^{Florent Jouinot from Swiss AIDS Federation reports on AFRAVIH 2026 in Lausanne.} 

An HIV diagnosis is the first step towards accessing treatment and maintaining people’s health. When diagnosis occurs late (CD4 < 350/mm³) or at the AIDS stage, there are numerous consequences: 

• increased risk of transmission;
• more severe medical complications;
• reduced healthy life expectancy;
• more intensive and costly care for healthcare systems. 

Across Europe, late diagnoses remain common and constitute a major obstacle to the goal of eliminating HIV transmission by 2030. 

In France, despite the number of new diagnoses having remained relatively stable for several years, estimates of late diagnosis remain high. Until now, figures have varied significantly depending on the definitions used. The VESPA3 survey therefore provides particularly valuable insights. 

A proportion of late diagnoses that remains high 

The study is based on data from nearly 3,000 people living with HIV who were monitored in hospitals in mainland France in 2023–2024. 

First finding: the frequency of late diagnoses remains high. According to the analyses presented, around a third of people discovered their infection at a late stage. However, a significant proportion have an unknown time to diagnosis, which further complicates the interpretation of trends. 

The results also show a mixed picture over the decades. 

While early diagnoses appear to be increasing, this improvement is partly linked to the decrease in cases where the time to diagnosis remains unknown. At the same time, the proportion of late diagnoses remains high and is even rising over time, linked to changes in the profiles of those affected. 

Shifting vulnerabilities 

Before 1996, men who have sex with men (MSM) appeared to be particularly at risk of late diagnosis. Between 1996 and 2013, the phenomenon affected migrant women and heterosexual men to a greater extent. 

Today, the differences between groups appear to be becoming more homogeneous. However, a new vulnerability is clearly emerging: non-heterosexual men with a migration background are now at increased risk of late diagnosis. 

This trend illustrates the growing complexity of inequalities in relation to HIV. Social, administrative and migration factors combine with issues related to sexuality and access to care. 

Among the factors associated with late diagnosis, several stand out: 

• migration history; 
• distance from specialist HIV services;
• ignorance of the main partner’s HIV status; 
• being over 40 years of age. 

These findings serve as a reminder that delays in testing are not solely a matter of individual behaviour. They also depend heavily on conditions of access to the healthcare system. 

The impact of distance from care 

One of the particularly striking aspects of the presentation concerns the impact of geographical and social distance from HIV services. 

People living far from specialist facilities are at greater risk of being diagnosed late. This finding directly calls into question the regional organisation of prevention and testing. 

The researchers thus emphasise the importance of bringing services closer to the populations concerned. A goal mentioned during the session: making services accessible within an hour’s journey. 

This consideration goes far beyond mere logistics. It also concerns: 

• cultural accessibility;
• administrative barriers;
• trust in institutions and healthcare providers;
• the ability of services to reach groups that are less visible to conventional prevention strategies. 

Better diagnosis to achieve the 2030 target 

Ultimately, this presentation serves as a reminder of a sometimes-forgotten truth: biomedical advances alone are not enough to end the epidemic. 

Screening remains a crucial step. Data from VESPA3 thus show that the fight against HIV cannot be separated from issues of migration, the stigmatisation of sexualities, regional inequalities and equitable access to care.