The advent of treatments and the significant drop in deaths due to AIDS has lessened the tragic dimension of the HIV infection epidemic. Some efforts to prevent transmission of the virus have been successful (drug users, blood transfusion, mother-to-child virus transmission), but transmission during unprotected sexual intercourse remains high.
The National AIDS Council (NAC) has therefore chosen to focus on how public policy on prevention should be organised to identify the remaining obstacles. The State’s commitment is currently not enough, whether with regard to the importance given to the fight against HIV in healthcare policy, or the consistency of the government’s action in the area.
The number of people living with HIV is growing with time. A transmission prevention policy needs to make it possible to prevent people from becoming infected by HIV and prevent those already infected from transmitting it. To improve this policy, the NAC has set forth a set of recommendations following its report on public policy on prevention in mainland France.
The NAC would like prevention policy to be supported by the entire State system and that it should come alongside powerful public communication. The Ministry of National Education needs to take action to ensure that sex education and prevention as called for in the government circular are integrated into school curricula. Over these past few years, the Domestic Security Act has deteriorated relations between the police forces and field players. It is essential that the enforcement of the Ministry of the Interior’s policies not be an obstacle to prevention in the most vulnerable populations: prostitutes, migrants and drug addicts. As for regulations on penitentiary establishments, they need to offer the incarcerated the means for protecting themselves, in particular by offering real access to the full range of risk reduction tools.
The State’s commitment will also mean determined action in favour of those most exposed to risk of transmission: young people, women and migrants from sub-Saharan Africa. In addition, high-risk behaviours are reaching a worrisome level amongst the gay population. For this reason, prevention campaigns need to be more frequent and give a more realistic image of HIV infection: lifelong medical treatment, permanently altered sexual relations due to worry over prevention, the difficulty of living with HIV on a day-to-day basis in a condemnatory society. Consequently, different messages need to be devised, for HIV-positive and those without HIV.
Lastly, a State that relies on associations to implement field actions needs to be able to deal with their absence when necessary. It also needs to foster knowledge-sharing about prevention by organising a consensus conference or public hearing about risks. This should make it possible for associations to achieve a foundation for consensus-seeking about prevention.