Prof. Molina is breaking down the results of Clinical trials that led to rolling out PrEP in France, the importance of GPs in scaling up PrEP and how close we really are in eradicating HIV.
Prof. Jean-Michel Molina is a Head of Infectious Disease department at Saint-Louis Hospital in Paris. He is a principal investigator (PI) of pivotal ANRS trials: Ipergay and Prévenir, with on demand and daily PrEP.
- How is HIV epidemic contained in France?
- What is PrEP?
- What is the result of making PrEP accessible in France?
- What is the cost-effectiveness of PrEP in France?
- Why did France decide to make PrEP fully reimbursed as of early 2016?
- How can other countries benefit from learnings acquired in French trials?
- How well are GPs involved in PrEP scale-up?
- Are we going to eradicate HIV soon?
(Video transcript - scroll down to download)
PrEP - An interview with HIV-positive MSM and his partner, a PrEP user, living both in UK and France
UNIVADIS: How did you find about PrEP?
HIV-positive MSM: I unfortunately only heard about PrEP once I have been diagnosed as HIV positive (June 2015). Since then there has been more awareness in the UK about PrEP and its importance for public health but maybe it’s because I'm more involved in the subject now that I have noticed it. It's very mentioned at GAY PRIDE!
PrEP user: I discovered PrEP through my boyfriend who educated me on what TasP was and why, if we are open sexually, it's important that I am protected from HIV coming from others (dealing with one diagnosis was quite enough). Public health campaigns in France such as posters on the metro are great and very public.
UNIVADIS: How do you obtain PrEP and for what price?
PrEP user: In the UK I was a part of a trial (PROUD) and if you are part of it it's free. If not, there is a newly established PrEP shop at 56 Dean Street, reasonable prices (WOULD LOVE TO SEE THIS MODEL EMULATED). Here in France, I obtain it through my social security “carte vitale”. I haven't seen other routes of obtaining PrEP apart from online through US websites. In France, I sense there is a high awareness but haven’t really spoken to my GP. When I asked my GP about PrEP I was referred to a specialist. I get tested every three months as needed to continue to get PrEP. I have no issues with it's usage so far.
UNIVADIS: What regime do you use for PrEP?
PrEP user: I use daily PrEP. Sometimes I forget but nothing major. I set an alarm on my phone and have a couple of pills in my bag so I can't leave the house without.
UNIVADIS: What are the issues you would like to address and would like to see improved in both systems in France and UK?
HIV-positive MSM: I know a lot of people in UK are worried about the effect of Brexit and a possible no-deal to the supply of medication. In France, an issue for me is the access to HIV medical treatment, it’s not easy with endless and ineffective bureaucracy in France - I'm still waiting for my “carte vitale” after a year of waiting, I have to go back to UK every 6 months to use NHS and get medication.
UNIVADIS: Do you feel the stigma associated with being HIV-positive or with the PrEP usage?
HIV-positive MSM: Stigma is engrained in our society but it’s getting easier in ways, but it's a double-edged sword. Generally, I feel that in Europe people know HIV is not deadly anymore but still maybe have no clue about it and mood of conversation is often awkward or unnecessarily sympathetic. Saying that I don't tell hook ups that I'm positive, there is no point. My boyfriend is on PrEP and tested regularly and I'm undetectable. If someone asks my status, I would never deny it, but I don't tell my hook-up voluntarily. I think there is a stigma even in the gay community especially as PrEP use goes up. As rates of HIV go down, more I feel looked at like a rarity or something of the past, as someone that did something wrong or was a slut. Just an impression. Slut shaming and bottom shaming is big in the gay community where PrEP comes in. People even make memes and jokes about the fact people use PrEP like a magic shield again all STDs (e.g. “Truvada queen” or “PrEP queen”).
Some in the UK tabloid media (particularly after NHS England was in the news) portray PrEP as expensive, and that it promotes and provokes more promiscuous behavior, but to be honest, I feel like this is backed by a level of heteronormative homophobia (internal included) and double standards, (once again seeking to confine HIV, PrEP and promiscuity as solely or mainly gay issues....). On hook-up apps a lot of people note they use PrEP, but some are aggressive wary of those who are PrEP users - like we are incapable of taking medical treatment or may deliberately lie about PrEP usage and adherence.
Otherwise, personally I will be open about my status with the right people because the only way to change perceptions is to talk and launch discussions and let them know that HIV is not a just a stats, news item, gay problem or public health campaign, it’s their friend's or loved one's reality and maybe one day - theirs.