Reduction of new infections and deaths on a global scale, more effective prevention, more effective treatments… The fight against HIV and AIDS is progressing, although the end of the epidemic still seems far away, a few days before the international day against the disease, on Sunday (December 1).

In the years 2010, the number of new infections from the virus that causes the acquired immune deficiency syndrome (HIV) fell by a fifth on an international scale, according to data published by the scientific journal The Lancet HIV.

Deaths – generally caused by random diseases, after AIDS has now manifested itself, in the final stage of infection – have fallen by about 40% and have now fallen well below the one million mark.

This trend is attributed above all to the improvement in the situation in sub-Saharan Africa, the region of the world affected by far more than any other by the AIDS epidemic.

However, the picture becomes much darker when the eye turns to infections, which are increasing in other regions, such as Eastern Europe and the Middle East. The world is a long way from the UN’s goal of essentially eliminating the epidemic by 2030.

Basic weapon of “pre-exposure prophylaxis”

Something experts agree on: prevention, treatments such as so-called PrEP (“pre-exposure prophylaxis”) are becoming increasingly important in the fight against the pandemic.

For people who are not carriers, but have behaviors considered high risk, they have an excellent effect in preventing infection.

Experts are thus pushing to expand PrEP. In France, health authorities consider that PrEP should no longer be recommended only for men who engage in same-sex relationships.

These pills “are something that every man who needs it at some point in his sexual life can use,” said infectious disease expert Pierre Delobelle during a press conference organized by the ANRS institute.

People who are already infected have increasingly effective and practical treatments available, especially because they need to be taken less often.

However, the availability of treatments, preventive and non-preventive, is hampered by various factors. This is especially true for the poorest countries, such as those in Africa, where drug costs remain a problem.

New formulation has fueled the war to a great extent in recent months. The pharmaceutical company Gilead has a drug with the active ingredient lenacapavir (Lenacapavir in English), promising unprecedented effectiveness in prevention and treatment.

Experts believe that it could change the data, but the cost his is astronomical: $40,000 per person per year.

Under pressure from AIDS campaigners, Gilead promised in early October that it would allow generics to be made at a reduced cost by drug companies to be made available in poorer countries.

However, the barriers are not only financial, especially when it comes to preventive treatments. The idea of ​​using them without must also be accepted fear of stigmatizationwhile behaviors such as homosexuality are considered unacceptable or illegal in various countries.

Wider use of PrEP in Africa faces the major challenge that “people at high risk need to be aware of and recognize it,” summarized a 2021 article published in the journal Lancet Global Health.

Exactly the same problem exists in early detection and diagnosis, which is particularly important as many infections are not detected until an advanced stage, which complicates treatment.

Some issues attract medical attention to a degree that may seem disproportionate. Vaccine research, for example, has not really yielded any convincing results to date.

But, given the effectiveness of preventive treatments, “isn’t it almost like having a vaccine?” asked Yazdan Yazdapana, head of ANRS, a French institute that has pioneered the fight against AIDS, in mid-October, adding, however, that “research to (develop) a vaccine must not be stopped.”

There have been a few cases in recent years where complete remission or cure has been found; less than ten in all. Although spectacular, they were due to stem cell transplants, a risky treatment only applicable in special cases