Paris (AFP)

The increase in HIV testing has been accompanied by a decrease in the number of HIV-positive discoveries in France, according to the latest Public Health France Weekly Epidemiological Bulletin (BEH).

In 2018, 5.80 million tests were performed in the analysis laboratories. A test number has been steadily increasing since 2013 (+ 11%), while the positivity rate (1.9 / 1,000 serologies) has decreased (-13%).

However, "the use of HIV testing remains very inadequate in metropolitan France," reads in this BEH dedicated to AIDS.

Nearly 6,200 people discovered their HIV status last year, down 7% from 2017. More than half of them had never been tested before (nearly a third of homosexuals / MSM and half heterosexuals).

One-quarter of these findings were early and 29% advanced, with stable proportions over the last three years.

"The decrease in the number of HIV-positive discoveries, coupled with an increase in screening activity, may reflect a decrease in the number of undiagnosed people infected and / or a decrease in the incidence (new cases, note) for several years ", note Françoise Cazein (SpF) and her colleagues.

Nevertheless, the number of people diagnosed at an advanced stage of the infection shows that screening still needs to progress, according to them.

- Combined approach -

The decline in new HIV diagnoses recorded in France at the national level has also been observed in other European countries for several years (Austria, Belgium, Finland Germany, Greece, the Netherlands, Portugal and the United Kingdom).

The combined approach, including "Test and Treat" and PrEP - preventive treatment for HIV before intercourse - is the strategy of success, says Valérie Delpech (Public Health England, London) in the BEH editorial.

PrEP is especially taken by homosexuals, among whom the repeated use of screening is on the rise.

For its part, the survey of the Health Barometer 2016 with nearly 15,000 people aged 18-75 living in metropolitan France, shows the divergence between the opinions on screening and what people actually do.

Nine in ten believe that everyone should be tested for HIV at least once in their lifetime. But more than half of men and almost one third of women have never tested.

This lack of screening during life was more frequent among the 55-75 year olds (63% without difference between men and women) and the 18-24 years old (52% for men and 38% for women).

While people who are screened are generally better screened than others, "about one in five people in sub-Saharan Africa and one in five MSM have never been tested for HIV," says Delpech. . "A worrying finding, given the health promotion actions targeted at these groups in recent decades," she adds.

Free-of-charge testing centers (CeGIDDs), which host populations at particular risk of HIV infection, can also be used to diagnose bacterial STDs, hepatitis B and C.

A quarter of homosexuals / MSM exposed to these infections accept the HIV Self-Collection Kit and these other STDs. These are mostly urban, highly educated, who seize this tool, according to a program promoted online in spring 2018.

Diagnosis of sexually transmitted infections (STIs / STDs) continues to increase in France, note Delphine Viriot and colleagues (SpF) who focused on screening for bacterial STIs in the private sector in France.

In 2018, 2.1 million people were tested for Chlamydia infection (up 9% from 2006), nearly 1.6 million for gonococcus (+ 18%) and 1.8 million for syphilis ( minus 7%). This decrease, observed for the first time 200, concerns only women.

© 2019 AFP