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Article

French

ID: <

10670/1.11zx4a

>

Where these data come from
HIV-AIDS in metropolitan France: unequally affected generations

Abstract

National audience in France, the generational concentration of AIDS cases and associated deaths is primarily the result of a combination of several factors not directly related to behaviours to prevent HIV infection specific to different generations. A large proportion of this concentration of AIDS cases on people born in the late 1950s, but especially those born in the early 1960s, reflects the interaction between: — the period during which HIV infection began to spread in France; — the strong influence of age on exposure behaviour; — and the therapeutic situation, through the generalisation, in 1996-1997, of the prescription, before the AIDS stage, of multiple antiretroviral therapies, which very frequently enables people infected with HIV to delay or even avoid the SIDA.A stage. A detailed analysis of the trend in rates by age of entry into AIDS over the generations and before this prescription of multi-therapies, that is to say, before 1995, shows, however, a reduction in these rates from the generations born at the end of the 1960s. This reduction, which occurs almost exclusively for infections associated with the use of injected drugs, does not result from this triple interaction (dissemination period * exposure ages * therapeutic conditions) but is the result of a change in the preventive context at the end of the 1980s, with the possibility for injected drug users to freely obtain their own injection equipment. More specifically, the observation of the differences between generations in the rates of entry into AIDS associated with the use of injected drugs can be explained by three assumptions: — a structurally selective phenomenon, linked to the weight of rapid changes towards AIDS in rates for young adults, and thus independent of the specific generational characteristics of preventive behaviour; — greater responsiveness to the preventive environment for generations born since the late 1960s; — a generation ‘snowball’ phenomenon affecting people born in the early 1960s, with injected drug users already frequently infected with HIV before the new provisions for access to clean injection equipment. Analysis of 2003-2010 of the rates per generation of HIV seropositivity associated with injected drug contamination shows that the 1st hypothesis referring to a mere structurally selective phenomenon cannot explain the totality of the differences observed. Given the age reached in the early 2000s by those born in the early 1960s, relatively high rates of discovery of HIV seropositivity associated with the use of drugs injected into neo-generation could help ‘snow’.

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