the Covid-19 has ruined the progress made in recent years

The figures are not good and they make fear the worst for associations fighting against AIDS. The Covid-19 pandemic has caused a significant drop in screening for the human immunodeficiency virus (HIV). With 5.2 million HIV serologies performed in laboratories, the screening activity, which had increased between 2013 and 2019, fell by 14% between 2019 and 2020, reveals Public Health France (SPF) in a press release, Tuesday, November 29. .

Between March 2020 and April 2021, the number of blood tests decreased by 16% compared to what was expected, the National Agency for Research on AIDS and Viral Hepatitis (ANRS) was already alarmed in a report published in September. This deficit was not offset by sales of self-tests, which decreased by 22% over the same period. As a result, the number of new HIV-positive people put on treatment has fallen by 20% in one year.

This situation alarms Florence Thune, general manager of the Sidaction association, who fears an epidemic rebound in the short and medium term:

“We are extremely worried, because screening is an essential tool in controlling the epidemic: a correctly treated HIV-positive person obtains a so-called undetectable viral load, as it is low in the blood. Concretely, she no longer transmits HIV. First and foremost, you need to know your HIV status. “

This delay in screening also means that infected people will discover their seropositivity late and be treated at an advanced stage of the disease – which can complicate their treatment path and threaten their health. “Currently, it is estimated that around 24,000 people are unaware of their HIV status”, reminds Florence Thune.

The only positive element: the health crisis had no consequences for the patients already followed. There were no stopping treatments. Teleconsultations and e-mail prescriptions appear to have made up for the closures of counseling services.

Decreased PrEP delivery

For those involved in the fight against AIDS, this decline is all the more annoying since between 2017 and 2018, after several years of stability, the number of HIV-positive discoveries finally recorded a slight decrease (- 7%). “It was little, of course, but the efforts made in terms of screening, prevention, support and treatment were bearing fruit. The Covid-19 has ruined this progress ”, said Florence Thune with a sigh.

“Once again, it is the most vulnerable and at-risk populations who will drink: migrants, sex workers, young gays”, points out François Emery, advocacy officer at Act Up Paris. According to data from Public Health France, men who have sex with men (MSM) and heterosexuals (men or women) born abroad remain the two groups most affected. They respectively represent 43% and 37% of discoveries of seropositivity declared between January 2019 and September 2020. “Taking care of your health takes time and money. These are people in a very precarious economic and social situation for whom it comes after ”, explains Mr. Emery.

The confinements and the long period of curfew have also prevented associations from reaching out to these isolated audiences. Their traditional missions in terms of screening and prevention have also been eclipsed by the need to meet the most vital needs of their beneficiaries (food, housing, continuation of antiretroviral treatment, psychological support, etc.).

Another subject of concern: the suspension of information and prevention campaigns aimed at young people. People under the age of 25 accounted for 13% of HIV-positive discoveries in 2019-2020, according to Public Health France. A proportion similar to that observed in 2017-2018. This data is accompanied by another worrying figure: in 2019, 23% of 15-24 year olds considered themselves poorly informed about HIV and AIDS, according to a survey published by the Sidaction association. For me^me Money, resuming and strengthening prevention among young people therefore falls within the“Vital emergency”.

Another bad news is that the ANRS has observed a drop in the delivery of pre-exposure prophylaxis (PrEP), the preventive “anti-AIDS” pill for people very exposed to HIV: – 17% between March 2020 and April 2021 compared to the expected figures. “PrEP is a well-tolerated treatment that is very effective in preventing new infections. Before the health crisis, its deployment was envisaged with new profiles of people. In fact, today, we have taken a step backwards ”, deplores the director of Sidaction.

“We are the other epidemic, the one that everyone does not care about”

“General attention has been focused on the Covid to the detriment of AIDS. It was very difficult to remain audible on the issue of HIV. We are the other epidemic: the one that we no longer talk about and that everyone does not care about ”, sums up François Emery bitterly.

Finally, the Covid-19 pandemic has turned the world of research upside down, including ongoing work on HIV. Like everyone else, scientists have been kept away from their labs for part of the year. Many specialists in epidemiology, immunology, virology and infectiology then embarked on a race for vaccines and treatments, even if it meant temporarily abandoning other projects.

However, HIV research is essential. Forty years after the first AIDS alert, on June 5, 1981, there is still no vaccine. There is no cure for AIDS: people living with HIV are forced to take treatment for life.

But research on AIDS could, in the long term, benefit from that carried out on Covid-19, in particular thanks to messenger RNA vaccines. For Christine Rouzioux, professor emeritus in virology at the René-Descartes Faculty of Medicine (Necker Hospital) and member of the National Academy of Medicine, this is a possibility:

” I am optimistic. Messenger RNA is a hopeful technology in the fight against AIDS. Given the power of these vaccines, the field of possibilities has become immense. However, there are still many steps to take before you end up with a prophylactic vaccine, that is, one that prevents HIV from entering the body. This virus is terribly complex. Many unknowns remain and it will take time. “