Key Points

HIV Infection

• In 2020, 5.2 million HIV serology tests were performed by clinical laboratories. HIV testing activity, which had increased between 2013 and 2019, decreased between 2019 and 2020 (-14%), due to a significant drop in testing during the first lockdown in the spring of 2020.

• The number of new HIV diagnoses in 2020 was estimated at 4,856 [95% CI: 4,481–5,231], representing a 22% decrease compared to 2019. This decrease in the number of HIV diagnoses can be explained in part by reduced testing activity. It could also be due to lower exposure to HIV linked to social distancing measures, which were most likely limited to the first lockdown.

• Among those who learned of their HIV-positive status in 2020, 43% were men who have sex with men (MSM), 38% were heterosexuals born abroad, 16% were heterosexuals born in France, 1.5% were people who inject drugs, and 1.5% were transgender people, all of whom were infected through sexual contact.

• The decline in the number of new HIV diagnoses in 2020 was more pronounced among people born abroad (-28%), regardless of their mode of transmission, than among those born in France (-14%). In addition to declining migration flows, this decrease can be explained by the fact that access to testing became particularly difficult for this population in the context of the health crisis. Among MSM born in France, the decline observed over the past several years continued in 2020 (-15%).

• In 2020, 30% of HIV infections were detected at an advanced stage of infection, which represents a missed opportunity in terms of individual care and a risk of HIV transmission to partners before starting antiretroviral treatment.

Chlamydia trachomatis infection

• In 2020, 2.3 million Chlamydia trachomatis (Ct) tests were performed by private laboratories and approximately 258,000 at CeGIDD, representing decreases of 6% and 30%, respectively, compared to 2019.

• Between 2019 and 2020, the number of Ct infection diagnoses decreased by 8% in the private sector and by 31% in CeGIDD. The positivity rate in CeGIDD remained stable over these two years, at around 7%.

• The majority of patients diagnosed in general practice in 2020 were women (54%) and heterosexual individuals (75%).

• Among Ct-positive anorectal samples analyzed in 2020 by the National Reference Center for Bacterial STIs, the prevalence of lymphogranuloma venereum (LGV) was 13.4%.

Gonococcal infection

• In 2020, 2.1 million gonococcal screenings were performed by private laboratories and approximately 254,000 at CeGIDD, representing decreases of 5% and 28%, respectively, compared to 2019.

• Between 2019 and 2020, the number of gonococcal infection diagnoses decreased by 13% in CeGIDD, and the positivity rate rose from 3.2% to 3.9%. This rate was higher among men (5.8%), particularly MSM, and transgender individuals (6.3%) compared to women (1.2%).

• The majority of patients diagnosed in primary care in 2020 were men (77%), 54% of whom were MSM.

Syphilis

• In 2020, 2.4 million syphilis tests were performed by private-sector laboratories and approximately 2,500 at CeGIDD, representing decreases of 6% and 31%, respectively, compared to 2019.

• Between 2019 and 2020, the number of syphilis diagnoses decreased by 18% in CeGIDD, and the positivity rate rose from 1.2% to 1.4%. This rate was higher among MSM (2.4%), whether born in France or abroad, compared to heterosexual men (0.4%) or heterosexual women (0.3%).

• All patients diagnosed in primary care in 2020 were men, 85% of whom were MSM.

Impact of the SARS-CoV-2 pandemic on HIV and bacterial STI testing

• The decline in testing rates in 2020, observed for both HIV and bacterial STIs, raises concerns about delayed diagnosis and increased circulation of these infections. It is therefore important, in the current context of the ongoing SARS-CoV-2 epidemic, to encourage the public to utilize the healthcare system, and in particular to take advantage of all available screening options, in order to ensure appropriate care.

• Furthermore, it is essential to improve the completeness of surveillance data—which has deteriorated significantly over the past two years—in order to have robust indicators at the national and regional levels, which are indispensable for monitoring the 2017–2030 National Sexual Health Strategy.