Public health, global health, population health, all frameworks for reflection and action which should have made it possible for more than 40 years to eradicate the human immunodeficiency virus (HIV). And yet. Instead of celebrating victories, each year World AIDS Day reminds us of the shortcomings of our interventions that leave the most vulnerable people behind. Why are our so-called developed countries so limited in their scope when the means to stop HIV are known: screening and treating early makes the viral load undetectable and prevents transmission of the virus, prescribing pre-exposure prophylaxis (PrEP) to avoid to contract the virus.
Several factors are fueling this slowdown. The situation is no longer as urgent as it was 40 years ago, HIV has become a chronic disease in rich countries, it no longer scares, people no longer die from it, it is no longer fashionable and it no longer creates a sensation in the media. However, by the end of 2022, there were an estimated 39 million people living with HIV, 1.3 million new cases despite increased access to treatment, and 630,000 people dead from HIV-related causes. AIDS still kills.
In Quebec, it is clear that the situation has not improved in recent years. Thus, the available figures show that in 2021, 54.4% of new diagnoses among men who have sex with men (MSM) had never been screened before. MSM are the category most affected by HIV and, despite everything, more than half of them have never been screened. Lack of sex education? Absence of prevention campaign? So many elements that slow down eradication.
The negative findings do not stop there. One of the indicators of the health of a person living with HIV is their immune system. The immune system can be assessed by the number of CD4 cells. If the CD4 count is low, it means the immune system is weak. However, the proportion of MSM whose CD4 count is less than 350 increased from 32.5% in 2019 to 45.2% in 2021. These are late diagnoses and as long as the person is not treated, the risk transmission of the virus exists. These are facts that should alarm public health and propel HIV prevention to priority status.
Other sectors show disappointing results. This is the case with pre-exposure prophylaxis (PrEP), which has existed since 2011 and which reduces the risk of contracting the virus by up to 97%. Underuse of PrEP amounts to not using a vaccine that would be available (which is not yet the case). PrEP remains little known among many health professionals, particularly in the regions. This is a major tool to help eradicate HIV and its prescription is restricted due to lack of information. We can do better!
For several years, those involved in the fight against AIDS have had to deal with the arrival of migrants. In 2022, almost half of the cases reported in Quebec were of origin other than Canadian. Caring for migrants requires flexibility and resources. Most of the time, these people learn their HIV status at an immigration clinic where they will take the medical tests necessary to obtain their residence permit.
Having just arrived in a new country whose codes they do not know, with a past often fraught with violence, they learn that they have an illness that cannot be cured, which adds to the language barrier and the burden of needs. basic necessities, food, accommodation, etc., plunging them into a situation of precariousness and dramatic vulnerability.
Poverty, stigma, racism, homophobia, transphobia, lack of self-esteem are all harms that harm the health of individuals. The fight against social injustices and for respect for rights helps improve overall health. Nevertheless, these struggles represent major challenges which, to be met, must rely on sustained will and multidisciplinary approaches which, over time, make it possible to reduce access barriers.
Conversely, if we do not take effective measures, HIV persists and in turn fuels prejudice and discrimination. These are poor observations that we repeat year after year and which reflect the trivialization of HIV. It is unacceptable that HIV has taken a back seat. HIV must remain a public health priority: it can be eliminated, what are we waiting for to take the means?