1. The Politics of PrEP The French Experience
Jean-Michel Molina
Saint-Louis Hospital, University of Paris Diderot,
ANRS (National Agency for AIDS Research)
Inserm U941, Paris, France
22th International AIDS Conference
Amsterdam, July 26, 2018 1

2. Disclosures Research grants: Gilead
Advisory Boards : Merck, Gilead, ViiV, Teva
Shareholder: none 2

3. From Biological Efficacy to Public Health Implementation
PrEP works in clinical trials and even better in the real world…when it is taken !
Low level of implementation: many countries still reluctant to implement/up-scale PrEP
Share experiences across countries to help breaking the barriers to PrEP acceptability and implementation
Community and civil society empowerment to increase awareness about HIV prevention

4. Increase in Newly Diagnosed HIV- Infections among MSM in France
6000 new HIV-infections in France in 2016
Newly diagnosed HIV-infections
43% MSM
2500
2000
1500
23% Foreign Heterosexual W
15% Foreign Heterosexual M
9% French heterosexual M
7% French heterosexual W
2% IVDU
1000
500
Public Health France, December 2017

5. Path to PrEP Approval in France
Discussions at ANRS with the community (TRT-5, AIDES) (2009): approval of a first grant on « on demand » PrEP
Community consultation and empowerment (TRT-5):
ANRS Ipergay trial starts (February 2012)
Results of the ANRS Ipergay and PROUD trials in March 2015: appreciation of the high efficacy of PrEP
ECDC comment on PrEP in Europe (April 2015) Integrate PrEP into existing HIV prevention package for those most at-risk of HIV
WHO updated guidelines (October 2015): PrEP should be offered as an additional prevention choice for people at risk of HIV infection
EACS Guidelines (October 2015): PrEP recommended in MSM and transgender individuals with inconsistent condom use
French group of experts (October 2015) : PrEP recommended in high risk populations
First PrEP clinic opens in Paris (November 2015) 5

6. January 2016 Approval for PrEP in France

7. PrEP in France Today PrEP approved and fully reimbursed since 01/16
Adults at high risk of sexual acquisition of HIV
Prescriptions: hospitals, STI clinics and GP
TDF/FTC in hospital and private pharmacies
Generic TDF/FTC available since July 2017

8. National Prevention Campaign for MSM

9. National Prevention Campaign for MSM

10. Support from the City of Paris
City Hall meeting, February 2016

11. Paris Campaign during 9th IAS 2017

12. Oral PrEP Global Roll-out in 2018
1,100
225,000
700
Est. numbers on PrEP:
<100
,000
1,000 – 10,000
10,000 – 100,000
>100,000
1,500
14,600
Data from AVAC.org

13. Ratio PrEP Users / HIV Diagnoses
HIV-infections: 6,000
PrEP Users: 8,000
Ratio: 1.3:1
HIV-infections: 40,000
PrEP Users: 225,000
Ratio: 5.6:1
HIV-infections: 1,100
PrEP Users: 14,600
Ratio: 13:1

14. Advertising for PrEP in Melbourne

15. Decline in HIV-Infections among MSM
in the Epic Study (NSW)
PrEP
25% decline
Grulich A. et al et al CROI 2018, Boston

16. AIDES Advertising Campaign 2018

17. Lessons Learned in France
Community empowerment and lobbying: PrEP approval and implementation
Increase awareness among doctors and people at risk about this new preventive tool
High risk individuals should benefit from comprehensive sexual health care including PrEP
Up-scale PrEP implementation and show its public health benefit on the HIV epidemic

18. Acknowledgments 18 18