^{Florent Jouinot from Aids-Hilfe Schweiz reports on AFRAVIH 2026 in Lausanne.}

Anal cancer remains relatively rare in the general population. However, there are significant differences in risk depending on the group affected. As Marion Di Ciaccio emphasised, men who have sex with cisgender men (MSM) have a greatly increased risk of anal cancer (33 times higher than in heterosexual men). For MSM living with HIV, this risk is even 85 times higher compared to cisgender heterosexual men who do not live with HIV. Cisgender women living with HIV are also affected, with a risk eight times higher than that of women without HIV.

At the heart of this issue lies the high-risk human papillomavirus (HPV-HR), particularly the HPV16 genotype, which plays a role in the vast majority of anal cancer cases. However, HPV infection is extremely common and can occur even when condoms are used and/or without passive anal intercourse.

HIV and HPV: a particularly unfavourable interaction

Déborah Konopnicki’s presentation highlighted the close interactions between HIV and HPV. In people living with HIV:

• high-risk HPV infections occur more frequently;
• last longer;
• recur more frequently;
• are more likely to develop into precancerous or cancerous lesions.

High-grade lesions occur up to fifteen times more frequently in the anal region in people with HIV.

HPV-related cancers now account for 15% of cancers observed in people with HIV. Furthermore, their prognosis is often poorer, particularly if HIV is not well controlled.

This trend highlights a gradual shift in HIV-related health issues: Thanks to antiretroviral therapies, people are living longer but are increasingly confronted with chronic comorbidities and cancers linked to persistent infections.

The paradox: preventable cancers

What is most striking is undoubtedly that these cancers are largely preventable.

The nonavalent vaccine (Gardasil 9) prevents around 90% of HPV-related cancers as well as genital warts. Nevertheless, vaccination strategies continue to focus largely on young girls, even though a third of anal cancers and a large proportion of HPV-related head and neck cancers affect men, particularly MSM.

The new data presented also show that vaccination remains effective and cost-saving for MSM and people living with HIV whose viral load is under control up to the age of 40.

Another important area of focus: the early detection of precancerous lesions.

International recommendations now point towards targeted early detection:

• From the age of 35: MSM and trans women living with HIV
• From the age of 45: everyone living with HIV; as well as MSM and trans women who do not live with HIV

Yet the gap between scientific findings and the recommendations – or the reality on the ground – remains wide

Anal health, still marked by taboos

Why is the topic of anal health still so rarely discussed?

Among those affected:

• Fear of judgement;
• Embarrassment regarding sexual practices;
• The expectation of pain;
• Lack of information;
• The perception of examinations as an attack on masculinity.

Among healthcare professionals:

• Unease about discussing anal sexuality,
• Lack of training,
• Low confidence in performing anorectal examinations.

Result: Discussions often do not take place, and the recommended examinations are rarely carried out.

Stigmatisation plays a central role here. Anal sexuality remains strongly associated with negative perceptions, even among women, although anal practices affect a large proportion of the population.

This stigmatisation has very concrete consequences:

• delayed use of healthcare services (vaccinations and screening);
• avoidance of doctor’s visits;
• downplaying of symptoms;
• prescriptions without clinical examination.

Integrating anal health into sexual health

In light of this finding, the speakers advocate for a more integrated approach. Anal health should no longer be treated in isolation or exclusively in highly specialised clinics. It must be integrated into standard sexual health care pathways:

New technologies could also bring about a breakthrough here. Thanks to new biomarkers, high-risk lesions can now be detected more effectively, thereby reducing the need for high-resolution anoscopies – specialised examinations that remain difficult to access, costly, only partially reimbursed and are sometimes painful.

What challenges does this pose for Switzerland?

In Switzerland, too, issues of anal health continue to receive little attention, despite the country’s historically strong commitment to HIV prevention.

For Aids-Hilfe Schweiz, several approaches appear important:

• to integrate anal health more closely into sexual health;
• to strengthen education for affected population groups;
• to support community-based testing models;
• promoting HPV vaccination, even beyond current national recommendations;
• improving the training of professionals, and primarily of those working in the field of sexual health.

Breaking the silence

Although anal cancer remains rare in the general population, it is associated with significant inequalities linked to HIV, sexual minorities, gender and stigma.

As long as it remains difficult to talk about, discuss or examine anal health, prevention opportunities will remain largely untapped and the chance to protect the health of those affected will be missed.