Luxembourg's Ministry of Health has announced details of the 2016 Progress Report published by the AIDS, Infectious Hepatitis and Sexually Transmitted Infections Surveillance Committee, which shows that, in 2016, the number of new cases of HIV infection recorded in Luxembourg totalled 98 patients, including 73 men and 25 women.

The main mode of contamination is heterosexual sex (39), followed by homo-/bi-sexual sex (32) and intravenous drug use (21), especially in the 26 to 35 age group.

Since 2014, the proportion of new HIV infections among intravenous drug users (IDUs) has increased significantly. Thus, from January 2013 to December 2016, 67 new cases of HIV infection among IDU were identified; 86% of patients were co-infected with hepatitis C virus and 62.5% were receiving substitution treatment.

"The significant increase in the number of infections among intravenous drug users in recent years is of great concern, especially given that Luxembourg has so far a wide range of successful risk reduction offers" said Lydia Mutsch, Luxembourg's Minister of Health.

In addition to screening and information campaigns, it is essential for the Ministry of Health to develop complementary strategies for the development of the new national AIDS action plan to stem this epidemic outbreak Among IDUs, those marginalised and in great difficulty.

"One of the responses envisaged is the introduction of a mobile device that will be used to reach the most exposed users, increase the coverage of HIV and infectious hepatitis among them and reintegrate them, as far as possible, in the aid and care system," said Minister Mutsch.

Injecting cocaine appears to be a key risk factor associated with the resumption of HIV infections among drug users and is often associated with sharing and poly-drug use. As Dr Vic Arendt, chairman of the AIDS, Infectious Hepatitis and Sexually Transmitted Infections Surveillance Committee, explained: "The breeding ground for this epidemic is, on the one hand, the consumption of cocaine by injection: on the other hand, social withdrawal: it is largely within a subset of intravenous drug users who have lost their social situation, housing and health insurance, that the epidemic is extended".

In particular, the committee advocates actions targeting IDUs outside the treatment and care channels, setting up or strengthening preventive measures such as informative video clips, awareness-raising interventions, and ultimately medical coverage For socially displaced IDUs. Pre-exposure prophylaxis (PrEP) in active drug injectors could also be considered as an additional prevention tool.

In this context, the Committee welcomed the decision of the Ministries of Health and Social Security to take charge of the PrEP, as part of a pilot project, which has been underway since 1 April within the National Infectious Diseases Service. Luxembourg will thus be the third country in Europe after France and Norway to make this new prevention tool accessible.

Using a European Center for Disease Control (ECDC) modeling tool, it is estimated that 87% of people living with HIV have been diagnosed, giving an estimated total of 1,065 people living with HIV in the country. However, out of 1,065 people, estimates indicate that 13% do not know because they have not been tested.

However, the only condition to have access to treatments to control the virus to the point of avoiding the occurrence of opportunistic diseases is whether one is infected. HIV testing is the only way to know about HIV status.

For the Ministry of Health, in close collaboration with the HIV Berodung of the Luxembourg Red Cross and the DIMPS (Mobile Intervention Device for the Promotion of Sexual Health), it is therefore essential to continue:

- to carry out actions and information and awareness-raising campaigns, targeting in particular marginalised persons, drug users and prostitutes;

- to stress the messages of prevention and protection, i.e. the systematic use of condoms during sexual relations with a partner whose serological status is unknown;

- encouraging early detection through HIV testing so that treatment can begin as early as possible, thereby reducing the risk of further contamination.