Alain Makinson, professor at the Montpellier University Hospital, takes stock of the situation in the territory.
In Montpellier, how many people are infected with HIV?
Since 2017, there has been a significant drop in the number of HIV diagnoses, especially among MSM (men who have sex with men). But we are not able to completely extinguish this transmission, despite the structuring of prevention and PrEP (preventive treatment which makes it possible to reduce the acquisition of the virus close to 100%). So currently we must be at about sixty diagnoses per year, against a hundred ten years ago.
What are the brakes?
There is a big accompaniment, so to speak, which is done. That is to say that among MSM, who are a more informed public, we have been more effective in terms of prevention. Afterwards, it is still a little more difficult to do prevention in populations that are less informed, more precarious but above all further away from care. Like foreigners, who are often more exposed. When they come to France, they are often negative. But they are in a social environment which means that, in their community in France, there is a higher prevalence, and therefore a higher number of cases of HIV. And so it increases the probability of acquiring the virus. Among young people who return to their sexuality or sex workers, here too there is prevention work to be done.
But if the number of diagnoses decreases, it is because the number of screenings increases, doesn’t it?
It increases yes. There is this “Go to” strategy to qualitatively and quantitatively reach this more exposed audience. That is to repeat the screenings. So the associations will seek out these people. That’s a first strategy. The second strategy is to finally trivialize screening for everyone. But there was a disaster, it’s the Covid.
Did it drop the number of screenings?
Indeed, the screening percentage fell by 14% in 2020 nationally. And we have not yet caught up with this delay. So we think there is an underdiagnosis of the numbers. And among foreign-born people, screening, 2020 compared to 2019, was down 28%. So we can clearly see that there are groups where it has gone down more than others. So maybe there are more people who don’t know they’re infected, who haven’t been tested, especially among people who are far from treatment.
In Montpellier, there is this desire, by 2030, to achieve the zero AIDS goal. Are there still many people dying of AIDS today?
AIDS is a complication of HIV. The virus attacks the white blood cells which weakens the body and diseases benefit from it. People will be immunocompromised. So those who die of AIDS die indirectly from the infections that come to light. And nationally, the number of people who turn out to be directly affected by AIDS is 30%. In Hérault, this percentage is 21%, because there are more MSM and therefore better screening. Our strategy is therefore to limit new infections and transmission as much as possible.
Can you recall the different solutions to achieve this zero AIDS objective?
There is screening, PrEP therefore, but also diversified prevention with condoms, vaccination against STIs (sexually transmitted infections, editor’s note) and treatments.