World AIDS Day: "unacceptable" flaws in French screening

The French policy in the fight against AIDS is a failure. This is essentially what the National AIDS Council (CNS), an independent public body, asserts in a damning report published Wednesday (November 27th) just before World AIDS Day. The document points to "weaknesses", delays in prevention. Worse, the CNS considers that the current situation is "unacceptable", given the fact "that all tools to stop the epidemic are available, whether it is HIV testing or treatments in their different preventive uses ".

"It is now, however, that we must act if we want to achieve the so-called '3 x 95' objectives that France has set for itself by 2020," says Nicolas Derche, director of the Arcat and Kiosque associations. News AIDS and Drug Addiction (SOS Group), in an interview with France 24. France aims indeed the goal of "3x95" which is that 95% of all people living with HIV know their serological status that 95% of people who know their HIV status have access to treatment and that 95% of people on treatment have a normal viral load by 2020.

HIV: rising tests and HIV positive discoveries down #sida 👉 https://t.co/p2aqeHIP98 pic.twitter.com/RmxXi3XEif

"Strong remobilization is needed"

Three goals that France is far from achieving. Firstly because the epidemic does not decline among French homosexual men. Secondly, because we find that among foreign-born women and men, particularly in sub-Saharan Africa, who for many are infected in France and not in their country of origin, contrary to popular belief, infections do not occur. do not fall either.

It is estimated that around 6,400 new HIV cases are detected each year in France. A "stable" figure, according to the study. However, significant declines have been described for several years abroad, in cities and countries with similar contexts in France, says the CNS document. "Strong remobilization is needed at the national level," say the study.

It seems that the first shortcomings of the preventive policy appear from the collection and the diffusion of the data. The statistics of the National Health Agency (ANS) and the Regional Health Agencies (ARS) are insufficient and very uneven depending on the territories. However, the fragility of these results does not make it possible to set up an appropriate public policy. "And the more we seek to have targeted information on cities and neighborhoods in particular to implement prevention operations, the more the data are unclear and uncertain", regrets Nicolas Derche, SOS group.

Simplification of the screening circuit

Beyond the lack of statistical data, "it should also simplify the screening circuits," says the director. By increasing the access to traditional blood tests, rapid orientation tests (TROD) proposed by associations and extending their delivery to pharmacists and general practitioners. The "Labo sans ordo" experience in Paris and the Alpes-Maritimes, which gives access to HIV tests in the city laboratories, without prescription and at no cost, to the insured persons and holders of the MEA, could, if it is conclusive, to be generalized.

There are also legal obstacles, according to many NGO observers. "The ability to do self-tests and send its results by mail to receive its results by SMS, as is done in London, is very efficient and fast but is not allowed by French law", underlines Nicolas Derche. However, the more we facilitate the process, the more we will amplify the screening.

Migrants, who are particularly vulnerable to HIV, "are more concerned about their survival than about their health, but it is precisely because they are precarious that they are more exposed to the virus," he said. Many women engage in risky sexual practices for accommodation or because they are at risk.

More means, so more results

Still in the legal field, the law that penalizes prostitution clients has further weakened sex workers. "Prostitutes must now practice outside the cities, most often in the woods to satisfy customers who are anxious not to be arrested, so they are moving away from the places where the screening possibilities are," says the activist. Moreover, since the law is passed, there are fewer clients. Prostitutes therefore have no choice but to satisfy the ever-increasing demands for unprotected sex.

Good news all the same in this dark picture. In Nice, where an ambitious anti-HIV policy has been put in place, spectacular changes have been noted: a 40% decrease in infections was noted in Nice in 2018. "Sign that when substantial resources are put into place, the results are there, "enthuses Nicolas Derche.

Unsurprisingly, community leaders intend to take advantage of the CNS report to demand additional human and financial resources. At the risk of recalling evidence: "Wherever screenings are distributed, it takes arms to do it."