In France, 5,000 people learn each year that they are HIV positive. HIVwhile effective preventive treatment exists and is 100% reimbursed. To mark National Sexual Health Week, the National Council for AIDS and Viral Hepatitis alert: pre-exposure prophylaxis, known as PrEPstay “little known and unevenly accessible“, and its appeal “remains insufficient“.
There PrEP involves taking antiretrovirals when you are HIV negative to avoid infection during sex without a condom. Available since 2016 and fully covered by Health Insurance, it reduces the risk of contamination by approximately 93% according to the EPI-PHARE study (ANSM-Cnam). President of the Sidaction scientific and medical committee, virologist Constance Delaugerre speaks of an effectiveness of “98%”, “one of the best prevention tools” on France INter.
HIV PrEP: a very effective but underused tool
In fact, the PrEP is 94% used by men who have sex with men (MSM), according to the National Council on AIDS and Viral Hepatitis. The CNS recalls that “almost half of MSM for whom it would be indicated do not use it“, particularly the youngest. Women remain a very small minority among users, even though they are also faced with the risk of HIV.
The CNS cites migrant women from sub-Saharan Africa, migrant MSM, sex workers, trans people or those in great precariousness and residents far from large cities among the forgotten. For these audiences, the
PrEP “remains little known and little used“Delays, language barriers, fear of judgment, lack of means of transport or papers make access to CeGIDD, PASS or hospital consultations theoretical.
Access to PrEP: stigma and precariousness
For the CNS, the PrEP “remains too often perceived in a restrictive and negative way, as a tool primarily “intended for gays” and reserved for very exposed people who “fail” to use other means of prevention“. This image places the responsibility on individuals and discourages patients and caregivers. The weakening of local associations, combined with restrictions on state medical aid, leaves many people without support.
Faced with this observation, the CNS calls for “change the way we look at PrEP, through the mobilization of all health professionals and through inclusive and positive communication“. Since 2021, general practitioners can prescribe it, reimbursed and generic. But many do not dare to address sexuality and prevention of HIVwhile each contraceptive screening or check-up could become a moment to make it “a first-line tool”.
Injectable PrEP: a step forward at risk of inequalities
A Injectable PrEP long-acting cabotegravir (Apretude) is given by bimonthly injection. For the CNS, “These formulations are likely to remove certain obstacles specific to oral PrEP, and their effectiveness appears particularly high in women.“. But he warns: “without prior expansion of access to information, without removing structural obstacles and without appropriate “go-to” and “do-with” approaches, these innovations will only benefit audiences already reached by existing systems.“.