AIDS Day: What has changed with PrEP, the preventive treatment?

After dropping sharply at the start of the coronavirus epidemic, especially during the period of the first confinement, the use of PrEP, the preventive treatment that makes it possible to avoid being infected with the AIDS virus, is gradually increasing, reveals a report from Epi-Phare, which associates the Health Insurance (Cnam) and the Medicines Agency (ANSM), published on Wednesday.

If the French have found (almost) “their life before”, and in particular have returned to good sexual activity, it is above all the opening of the first prescription of PrEP since June 1 to all doctors, including general practitioners, which made it possible to bring up the figures of beneficiaries. A huge advance when we know that general practitioners could only renew the prescription, the first prescription could be made only by doctors practicing in the hospital or in a free information, screening and diagnosis center (CeGIDD).

Democratization of treatment

“Opening up to general practitioners is the democratization of treatment in a way. Some did not have a hospital or center near their home, access was not necessarily easy, ”acknowledges Camille Spire, president of Aids to 20 Minutes, who is hoping the expansion might convince more people to take the treatment.

And to read the testimonials received by 20 Minutes, the treatment has many benefits. “PrEP has allowed me to live a more fulfilling sexuality where the question of the serological status of the partner is no longer a stress”, explains for example Mattéo, 33 years old, who is taking this preventive treatment intended for seronegative people to avoid contamination by HIV during sex without a condom. For Thomas, 34, who has been taking it since January 2020, it is first and foremost the fact of being an actor in his own health that motivated his decision: “What has changed is a certain assurance. Without necessarily being sexually active, I know that by taking PreP rigorously, I would never have HIV. I am an actor of my own health, it is I who choose to protect myself ”.

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Benefits and efficiency

And if it appeals so much, it is because the treatment is more than 86% effective. “It is one more weapon and all weapons are good to take.” It is an extremely effective method, the only exceptions are patients who had not taken the treatment correctly, ”explains Charles Roncier, journalist specializing in HIV issues and editor-in-chief of the vih.org site. This is the reason that prompted Benoît, 41, to take PrEP, after being exposed to HIV: “I decided to take PrEP to better protect myself after several post exposure treatments (EPT)”, says- he, specifying even taking the time to explain the benefits of the treatment to all his sexual partners.

The treatment, which comes in the form of a pill, “can be taken either continuously every day if you have regular sex, or intermittently, if you need it at a specific time,” continues Charles Roncier. If the treatment is taken intermittently, that is to say according to the sexual activity, “the protocol is strict, it must be followed as a rule, with a tablet before, during and after the report”, adds the specialist.

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The other strong point of PrEP is that it is not coupled with intercourse, like the condom can be. This is also the reason why Alexis, 40, chose to take the treatment: “It allows me to live my sexuality much more freely and simply, but also to develop it. The fact of using the condom breaks the relationship a bit. Without, I find it much more fluid ”. However, there is no question of doing without the condom, “it is a complementary tool, it does not replace it”, warns the president of Aide.

Still too few beneficiaries

Because the treatment is intended for everyone, women and men, but particularly for people who do not always use a condom during their sexual intercourse and who are at risk of contracting HIV. For Charles Roncier, the treatment, which is fully covered by Social Security from the age of 15, “is for all people who feel they need it”. According to the report “Medical care for people living with HIV ”, published in 2015, the use of PrEP is recommended for“ HIV-negative MSM (men who have sex with men) ”and“ transgender people who have sex at high risk of acquiring HIV. HIV ”. “We would like the treatment to be generalized to all audiences who have risky practices, not just MSM,” said Camille Spire, president of Aids to 20 Minutes.

According to the Epi-Phare report, published on Wednesday, PrEP users are “predominantly men aged 35 on average residing in Ile-de-France” and they are “mainly men having sex with men (MSM) ”. “There are still very few women who take PrEP in France, due to a lack of communication, but we hope that will change”, pleads Charles Roncier.

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For specialists, if prescriptions go up, the figures are still below the objectives. “There is progress, but it is not yet sufficient”, regrets Camille Spire, who relies on openness to doctors to increase prescriptions. “In 2019, for the first time, there was a drop in contamination in France. PrEP is obviously not the only factor, but it has contributed to the decrease in contamination, that’s for sure ”, assures the president of Aide, who adds:“ It’s part of the arsenal of tools that allow us to say that we can eradicate the AIDS epidemic by 2030 ”.