HIV: the notion of at-risk groups coming back into fashion?

[10 August 2009 - 11h12]
[mis à jour le 14 September 2009 à 16h53]

HIV – the notion of at-risk groups coming back into fashion?

After literally being written off in the second half of the 1980s in the name of political correctness, the notion of at-risk groups is now making a comeback in the fight against HIV.

Needs must, as they say: the most recent UNAIDS report shows clearly that the pandemic is far from being kept under control. In the more disadvantaged countries, the number of sufferers is increasing more rapidly than the number of patients being treated. In other countries, such as France, more and more cases are being screened at the clinical AIDS stage of the disease. Jean-François Delfraissy, director general of the French National Agency for AIDS Research (the ANRS), points out “that for every minute during which one patient is placed on antiretrovirals, 2.6 new cases of infection occur. In total, 2.8 million additional cases each year across the world.”

Efforts aimed at prevention must be reintroduced – how long is it since you last saw an AIDS prevention message on your television screens? – and at-risk groups must be better targeted. At the 5th International AIDS Society (IAS) Conference in Cape Town, South Africa, the warning message was general.

Combating the trivialisation of HIV…

“Even though they may have shown their limitations, messages to raise awareness must be pursued”, stressed Delfraissy. "Circumcision only reduces the risk by 50% to 60% but it must continue to be recommended. And in the countries of the North, the epidemic continues, particularly among young homosexuals. What’s new is that people can talk about it”. Professor Jean-Michel Molina of the Saint-Louis University Hospital, Paris, points out that “in gay environments people know who is HIV positive. They seem fine and so people think ‘it’s really not so bad …’ Yet thanks to programmes targeting drug addicts we no longer have new cases among this group. But we do have this problem with the gay community and with certain migrant communities.

Jean-François Delfraissy points out that today, “there is consensus in Europe in estimating the prevalence of HIV(among this population) at between 7% and 8%. It is therefore essential to create new approaches to screening.” Experience tells us that what is needed is systematic screening and indeed preventive treatment aimed at specific population groups, ie young homosexuals and the prostitution environment.

There must also be a return to people taking responsibility for their behaviour. Any at-risk behaviour must, of course, lead to precautionary screening. But identifying HIV must also become part of biological testing. At least once during one’s life, more if necessary. Professor Molina estimates that in France alone, over 30,000 people who are HIV positive are unaware of it. He also deplores the fact that roughly 30% of sufferers are diagnosed in hospital at the clinical AIDS stage.

This is confirmed by Professor François Raffi. In his unit at Nantes University Hospital he receives “1 to 2 new patients each week. My last two patients were 55 years old. They were married and came for a consultation at the clinical AIDS stage. To have reached this stage today, they must have been infected between 8 and 15 years ago…”

Source : from our special correspondents at the 5th IAS Conference, Cape Town, 19-22 July 2009; interviews with Professor Jean-François Delfraissy and Professor Jean-Michel Molina, 19 July 2009, and with Professor François Raffi, 22 July 2009.

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