Jointly led by IRD and INSERM, this research evaluates the 'Test and Treat' strategy for HIV among MSM in West Africa.
ter Tiero Elias Dah, researcher at TransVIHMI (Institut de Recherche pour le Développement).
Thesis defended in 2021 at the doctoral school École doctorale Sciences Chimiques et Biologiques pour la Santé (Montpellier ; 1992-....).
This research is the result of an international co-supervision between several partner institutions.
Referenced in the ABES/STAR network, this thesis meets the rigorous criteria of French higher education.
The HIV epidemic in West Africa, particularly among men who have sex with men (MSM), requires special and sustained attention. This population, often marginalized, represents a high-risk group that deserves targeted and effective interventions. The 'Test and Treat' strategy, recommended by the World Health Organization (WHO), aims to reduce the transmission of the virus by targeting this key population, but the results of the study conducted under the CohMSM ANRS 12324-Expertise France project reveal crucial elements for decision-makers.
On one hand, adherence to testing is satisfactory among HIV-negative MSM, which demonstrates a willingness to engage in their health. However, the incidence of HIV remains high in this population, raising questions about the effectiveness of current strategies in place. Why, despite a good acceptance rate of antiretroviral treatment (ART) among HIV-positive MSM, is retention in care so low? This paradox could be attributed to several factors.
- Stigma and discrimination: MSM often face social stigmas that prevent them from seeking healthcare. The fear of judgment can deter these individuals from going to health centers, even when they are aware of their serological status.
- Lack of psychological support: The absence of psychological and emotional support can also play a major role. MSM may experience feelings of shame or isolation, complicating their engagement in regular medical follow-up.
The response to these challenges may lie in the need for a more integrated approach, including pre-exposure prophylaxis (PrEP) for HIV-negative MSM. PrEP, which involves taking antiretroviral treatment to prevent HIV infection, could play a key role in reducing the incidence of HIV in this population. By offering PrEP, healthcare professionals could not only protect HIV-negative MSM but also strengthen their confidence in the healthcare system.
On the other hand, the rapid initiation of ART is a step in the right direction, but it is not enough to ensure optimal patient retention. Decision-makers must look into the reasons for this sub-optimization. Is it a lack of post-treatment follow-up? Do HIV-positive MSM have access to health services that meet their specific needs?
- Barriers to accessing care: Health infrastructures may be inadequate or insufficient to accommodate MSM, further complicating their access to care. Health centers must be trained to provide inclusive and tailored services.
- Community support: The development of community support networks could also improve retention in care. Peer-led support groups could provide a safe space to discuss health-related challenges and daily life.
It is imperative to rethink the testing and treatment strategy. The addition of PrEP could not only reduce the incidence of HIV but also strengthen the confidence of HIV-negative MSM in the healthcare system. Decision-makers must act quickly to adapt public health policies to meet the specific needs of this population.
In summary, the fight against HIV in West Africa requires a holistic approach, taking into account not only testing and treatment but also prevention and ongoing patient support. The results of this research should prompt deep reflection on health policies in West Africa.
It is essential that governments and non-governmental organizations collaborate to create programs that meet the needs of MSM. This could include awareness campaigns to reduce stigma, as well as training for healthcare professionals to better equip them to treat this population with respect and dignity.
Finally, it is crucial to involve MSM in the design and implementation of health programs. Their experience and perspective can provide valuable insights for developing effective and tailored interventions. The fight against HIV cannot be won without the active engagement of those directly affected by this epidemic.
Key Facts
- 95% : percentage of HIV-positive MSM accepting to initiate ART immediately.
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Sources and Access
ter Tiero Elias Dah. Evaluation de la stratégie 'Dépister et Traiter' dans l'infection par le VIH chez des hommes ayant des relations sexuelles avec d'autres hommes en Afrique de l'ouest. Médecine humaine et pathologie. Université Montpellier, 2021. Français. ⟨NNT : 2021MONTT032⟩. ⟨tel-03445709⟩