The current Covid-19 epidemic has not magically erased the HIV epidemic and may even hinder recent progress in this area. In fact, the collection of epidemiological information, more complicated than ever, does not allow us to know the number of new HIV-positive discoveries, even though it underlines that the total number of HIV screening tests carried out has clearly decreased.
As every year on the occasion of 1 December, World AIDS Day, French public health has produced updated data on HIV infection and sexually transmitted bacterial infections (STIs) in France. But this year, Covid-19’s monopolization of healthcare workers has led to a significant underestimation of data for 2019. The consequence is that the number of HIV-positive findings has not yet been possible. estimated for the year 2019.
However, the published data provide us with information on the HIV / AIDS epidemic in France.
An increasing number of serology … up to Covid
The number of screening tests performed per year, regardless of the sampling location, is established through the LaboVIH survey. The participation rate of medical biology laboratories for the year 2019 is 72%, which is significantly lower than in previous years, estimated between 85% and 89% up to 2017, and which was 81%. % in 2018.
In 2019, 6.2 million HIV serologies were performed by medical biology laboratories. HIV testing has been on the rise since 2014, + 10% in 4 years, and this increase has accelerated in 2019, with + 6% in one year. The number of confirmed positive serologies also increased, with a + 6% between 2018 and 2019.
Unfortunately, Covid-19 had a strong impact on screening activity in 2020 and in the month of March-April 2020, during the 1st birth, a much greater decline is observed than the usual monthly variations. Thus, the number of serologies decreased by 56% between February and April, particularly in men (-66%, compared to -49% in women). This significant decline is particularly marked among the youngest (-62% for 15-24 years) and the elderly (-62% for those over 50).
The screening of HIV self-tests (ATVIH), which have been available in pharmacies for several years, has not been postponed. Sales also decreased in the first half of 2020, by -22% compared to the first half of 2019. In March the drop was even -32% and in April by -50%, compared to the same months of 2019. Pharmacies not having supply problems, this decrease corresponds to a sharp decrease in the number of ATVIH purchased.
The number of serologies did not increase sufficiently during deconfinement, in May and June, to reach pre-crisis levels.
Testing is one of the key components of the HIV response. Without testing, there is no access to treatment, no sustained quality of life for people living with HIV, and no prevention of transmission through treatment. These figures lead us to fear a global screening deficit for 2020.
New people living with HIV
Although we do not yet have an overall figure, these data still allow us to know the profile of people who discovered their HIV status between January 1, 2019 and September 30, 2020.
Men who have sex with men (MSM) and heterosexual people born abroad remain the 2 most affected groups, with 43% and 37% HIV positive results respectively.
In 2019-2020 as in 2017-2018, men accounted for 65% of HIV positive results. Heterosexuals and MSMs accounted for 51% and 43% of HIV positive results in 2019-2020, respectively. Transgender people infected through sex and injectable drug users (IDUs) each account for 2% of the findings. Again, these proportions are similar to those observed in 2017-2018. Foreign-born people account for 69% of IDUs and 83% of sex-infected transgender people.
73% of heterosexuals were born abroad. Most heterosexual people born abroad were born in sub-Saharan Africa (79%) and are women (64% versus 36% men). These proportions are reversed for heterosexual people born in France, who have 64% men and 36% women.
As for homosexual and bisexual men, 32% were born abroad (compared to 26% in 2017-2018), mainly in the Americas, and 68% in France. MSMs born in France thus represent 29% of all discoveries in 2019-2020.
Finally, people under the age of 25 account for 13% of discoveries and those over the age of 50, 21%. Among MSM, these proportions are respectively 18% and 15% and among heterosexuals 11% and 22%.
What we know about the new cases detected in 2019-2020 therefore seems to show an overall stability in the characteristics of the HIV-positive findings compared to the previous two years. Like last year, the proportion of foreign-born MSMs appears to be on the rise. The data from the GANYMEDE study, conducted by Romain Palich (IPLESP, APHP), currently underway, should allow us to identify the individual and collective contexts that favor the increase of these diagnoses among MSM born abroad. Explore the different facets of the journey of HIV positive MSMs born abroad before their diagnosis, based on a large sample of people followed in the 15 largest HIV treatment centers in Île-de-France. .
Early and late discoveries
In 2019-2020, 21% of HIV positive findings were early diagnoses, compared to 24% in 2017-2018. On the other hand, 26% are diagnosed at an advanced stage of the infection compared to 25% in 2017-2018).
As in previous years, the early diagnosis rate is higher among MSMs (30% in 2019-2020) than IDUs (14%), heterosexual people (12%) and transgender people (10%). However, there is a decrease in the rate of early diagnosis among MSMs, but not among heterosexuals.
In contrast, late-stage diagnoses are more common among IDUs (35%) and heterosexuals (31%) than among transgenders (20%) and MSMs (17%).
Disparity also between those born in France and those born abroad: early diagnoses are more frequent among those born in France than among those born abroad.
Finally, in 2019-2020, 51% of HIV-positive findings concern people who claim it is their first test. This is still a high figure, which highlights the distance that remains to be covered to increase the use of shielding, covid or non-covid.