With 64 HIV discoveries per million inhabitants in 2022, the Paca region comes (very) far behind Île-de-France and its 190* cases. However, it still remains the second region most affected by HIV in mainland France.
So how can we explain such a positioning? Already, mechanically, because screening is also stronger there than elsewhere, replies the vice-president of the Aides en Paca association. And also perhaps because the region concentrates populations whose access to care is complicated, and in particular people in a situation of migration, suggests Céline Offerlé, with whom 20 minutes spoke on the occasion of World AIDS Day, this December 1st.
Where are we with the epidemic in Paca?
Paca remains the second most affected region of metropolitan France, where the only populations for whom diagnoses are not declining are those whose access to health is compromised. Particularly trans people, men who have sex with men [HSH] born abroad or even migrant women sex workers. And we are very worried about the threats weighing on the AME [l’aide médicale d’Etat qui permet aux étrangers en situation irrégulière de bénéficier d’un accès aux soins et qui est discutée à l’occasion de l’examen du projet de loi immigration]. If it were to be removed, it would be a pure disaster for access to screening and care for people who are already very far from it.
And whose diagnosis is very late?
According to the latest data from Public Health France, discoveries of seropositivity are still made late [au stade Sida ou au moins quand le système immunitaire commence à être fragilisé] in 43% of cases, all population categories combined. And this is even more true for these people who have limited access to health services. Being born abroad is in any case correlated with late detection. However, screening is the first lever to slow down the epidemic. When someone is diagnosed, they are almost immediately taken care of and treated. The viral load becomes undetectable and it is no longer contaminating. This has been a scientific achievement since 2011. The treatments have a therapeutic effect for the person concerned, but also a preventive effect for the entire community.
How can we improve support for these audiences?
Aides is in the final stages of experimenting with community-based sexual health centers, precisely there to seek out these people and offer them easier access. There are currently four of these “spots” in France, in Nice, Marseille, Montpellier and Paris, and the idea is to develop them in all major urban centers, where the epidemic is most active. We propose strategies for test-and-treat [tester et traiter]with treatment as early as possible in the context of a positive diagnosis or placement on Prep [le traitement préventif] if it is negative.
How can we explain that the Paca region retains its position as the second most affected region in France?
When we talk about the regions most affected by HIV, we talk about discoveries of seropositivity. So, that also means that we are screening a lot [Paca était également la deuxième région, toujours après l’Île-de-France, à réaliser le plus de sérologies en laboratoire, avec 113 tests pour 1.000 habitants, contre une moyenne nationale de 96]. The more we detect, the more we discover, it’s mechanical. It also means that we track well, that we are not too bad at targeting. We could do a lot of tests and only get negatives, missing the mark. It is not for nothing that we have installed two “spots” in Nice and Marseille. This is where we really have two epidemiological centers. It should also be noted that there are population movements in the region. It didn’t escape anyone’s notice. And people in migration situations are over-represented. They now form a third of the active queue [le nombre de patients infectés par le VIH pris en charge au cours d’une année], particularly in Marseille. It is not necessarily a population which, numerically, is increasing a lot. But it is a population which in any case combines all the factors of exposure to HIV. And if the virus affects a few individuals in that community, it spreads very quickly.
Is Prep, the pre-exposure prophylaxis treatment, clearly effective?
What is certain is that we are seeing a drop in diagnoses and a priori also the incidence among MSM born in France, who represent the vast majority of people who benefit from it. While populations born abroad, and therefore once again less familiar with associative, community and especially health-related environments, are the only ones not to see the number of HIV-positive discoveries drop. These major therapeutic and preventive advances developed and implemented over the last ten years do not benefit all HIV target populations in the same way. There is a gap that is widening.
In 2017, Nice joined Paris in its “Zero AIDS Objective” in 2030. Marseille followed suit. Is this still a realistic objective today?
Yes. It must. We must not give up. It shouldn’t become an element of marketing language either. We must continue to give ourselves this horizon. We say 2030, it will perhaps be 2032 or 2033, but the situation has not changed. We always have the tools to get there. And we are experimenting with devices that can really make a difference. All this obviously assumes that there are not the massive budget cuts that await the associations, that there is not the end of the AME. It all depends on the political context. Public Health France announced that on a national scale, there were between 4,200 and 5,700 HIV-positive discoveries in 2022. And there is no reason why these few thousand cannot be overcome. Otherwise, it will say something about France’s capacity to deal with future emerging epidemics.
*According to the last bulletin published by Public Health France