Analysis

Routine testing to reduce late HIV diagnosis in France

BMJ 2007; 334 doi: 10.1136/bmj.39225.458218.94 (Published 28 June 2007)
Cite this as: BMJ 2007;334:1354

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  1. Cyrille Delpierre, epidemiologist1,
  2. Lise Cuzin, physician2,
  3. France Lert, researcher3
  1. 1INSERM U558 F-31073, Toulouse, France
  2. 2Unit of Infectious and Tropical Diseases, Hôpital Purpan, Toulouse, France
  3. 3INSERM U687 F-94410, Saint-Maurice, France
  1. Correspondence to: C Delpierre, Department of Society, Human Development and Health, Harvard School of Public Health, Landmark Center, 401 Park Drive, Boston MA, USA cdelpier{at}hsph.harvard.edu
  • Accepted 4 April 2007

Although around half the French population has had an HIV test, many people are still not diagnosed until the disease is advanced. Cyrille Delpierre and colleagues believe the answer is to expand routine testing

Around 130 000 people in France were infected with HIV in 2005. Among the 7000 people newly diagnosed in 2004, 58% became infected through heterosexual intercourse, 29% through homosexual intercourse, and 2% through intravenous drug use. Around half of those infected through heterosexual intercourse came from sub-Saharan Africa.

In France, testing is free in all healthcare settings, and anonymous counselling and testing is provided in dedicated sites all over the country. Besides prenatal routine testing, current policy focuses on high risk groups (men who have sex with men, sub-Saharan migrants) and behaviours (unprotected sex). This policy results in a large number of tests annually. However, around 40% of cases identified are in people with advanced infection, most of whom belong to groups not focused on by the current testing policy. We discuss the consequences of late testing on mortality and spread of infection and recommend expanding HIV testing to all primary care settings.

Testing policy

Since the 1980s, France's institutional framework of HIV testing has been based on wide access to free voluntary counselling and testing, routine testing in blood and tissue donors, and routinely offering HIV tests to pregnant women and to people getting married or entering prison. Since 1997, national and regional information campaigns have been launched to increase the awareness of the potential benefits of early diagnosis. However, these efforts remained mainly focused on people with high risk behaviours. The result of this policy is a high rate of testing, with 82 tests per 1000 population in 2004, the highest rate in Europe after Austria,1 and a positive test ratio of 2.4/1000 tests in 2004. …

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