HIV infection

• In 2021, 5.7 million HIV serology tests were performed by clinical laboratories. HIV testing activity, which had decreased by 13% between 2019 and 2020 due to the COVID-19 pandemic, increased again in 2021 (+8% compared to 2020), though it did not return to 2019 levels.

• The number of new HIV-positive diagnoses in 2021 was estimated at 5,013 [95% CI: 4,530–5,497], a figure stable compared to 2020. This stability follows a sharp decline between 2019 and 2020 (-22%), explained in part by reduced testing activity, but possibly also by lower exposure to HIV due to social distancing measures and a decline in migration flows, particularly from sub-Saharan Africa.

• Among those who learned of their HIV-positive status in 2021, 51% are heterosexual (36% born abroad and 15% born in France), 44% are men who have sex with men (MSM) (32% born in France and 12% born abroad), 2% are transgender individuals infected through sexual contact, and 1% are people who inject drugs (PWID). Less than 1% are children under 15, primarily infected through mother-to-child transmission.

• The number of new HIV diagnoses remained stable in 2021 regardless of the mode of transmission and place of birth (France vs. abroad) of those diagnosed.

• In 2021, 29% of HIV infections were diagnosed at an advanced stage of infection, a proportion that has not decreased in several years. This represents a missed opportunity in terms of individual care and a risk of HIV transmission to partners before the start of antiretroviral treatment.

Chlamydia trachomatis infection

• In 2021, 2.3 million people underwent at least one reimbursed screening for Chlamydia trachomatis (Ct) infection, representing a screening rate of 42 per 1,000 inhabitants. After a decline in 2020, the screening rate rose again in 2021, reaching a level higher than that of 2019 (+9%). More than two-thirds of those tested were women (70%).

• The number of Ct infection diagnoses in private laboratories also increased again in 2021, by 9% compared to 2019.

• The majority of patients diagnosed in primary care in 2021 were women (55%), whereas at CeGIDD (Free Center for Information, Testing, and Diagnosis), the majority were men (60%). However, regardless of the location of diagnosis, the vast majority of patients had been infected through heterosexual intercourse (approximately 80% of them).

• Among the Ct-positive anorectal samples analyzed in 2021 by the National Reference Center (CNR) for Bacterial STIs, the prevalence of lymphogranuloma venereum (LGV) was 17%, an increase compared to 2020 (13%).

Gonococcal infection

• In 2021, 2.7 million people underwent at least one reimbursed screening for gonococcal infection, representing a screening rate of 49 per 1,000 inhabitants. After a decline in 2020, the screening rate rose again in 2021, reaching a level higher than that of 2019 (+6%). Three-quarters of those tested were women.

• Since 2016, the number of gonococcal infection diagnoses has been rising in CeGIDD, with a more pronounced increase among men.

• MSM account for the majority of cases (70% in CeGIDD and 53% in general practice).

Syphilis

• In 2021, 2.8 million people underwent at least one reimbursed syphilis screening, representing a rate of 51 per 1,000 inhabitants. After a decline in 2020, the screening rate rose again in 2021, reaching a level slightly higher than that of 2019 (+3%). Two-thirds of those tested were women.

• The number of syphilis diagnoses in CeGIDD has remained relatively stable since 2016.

• MSM account for the majority of cases (78% in CeGIDD and 73% in general practice).

Against a backdrop of steadily increasing HIV and bacterial STI testing activity through 2019, a decline was observed in 2020, linked to the COVID-19 pandemic. In 2021, a resurgence was observed for all these screenings, allowing bacterial STI testing to return to 2019 levels, though HIV testing remains below 2019 levels. It is therefore important to re-engage healthcare professionals and key populations on the importance of combined testing for these STIs. Early testing of individuals and their partners, followed by prompt initiation of treatment, is essential to interrupt transmission chains.

Furthermore, following the sharp decline in the completeness of surveillance data in recent years, this must be improved to ensure robust indicators are available at the national and regional levels, which are essential for monitoring the 2017–2030 National Sexual Health Strategy.