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Awareness-raising campaign on the prevention of AIDS with this release of balloons at the São Paulo Hospital in Brazil, November 29, 2019. REUTERS / Amanda Perobelli

This Sunday, December 1st, is World AIDS Day. An epidemic that according to a UN-AIDS report reached in 2018 nearly 38 million people in the world. This day is traditionally an opportunity to focus on the evolution of the disease and the importance of prevention.

HIV-related deaths in 2018 have dropped to about 770,000, one-third less than in 2010, according to UN-AIDS figures, and some 37.9 million people are currently living with HIV worldwide.

Continued increase in Eastern Europe and Asia

While worldwide new infections have fallen by around 40% since the end of the 90s, in Eastern Europe and Central Asia, on the contrary, this figure continues to increase. As proof, in the last six years, 30% of new cases have been recorded in the region. There are several reasons for this, explains Professor Michel Kazatchkine, UN Special Envoy on HIV / AIDS in the region. " The first (reason) is that it was an epidemic that began in the mid-1990s, in a region of social and economic disarray, where there was a huge wave of intravenous drug use. And we know that people who inject drugs are twenty-two times more likely to become infected with HIV than the general population and a thousand times more likely to become infected with the hepatitis virus than the general population. .

And then, this epidemic has fallen in countries where health systems were still - and are still in transition - without any connection. The doctors were not prepared. For them, it was a disease of the West and Africa.

The health authorities had no budget, a scientific disarray, and overall, a social and governmental reaction of rejection, of discrimination, which made that, people belonging to the groups most at risk have a very bad access to diagnosis and care. Put all these factors together and you have an epidemic that is still not controlled .

A new effective prevention tool : PREP

Some 24.5 million HIV-positive people were receiving anti-HIV treatment in mid-2019, about two-thirds of the world's HIV-infected population, according to UNAIDS. This represents an increase of 1.2 million in the number of people treated in six months, but there is still work to be done to reach the target of 30 million by the end of 2020.

Among the avenues for prevention , while condom use remains a very effective prevention tool, there are others with a more medical approach. This is particularly the case with PREP: pre-exposure prophylaxis. For Professor François Dabis, director of the National Agency for Research on AIDS (and viral hepatitis), it is a method too little used while it gives good results . " It's about giving antiretroviral drugs to people who are negative, who do not have the HIV virus, but who take risks and who for various reasons do not go, or at least not enough, take The preservative.

And the PREP is going to be incredibly effective, in the order of 95%, to prevent transmission, if you have an HIV-positive partner. PREP is now registered in most countries, it is included in most prevention programs, but it is still too much, too little used.

In Africa, it is used very little. First, it has been a short time for programs to fund it. It is still less time that health professionals have been properly informed and organized to provide these services . "

In addition, information is starting to circulate in communities that could benefit from this preventive treatment.

See also : In the Central African Republic, living with AIDS when you are young

This member of Lubumbashi's LGBT community is no longer in hiding. For him, the fight against AIDS without a focus on prevention will not succeed. Testimony.

In the DRC, poor support for the LGBT community affects the entire fight against HIV. Report 01/12/2019 - by Denise Maheho Listen

Huge progress but ...

I'm moderately optimistic, says Professor Dabis, " because having already tracked more than two-thirds of the people who live with the virus and treated more than half of it is a huge improvement that is not always appreciated. it has been difficult and how much now is successful.

Now, what I perceive is that if we do not move up a ladder yet, we risk losing some of the benefits we have to win, if only because we are dealing with twenty and soon Thirty million people for life is something incredibly complex, incredibly heavy and incredibly expensive.

So that's why research must continue to find solutions to prevent new infections, even more effectively than what we have now. And on the other hand, try to cure some of the people who live with this virus. If not, it is true that this goal that we set, to control the epidemic in 2030, it remains today a goal that we will have trouble reaching .