Washington (AFP)

This is the paradox of great containment: if it slows down the spread of the new coronavirus, it could indirectly help another virus, HIV: the absolute priority given to Covid-19 had the collateral effect of weakening the edifice of prevention on which the war on AIDS is based.

Travis Sanchez, epidemiologist at Emory University, interviewed a thousand men who have sex with men online in early April, and half of them reported a decrease in the number of their sexual partners, and reduced use. dating apps.

But Travis Sanchez immediately adds worrying information: a quarter say they have problems getting tested because of the closure of thousands of screening sites. Those who continue with the evening plans therefore find themselves in the dark about their status - a potential time bomb.

"It is very likely that risky behaviors will resume before prevention services have fully reopened," worries the researcher. "This conjunction could lead to more HIV infections."

The impact of the pandemic on HIV will not be known until next year, when the Centers for Disease Prevention and Control (CDC) will publish infection figures for 2020.

But multiple experts and public health professionals fear a relaxation, a year after the United States set the goal of reducing the number of new infections by 75% by 2025.

In Washington, a city very affected by HIV, the Whitman Walker clinic had to close the daily walk-in reception for screening for this virus and other sexually transmitted infections (STIs): syphilis, gonorrhea, chlamydiae.

About fifty people came before to be tested every day, including many gays, for whom it was the routine, every three months.

"All of these people are no longer being tested," says Amanda Cary, a specialist nurse who continues to see symptomatic patients, by appointment only. "I am sure there will be a rise in STIs."

The CDC says AFP expects a short-term drop in STI diagnoses, but "a long-term increase once restrictions are lifted and more people are tested." For HIV, site closings "could cause more infections" in the long term.

- Everything can change -

In San Francisco, medical researcher Matthew Spinelli is concerned about the homeless, those who no longer have telephone or internet credits to teleconsult.

"People are afraid to go to the hospital right now, it worries me," said the doctor, who practices at the large local public hospital.

His unit also tracks 3,000 people with HIV. He fears that in the chaos of the pandemic, some will no longer go to the pharmacy or no longer take their pills every day, which would boost their viral loads and make them contagious.

"I am afraid that their psychological health will deteriorate in the current environment, or that their drug addiction will worsen," he said.

In the United States the preventive treatment PrEP, which makes it possible to avoid almost 100% of being contaminated, has developed but according to Matthew Spinelli, some stopped it during confinement. Will they resume then? "I predict that, ultimately, the HIV epidemic will worsen," he said.

But by forcing professionals to improvise, the pandemic will also change lastingly, for good, prevention practices. Telemedicine will become commonplace.

Syringe exchange sites already distribute more syringes at once, or even deliver or send them by parcel.

Home HIV tests, which have been around for years but are little used, will grow, says Stephen Lee, director of Nastad, an association of public health officials specializing in HIV. The CDC is encouraging him and Florida and Tennessee are considering it, he told AFP.

"The pandemic has shown us that we can and must do it," he said.

© 2020 AFP