Sophie Le Coeur

Thailand was the first Asian country severely hit by the AIDS epidemic, in the late 1980s. More than a million persons have been infected there since the onset of the epidemic, and it has had major demographic consequences: half a million people have died, above all young adults, in a population of slightly over 60 million. In addition to prevention campaigns targeting the public at large, there is a government-run program to combat AIDS based on the understanding that together with patient treatment and anti-discrimination measures, research-clinical, epidemiological, but also social science research-is fundamental to combating the disease. Thanks to this government program, and active application of research results, Thailand is one of the few countries to have reversed the epidemic trend-as early as the mid-1990s. Thailand’s battle against the epidemic may therefore be considered exemplary-a model.
INED has been involved in research studies with the IRD (Institut de Recherche pour le Développement) to improve strategies for preventing mother-to-child transmission of HIV. The research results were applied immediately in Thailand, thereby considerably reducing the number of children born with HIV. What’s more, our results have provided the basis for WHO recommendations to countries with limited resources. INED is also participating in programs for optimising adult and child treatment for HIV.
Lastly, INED and the IRD have initiated a research project funded by Sidaction, for assessing the living conditions of teenagers born HIV positive in Thailand. Being HIV-positive makes adolescence a particularly painful time of life. How are these young people to deal with their new sexuality? How can they acquire the self-confidence needed to start out in adult life when they are so often stigmatised? How can they overcome the effects or after-effects of the disease? It happens that young people entering adolescence stop taking their medication and so endanger their own lives, as shown by the jump in mortality observed for this life period.

In its 2012 report, UNAIDS estimated the number of HIV-infected persons in the world at 35.3 million, 25 million of whom are in Africa and slightly under 5 million in Asia. Also in 2012, there were an estimated 2.3 million cases of new infection (33% less than in 2001) and 1.6 million deaths.
According to data from France’s Institut de Veille Sanitaire (InVS), there were approximately 150,000 persons living with HIV in France in 2012. Of the 6,100 persons who discovered they were HIV-positive that same year, 40% were men who had had sexual relations with men. The hardest-hit regions were Ile de France, the Côte d’Azur and French Guyana.

Antiretrovirals have dramatically reduced HIV/AIDS-related morbidity and mortality, turning HIV infection into a chronic disease. In the last years the number of infected persons benefiting from these treatments has risen sharply: nearly 10 million persons worldwide in 2012.

Two major advances have been made in recent years:
The first, early treatment, not only enables infected persons to live better and longer but has also been found to lower transmission significantly, slowing the spread of the epidemic. The WHO now recommends getting infected persons on treatment earlier. With this in mind, a new strategy is being used in several countries with high HIV prevalence: all pregnant women who test positive for HIV are offered a simple antiretroviral treatment for life. In addition to preventing mother-to-child transmission, this strategy appears to reduce the rate of transmission to HIV-negative partners and may ultimately work to limit the spread of the epidemic.

The second is the prospect of being "cured" of the infection. A small number of persons treated extremely quickly after becoming infected and whose treatment was then interrupted are in good health and there is no trace of the virus in their blood. The prospect of being "cured"-still exceptional-has raised great hopes, whereas up to now the only thing that allows infected persons to have a nearly normal life is life-long treatment and they still have to cope with new challenges, such as early ageing, a phenomenon we have not yet been able to explain very well.