This decline is primarily due to a decrease in testing in 2020, which may have led to delays in diagnosis and access to antiviral treatments—whose preventive effect has a direct impact on the dynamics of the epidemic. In this context, Santé publique France is relaunching its campaign “Living with HIV means living first and foremost,” which aims to raise awareness of the preventive effect of antiretroviral therapy (TasP) and combat discrimination related to HIV-positive status. By promoting a better understanding of the reality of living with HIV, this campaign also serves as an incentive for testing.

Decline in testing and in the number of HIV and bacterial STI diagnoses

The number of new HIV diagnoses in 2020 was estimated at 4,856, a 22% decrease compared to 2019. With 5.2 million HIV serology tests performed by clinical laboratories, HIV testing activity—which had increased between 2013 and 2019—decreased by 14% between 2019 and 2020. These data should, however, be interpreted with caution, as the COVID-19 pandemic led to a drop in healthcare professionals’ participation in various surveillance systems.

The decline in the number of new HIV diagnoses in 2020 was more pronounced among people born abroad (-28% compared to 2019), 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 access to testing becoming particularly difficult for this population in the context of the health crisis. Among men who have sex with men (MSM) born in France, the decline observed over 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 the initiation of antiretroviral therapy.

A decline in testing was also observed in 2020 for three bacterial STIs (Chlamydia trachomatis (Ct) infections, gonorrhea, and syphilis) of around 6% in the private sector and, more markedly, in Free Information, Screening, and Diagnostic Centers (CeGIDD), of around 30%, due to partial or total closures during the first lockdown.

This decline in testing led to a decrease in the number of diagnoses of these STIs, observed particularly in CeGIDDs and more significantly for Ct infections (-31% vs. -18% for syphilis and -13% for gonorrhea). This difference could be explained by the fact that Ct infections are more frequently asymptomatic and therefore did not lead to a medical consultation in the context of the COVID-19 pandemic.

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—to ensure appropriate care.

"Providing early care to as many people infected with HIV as possible is a public health priority of the highest order. Getting tested is crucial to reducing the time between infection and diagnosis and ensuring early access to treatment, for the benefit of both individuals and the community. Let us remember that antiretroviral treatments allow HIV-positive people to live healthy lives, with restored life expectancy, without fear of developing AIDS and without the risk of transmitting the virus. Continuing to raise awareness through information campaigns is essential to permanently change the way HIV-positive people are viewed. Promoting a better understanding of what life with HIV is really like today also helps remove barriers to testing." Prof. Geneviève Chêne, Director General of Santé publique France.

Promoting the preventive effect of HIV treatment to change perceptions of people living with HIV and remove one of the main barriers to testing

To mark World AIDS Day, Santé publique France is relaunching the campaign “Living with HIV means living first and foremost.” By reminding people that HIV-positive status is not an identity, nor a problem, nor a barrier to romantic relationships, and that people living with HIV who are on effective treatment cannot transmit the virus, this campaign aims to debunk misconceptions to combat stigma and encourage testing.

The campaign, visible starting November 29, includes:

• posters: the five visuals depicting couples and families in carefree moments are aimed at the entire population in all its diversity, with a particular focus on the populations most affected by HIV (MSM, people from sub-Saharan Africa). They will be displayed:

  • outdoors to reach the entire population (bus shelters, storefronts)

  • in local shops

  • in mainstream and community media (specifically targeting MSM and migrants)

• media partnerships (production and distribution of articles on the preventive effect of TASP treatment) in mainstream and community media (press, radio, website)

• testimonials (videos) from people living with HIV who, through a “letter to themselves,” send a message to the person they were when they learned of their HIV-positive status and emphasize the importance of testing.

• articles in professional journals (for general practitioners, dentists, and gynecologists)

"Living with HIV Means Living First and Foremost" Campaign

• Videos:

  • Letter from Nicolas

  • Christine’s Letter

  • Letter from Andrea

The results of the 2021 Sexual Behavior Survey (ERAS) published in the BEH show just how crucial it is to educate the public about TasP. Among the 14,706 respondents included in the analysis—who reside in France and have had at least one sexual encounter with a man in their lifetime—only 60% are aware of TasP.

In the midst of the COVID-19 pandemic, it is essential to continue taking care of oneself. Testing is the only way to establish a diagnosis and access antiretroviral treatments. The earlier the diagnosis, the greater the benefits of treatment—both individually (preserved life expectancy) and collectively (prevention of transmission to others). Testing therefore remains the cornerstone of the fight against AIDS.

That is why, beyond this campaign, Santé publique France is committed year-round to promoting testing through, on the one hand, its social marketing initiatives (regular social media campaigns, radio programs, media partnerships, etc.) and, on the other hand, its partnerships with organizations, which enable long-term community-based initiatives to promote testing for HIV and other STIs and, more broadly, diverse prevention efforts.