Since 1is September 2024, patients have the possibility to request screening for four sexually transmitted infections (STIs) in addition to human immunodeficiency virus (HIV) in medical biology laboratories: Chlamydia trachomatisgonococcal, syphilis and hepatitis B. This novelty is a response to the resurgence of STIs since the early 2000s. According to the latest data from Santé Publique France, nearly 5,500 people discovered their HIV status in 2023. A danger that continues to grow despite the significant drop recorded in 2020. Last year, the number of infections diagnosed Chlamydia trachomatis, gonococcal and syphilis infections were estimated at 55,500, 23,000 and 5,800 respectively. However, these infections, which we no longer call “diseases” because they are often asymptomatic, can have serious consequences such as infertility, cancers and lifelong therapies for AIDS. We must add to this table infection by human papillomavirus (HPV) which is the subject of a campaign to encourage vaccination of adolescents. These viruses, which can affect 80% of men and women during their lifetime, are responsible for lesions which can develop into cancer, particularly of the cervix.
Sex and the pharmacy
Community pharmacies play an essential role in prevention policies. Since 1is January 2023, young people under 26 have access to free condoms: 16.7 million were distributed in one year, President Emmanuel Macron announced at Sidaction last March. Pharmacies have HIV self-tests available, sales of which amounted to 79,500 units in 2019, according to Public Health France. The prevention assessments which are starting to be put in place for certain age categories, including 18-25 year olds, are also an opportunity to take stock of sexual health and screenings. Above all, “pharmacies are easily accessible, without appointment, with long opening hours, testifies Paul Lemarquis, holder in Aire-sur-l’Adour, in Landes, and member of the commission for new registrants of the Council of the Order. We are lucky to have two extraordinary assets in France: free access and anonymization. It is possible to make contraceptive prescriptions anonymous so that adolescents can be in control of their sexual health. I also receive parents who come to me asking for information on the papillomavirus vaccine. In one year, we have doubled the number of prescriptions, which is a source of pride. » The young pharmacist participates in information meetings at the college as part of his local health professional community. He organizes training on these pathologies for his team and is preparing to set up prevention interviews in a reserved space.
However, gaps in sex education remain considerable. For its fortieth anniversary, the Aides association carried out a survey with the French Institute of Public Opinion (Ifop) which highlights a decline in awareness of the dangers in this area within the French population: 40% of respondents and 51% of those under 25 consider that the risks of being contaminated by the AIDS virus are low today. The response was 14% on average in 1988. On a European scale, a recent report from the World Health Organization warned of the alarming decline in condom use among adolescents between 2014 and 2022: from 70 to 61% at their last sexual intercourse for boys and from 63 to 57% for girls. “ Young people do not live in the fear of AIDS as in the 1990s, analyzes Michaël Grynberg, gynecologist and researcher attached to the National Institute of Health and Medical Research (Inserm). They think it’s curable, so it’s not serious. Of course, sex education is taught in middle and high school, but it remains very basic. When a life and earth sciences teacher (SVT) gives a lesson on geology one day and on STIs the next, he is not audible. » For Michaël Grynberg, it is preferable to involve an expert, health professional or association representative, to address this subject in class. Especially since establishments also lack school doctors.
In confidence
As the owner of the Wellpharma Jules Ferry pharmacy in Waziers, near Douai, in the North, Christine Vanhamme also notes the lack of information: “When a young girl comes to see us after unprotected sex, she thinks “contraception”, but we remind her of the existence of STIs. We have a separate room in which young people can talk to us freely about subjects that they do not dare to discuss with their family, and they do so willingly. One evening I had a boy over who wanted to know how to use a condom. He asked his father who sent him back to us! » For adolescents, the pharmacy is more suited to confidences than the home or even the doctor’s office, where they often go accompanied by their mother. The taboo is very present, among adults too. “Sidaction is an opportunity to distribute information booklets but many parents do not want to hear about it, continues Christine Vanhamme. Even when I carry out HPV vaccinations, many young people do not know why they are being injected. I take this opportunity to explain to them. When we welcome trainees of 3eI also spread the message about STIs and the pill. » Concerning HIV self-tests, the practitioner believes that the results are difficult to interpret for the general public: “We need an explanatory kit on STIs as for people who quit smoking. We think people are informed but that is not the case at all. » Community pharmacists should not hesitate to order the brochures published by the Health and Social Education Committee of French Pharmacy (Cespharm).
A shift at all ages
Because the questions do not only concern young people who are discovering sexuality. The lack of information and the relaxation of vigilance concern all ages. According to Public Health France data for 2023, the incidence rate of diagnoses increases more markedly for gonococcus among those aged 50 and over and among heterosexual people, men and women. Same for Chlamydia trachomatis. For syphilis, the increase is more marked among women and those over 50. “Even in the AIDS generation, we observe a population of fifty-year-olds who separate from their spouse after having had unprotected sex for several years. They have a lot of trouble getting used to condoms again, and they even think that at their age they can live with HIV”underlines gynecologist Michaël Grynberg. In his pharmacy, Paul Lemarquis regularly receives adults: “I was recently consulted to find out what PrEP, pre-exposure prophylaxis, was. I provided explanations and referred to a doctor. I was also consulted to find out how to get vaccinated against mpox. »
The neighborhood pharmacist is often the only local health professional available, which raises the question of unequal access to prevention structures, hospitals, laboratories, free information, screening and diagnosis centers (Cegidd ), family planning… Christine Vandamme’s pharmacy is located in a population area which has two doctors for 8,000 inhabitants, one of whom is retiring soon. “I have practically abandoned the counter, I mainly do screening, as the needs are immense,” she emphasizes. In Aire-sur-l’Adour, a semi-rural town of 6,000 inhabitants, Paul Lemarquis’ pharmacy is attached to a health center, which facilitates the sharing of information. For professionals, there is no doubt that we must relaunch a public health campaign on STIs and condoms to amplify their action on the ground.
To remember
- Reported sexually transmitted infections are on the rise and condom use is declining among young people.
- The pharmacy is the preferred health space for prevention due to its territorial coverage and its accessibility.
- Sex education in schools should be provided by health professionals rather than teachers.
