treatment. Gold in 2023, Public health France estimates that more than 10,000 people are living with the virus in France without knowing it. More than ever, the association therefore recalls the importance of screening. And on this level, the latest available figures are rather encouraging.
More than 7.5 million HIV serological tests were carried out last year, a very clear increase compared to 2022, which had already seen the number of tests return to their pre-Covid-19 level. “This increase is clearly the product of political action,” welcomes Sidaction, in reference to the decree which made HIV testing free, without an appointment and without a prescription, in all medical analysis laboratories in France since on January 1, 2022. Please note that for those under 26, this free service has been extended screening for four other sexually transmitted infections (chlamydia, gonococcal, syphilis or hepatitis B virus infections) from September 1, 2024.
Mechanically, this increase in screening led to an increase in positive cases detected. Thus in 2023, nearly 5,500 people will discover their HIV status – this is approximately the level of infections detected before Covid-19. For Sandrine Fournier, from Sidaction, “it’s encouraging, it means that we are catching up with people, before their situation becomes too serious.”
Indeed, HIV is a virus that attacks certain of our lymphocytes (also called “white blood cells”) which make up our immune system. If left untreated, these affected cells multiply. The immunity of untreated infected people gradually declines, until it reaches an advanced stage where they can then develop a range of opportunistic diseases. We then speak of acquired immunodeficiency syndrome – AIDS. In 2023, 43% of diagnoses were made at a late stage, as pointed out by Public Health France.
Conversely, when the virus is detected at an early stage, rapid treatment can reduce the presence of the virus in the body until it becomes undetectable. In other words, when the HIV-positive person takes their tests, their viral load has been reduced to a point where current laboratory techniques cannot detect the virus in the blood. At this stage, the infected person leads a completely normal life and does not even transmit the virus to their sexual partners. This is also the message tirelessly repeated by associations in recent years: “I = I”, i.e. undetectable viral load = untransmissible virus. “I don’t know why, but it doesn’t print,” laments Sandrine Fournier.
AME, an essential weapon against the proliferation of the virus
Today in France, not all populations are equal in the face of contamination. The “Epinal image” of the HIV-positive person is often that of a white, homosexual man, aged 25 to 50, but in the figures, this image is less and less true. The share of men who have sex with men among HIV-positive people fell between 2019 and 2023 (and even more if we go back to 2012). On the other hand, all categories of people born abroad are increasing, starting with the share of heterosexual women born abroad, who represent more than a quarter of new cases discovered.
“We must in no case stigmatize these people,” warns the Sidaction spokesperson, recalling that a little less than half of the migrants whose HIV status is discovered in France were contaminated in France. For Sandrine Fournier, “this clearly shows that precariousness and distance from the healthcare system are factors that facilitate the proliferation of the virus and the infection of vulnerable populations.”
In this context, the debates within the government on a possible abolition of state medical aid are of great concern to associations who fear a decline in screening among some of the populations most at risk. Worldwide in 2023, around 40 million people would be living with HIV, according to the Joint United Nations Program on HIV-AIDS. 1.3 million would have been contaminated during the year 2023.