Laurette Onkelinx launches a national plan against AIDS

  •    The rate of new infections remains high: 3 per day.
  •    Screening will be more targeted.
  •    More HIV positive people will be treated.

After months in development, Health minister Laurette Onkelinx launched a federal program against AIDS. This still-secret plan will include about fifty key actions. They were formulated with the cooperation of physicians and epidemiologists as well as with patient groups and associations for high-risk populations such as homosexuals and immigrants.

Once she heard the experts’ conclusions, the health minister expressed her desire to break from political correctness to “face the disease.” Several observations stood out: one of two patients is not Belgian, the transmission rate of the disease in the male homosexual population is increasing sharply, and there is large core of infected people from Sub-Saharan Africa.

“We must interact with these communities while completely avoiding stigmatization. Screening must be targeted where the risks are the highest and used as effectively as possible,” she explained to Le Soir a year ago when the last step was being planned. Several authorities are involved in this with the 7 health ministers. For the past three months, intense discussions have been ongoing with the goal of bringing the agreement to reality. What would this plan’s key measures be?

1. Screening reinforcement. Screening will no longer be limited to a medical environment. Half of patients now receive treatment too late: the disease is detected after it has already ravaged a patient’s body. Patients who don’t know they are infected are more likely to transmit the disease. Screening needs to leave the medical environment and go into the streets, into nightclubs and similar venues where “at risk” groups tend to gather. To date, screening has been hampered by the fact that a doctor had to be present by law. Preliminary outreach experiments were conducted, mainly by the Ex-Aequo Association and the AIDS Prevention Platform, and those experiments will be expanded thanks to the collaboration of community groups. “We need people who speak their language and share their values,” explains the minister.

2. More  treatment.  Today treatment is not covered by Social Security until patients have reached a certain stage of the disease. Based on international rules, medication is given only when a patient’s CD4 cell count is below 500  (immune cells) per mm. This obsolete limit must be eliminated.  “This doesn’t mean that we’re offering treatment to all 22,000 HIV positive patients, but instead, we’re offering an individual solution using more criteria. We will be able to treat those who need it,” states a manager from an AIDS referral center. “To date, only 13,000 infected people are receiving medical treatment.”

  3. Greater prevention. The plan provides for media campaigns targeting different high-risk groups while retaining a more global approach.  In gay commercial areas “especially for those where sexual services are offered,” the associations are relying on obtaining the means to increase condom and gel distribution in bars and nightclubs.  They also need to reach immigrants, legal or not. “These campaigns need to communicate to each group in its language and approach sexual issues in its own social and cultural environment,” says one of the experts. One approach involves prevention in prisons where access to the means of prevention is difficult and where tuberculosis co-infections are likely to develop. Youth, prostitutes, drug addicts and the general population will also be included in this part of the plan.

4. Revive condom use. Some of the actions will involve breaking down barriers that prevent good condom use such as alcohol abuse, pleasure seeking without limits, lack of access to condoms in places where sexual services are offered and partner age differences. “The campaigns now underway are too low key either because of a lack of means or prudishness,” explains someone active in the field. The underused female condom needs to be promoted.

5. Forgetting the condom (very rarely). This action is under the most discussion due to a recent recommendation from the Superior health council. An infected person’s partner might forgo condom use after six months of no detection of the virus in the infected person. The circumstances under which this solution, engineered to minimize as much as possible any risk of infection, could be offered to a non-infected partner are numerous: HIV-free, total treatment compliance, stable and faithful relationship where the non-infected partner has given informed consent, and specialized physician support.

6. Treatment to lower risk of contagion. The plan considers the use of treatment as a preventative along with reinforcing treatments aimed at preventing an infection following a high-risk relationship. This would include the use of antiretrovirals beginning in the early stages of the infection, which would reduce the risk of transmission. This option, however, can only be implemented once its effectiveness is scientifically proven. A group of experts will make this their ongoing mission. Among other ideas are home test kits or an “AIDS treatment pathway”. How much will this all cost? No one can say yet. The implementation phase should begin in its entirety immediately and continue until 2019.

FRÉDÉRIC SOUMOIS

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