The National AIDS Council (CNS) welcomes the publication by the French National Authority for Health (NAH) of a set of proposals to redefine measures and policies regarding screening for HIV infection in France. The NAH proposals coincide in every respect with the recommendations of the CNS in its November 2006 report, “The evolution of HIV screening programmes in France”, and they should lead to more effective screening measures — an element that will be indispensable if we are to reduce the incidence of the HIV epidemic. Greater priority on screening is vitally important: an estimated 40,000 people do not know that they are seropositive for HIV, and more than half the people who are newly diagnosed receive this diagnosis well after the period currently considered to be optimal for onset of treatment. This delay in screening is not simply a loss of therapeutic opportunity for the people involved. It is also a missed opportunity for limiting the transmission of the virus. Knowledge of one’s serological status is clearly an important factor in adopting prevention behaviour; additionally, treatment strongly reduces the risk of sexual transmission of HIV.
France’s screening policy was set up in the late 1980s and has never been significantly modified since that date, despite significant evolution of the epidemic and the appearance of effective treatments – elements that have radically altered the significance of screening for the individual and, more widely, for society. Over the past few years the CNS has noted aspects of screening programmes that are poorly adapted to current conditions, and has defined a series of perspectives for reform. These recommendations have been validated today by the work of the NAH, whose proposals should, therefore, be put into practice by the authorities as swiftly as possible.
Because of the complexity of the issues involved, the CNS wishes to clarify any confusion regarding the generalisation of screening. The goal of systematic proposalofscreening tests to the entire sexually active population – particularly during contact with the health-care system – is not the same thing as “systematic screening” of the whole population; it is certainly not a synonym for “obligatory screening”. The NAH, like the CNS before it, has clearly reaffirmed the principle that consent to screening must be informed and fully voluntary. This continuing guarantee is a question of the fundamental rights of the persons involved, and is, moreover, imperative from the point of view of public health, since experience has clearly demonstrated that approaches based on voluntary engagement are far more effective than measures based on constraint. The NAH proposal to encourage screening does not call into question the principle of consent. It will, however, contribute to making screening a more ordinary event, one that should become a normal part of medical check-ups.