Has the fight against HIV reached a plateau in France? Although infections have not increased for a decade, they have stopped declining. Published a few days before World AIDS Day, Sunday December 1, the annual report from Public Health France estimates that 3,650 people will have been infected in 2023, i.e. a national incidence rate of 5.3 per 100,000 residents. A stable figure since 2021, but which breaks with the decline observed since 2012.
Also in 2023, 5,500 people discovered their HIV status, linked in half of the cases to contamination occurring more than two years previously. “This number has increased fairly steadily following the sharp decline observed in 2020,” indicates Public Health France, emphasizing that this increase particularly affects people born abroad.
“A resumption of migratory flows after the restrictions linked to Covid could explain part of this increase, but it should be noted that 42% of people born abroad and diagnosed in 2023 were contaminated after their arrival on French territory” , notes the agency.
In mainland France, Île-de-France comes first with 173 HIV discoveries. It is also the region which concentrates the highest rate of new contaminations (40%) and the greatest number of HIV-positive people (39%), due in particular to a “over-representation of people in precarious and vulnerable situations”, explains Bastien Vibert, head of HIV programs at Crips (regional AIDS information and prevention center) Île-de-France.
A record year for screening
But how can we explain that cases are no longer decreasing? This is firstly due to the scale of screening: it reached a record in 2023, with 7.5 million serologies carried out, i.e. 25% more than in 2021. An increase “partly linked to the HIVTest system, which allows free screening to be carried out, without a prescription and without an appointment”details Public Health France. Screening activity was particularly intense in Île-de-France, with 144 serologies per 1,000 inhabitants.
“We have a screening offer in France and Île-de-France that meets the challenges, which is excellent news,” rejoices Bastien Vibert. However, he believes that this data is not enough to explain why the country has broken with a decade of decline “more or less constant”. “If we look in detail, there are populations in which contamination is decreasing or stagnating, and others where it is increasing, notably women born abroad, in particular those of Afro-Caribbean origin, and MSM (men having sex with one or other men, Editor’s note) born abroad”, raises the specialist.
“Conversely, MSM born in France become less contaminated (–36% of contaminations between 2012 and 2023), which demonstrates the very positive impact of PrEP,” a preventive treatment available since 2016 for people at high risk of exposure to HIV.
Expanding PrEP treatment
Hence the need to adapt the prevention strategy according to him: “Today, less than 5% of PrEP users are women, even though they represent 30% of HIV infections. We must therefore ensure that these people take better ownership of this tool. » It is in this direction that the recent recommendations of the High Authority of Health are going, which encourages broadening access to this treatment. “to all situations considered to be at risk of exposure to HIV, regardless of the gender and sexual orientation of the person”.
Beyond PrEP, Bastien Vibert calls for greater efforts to “break the stereotypes about HIV”. “Forty years later, many continue to think that it is a disease of homosexuals, even though 55% of people who discovered their HIV status in 2023 are heterosexual. » As for the prevention measures put in place, such as free condoms for those under 26, they must be accompanied by real “education about the emotional and sexual lives of young people. Whether it’s a condom or something else, the best prevention is the one we choose with full knowledge of the facts.”
