French statements

In April 2009, an advisory body of experts, the Conseil National du Sida (National AIDS Council) issued a position paper which focused more on 'treatment as prevention' as part of public health policy than on advice for individuals.

The paper suggested that as well as being beneficial for an individual’s own health, HIV treatment could now also be employed for its impact on transmission, and that it could become a prevention tool.

Nonetheless the paper explicitly rejects the Swiss statement that within certain tightly defined criteria, HIV-positive people with an undetectable viral load “do not” transmit HIV. The French say: “[Study] results will not…identify a specific plasma viral load threshold below which the risk of transmission would be null.” It recommends that health messages should provide information on the reduction in sexual transmission risk offered by treatments, “while indicating that a residual risk may remain”.

However the statement's tone is primarily optimistic. Treatment should reassure people with HIV about their risk of transmission, and should allow them “to live their sexuality in a more peaceful and radiant way”, the paper says.¹

Nonetheless the paper was publicly rejected within a week by the French government's lead organisation for public health, the Direction générale de la santé (DGS). A press statement insisted that only male or female condom use could guarantee a maximum protection against HIV and other sexually transmitted infections, and that condoms must be used consistently during casual sex or when the HIV status of a stable partner was not known. The statement said there was no conclusive evidence on men who have sex with men, the efficacy of antiretroviral treatment as a sole prevention strategy or the risks of resistance if more people took treatment. The DGS announced that a new group of experts would be asked to reconsider this issue as part of their review of HIV prevention strategies.²