As France prepares to host the Global Fund Replenishment Conference on fighting AIDS, experts warn against complacency in the global fight against HIV. France leads in some areas of the battle but has some catching up to do in others.
The United Nations Programme on HIV and AIDS released its 2019 Global Update on Tuesday, reporting that of the nearly 38 million people known to have the human immunodeficiency virus (HIV), 14.6 million are still without access to antiretroviral therapy (ART).
Though the report focuses primarily on eastern and southern Africa, the regions most seriously affected, acting executive director of UNAIDS Gunilla Carlsson emphasised that even high-income, more developed nations must continue to be vigilant in their defence against the spread of HIV.
“HIV is not over. The so-called Western world still needs to keep an eye on the key populations: gay men, sex workers, drug users and transgender people,” Carlsson told FRANCE 24. “There is still a need to make sure that these people are not marginalised.”
Peter Ghys, one of the researchers who worked on the UN’s report, echoed Carlsson’s appeal to address certain populations very specifically. He offered the example of the increasingly popular preventative measure Pre-Exposure Prophylaxis. Known by its acronym PrEP, the strategy involves taking daily HIV-fighting medicines that, when used correctly, are proven to be 100 percent effective at preventing infection.
“Overall, our approach to tackling HIV is similar worldwide, but there are certain differences,” Ghys told FRANCE 24. “Much of the transmission in Western Europe is between gay men, which is much less of a concern in southern Africa. So in Europe, increasing access to PrEP is key.”
Awareness isn’t enough
While France is considered one of the leaders in HIV awareness in Europe, alongside the UK, the 2019 Global Update reports that France has yet to reach the top tier of countries who have taken initiatives against HIV. Those countries that have achieved 90 percent awareness of, treatment for and suppression of HIV – known as the 90/90/90 – include both “high-income” countries such as the UK and lower income nations like Namibia.
Though significant efforts have been made in France, co-coordinator of Collectif Sida 33, Maryse Tourne, is unsurprised that France has yet to achieve 90/90/90 status.
“We are always behind Anglo-Saxon countries when it comes to identifying and treating people with HIV,” she told FRANCE 24. The Bordeaux-based collective (AIDS 33) seeks to promote disease prevention and treatment in the city and nationwide.
“General doctors, specialists, all public health workers should be encouraging patients to get tested,” Tourne added. “We need everyone.”
As France looks to boost the percentage of people living with AIDS who are receiving treatment from 83 to 90 percent, according to UN estimates, Ghys noted that Western Europe should be following the same basic strategies promoted by the UN for reducing mortality rates worldwide.
“The most important thing is for all people who have been diagnosed with HIV to start treatment immediately, instead of waiting for their bodily systems to degrade and deteriorate,” he said. “What is true in France and in Western Europe is also the case in Africa. Both populations are dealing with similar issues.”
In terms of practical responses, Ghys underscores that awareness can only be the start of the solution.
“In part it’s awareness, but it’s also condom use, harm reduction for drug users, circumcision and PreP,” he said. “Stopping the spread of AIDS is related to scaling up all those programmes.”
'But what about women?'
The UN estimates that approximately 170,000 adults and children are living with HIV in France, with an estimated 30,000 of whom (17.6 percent) are not on the lifesaving ART treatment.
One French study conducted in 2006 estimated the population of MSM, or men who have sex with men, in France to be 330,000. Less than half of those men (44.5 percent) regularly use condoms, according to the European Centre for Disease Prevention and Control, which likely contributes to the 14 percent of MSM with HIV, compared to 0.3 percent of the general population.
“There has been a drastic decrease in government funding for contraceptives … it’s concerning,” said Tourne. “PrEP is effective, but it’s not a substitute for contraception.”
The EU estimates that 86 percent of French MSM are aware that they carry HIV, and 78 percent are receiving antiretroviral therapy. However, there is far less data available on the 45,000 women (age 15 and over) living with the virus in France.
“Females are always forgotten when we talk about HIV,” Tourne said, emphasising that more attention should be paid to sex workers, a high-risk population that is predominantly female. “PrEP is very effective at preventing infection in men, but what about women?”
With her organisation, Tourne often does testing “in the field”, seeking out people at high risk for infection and offering them free screenings. However, she notes that France needs to go further if it wants to become HIV-free.
“There are too many people with HIV in France who remain undiagnosed, who are carrying viruses or diseases and don’t even know it,” Tourne insisted. “We have to establish more testing and consultation centres – ones located in high-risk areas, that stay open late, and that can respond appropriately to the needs of those at risk.”
‘The last mile’
The Global Fund to Fight AIDS, Tuberculosis and Malaria announced last May that France would host the sixth annual Replenishment Conference in Lyon this October. The goal of the conference is to raise money to fund projects that are part of the United Nations political declaration on ending AIDS, made by the UN General Assembly in 2016.
“We are extremely grateful to President [Emmanuel] Macron for leading efforts to renew and expand our impact, to the benefit of millions of people,” said Peter Sands, executive director of the Global Fund, in a statement.
As one of the founding partners of the Global Fund and its second-largest donor, France has been called a “pioneer” in its efforts to combat the AIDS epidemic worldwide, but UNAIDS workers are clear that the financial gap remains significant.
“The gap between the resources available and the resources estimated to be needed is slightly over $7 billion (€6.2 billion),” explained Ghys. “In 2017, it was around $6 billion, so the amount of available resources is decreasing. That is not the direction that the world should be going when it comes to support for AIDS. It is an issue of global solidarity.”
UNAIDS Director Carlsson is adamant that the Global Fund’s goal of ending the AIDS epidemic by 2030 is still achievable, but says that people have to remain dedicated to the cause.
“It is possible to control AIDS. We know what works, but we need to walk the last mile together,” she said.
“We all have to galvanise and make sure that we don’t stop supporting low-income countries too early. We committed to ending AIDS worldwide, and we owe it to them to keep that promise.”