FRANCE’S HIV prevention efforts remain off track as limited uptake of pre-exposure prophylaxis (PrEP) slows efforts to reduce new HIV diagnoses, particularly among women, migrants and other socially vulnerable groups.
Despite full reimbursement through the French health system, PrEP access remains uneven and heavily centred on hospitals and men who have sex with men (MSM).
PrEP is a preventive HIV treatment used by HIV-negative individuals to reduce their risk of acquiring the virus. While it has transformed HIV prevention globally, organisational barriers, restricted prescribing pathways and social perceptions continue to limit its reach in France.
More than 40 years after the start of the HIV epidemic, France continued to record around 6,500 new HIV diagnoses annually between 2013 and 2016, with increases persisting in some populations, particularly MSM.
Hidden HIV Infections Continue to Drive Transmission
France adopted treatment as prevention (TasP) in 2013, aiming to reduce transmission through widespread antiretroviral treatment and viral suppression. However, the strategy depends on early diagnosis and consistent follow-up, which are not always achieved in routine care.
The role of undiagnosed HIV infections cannot be overstated, with an estimate of more than 10,000 people in France potentially living with HIV without knowing their status. Among MSM, up to 50% of infections are thought to originate from partners in the primary infection stage. This is a period where many individuals have not yet been diagnosed or started treatment but have an extremely high viral load and infectivity.
PrEP and TasP were described as complementary tools within combination HIV prevention strategies, with post-exposure prophylaxis acting as a bridge into PrEP, as repeated exposure events prompt healthcare providers to move patients from emergency prevention to continuous protection.
Structural Barriers Limit PrEP Access
Between 2016 and 2019, around 20,000 MSM in France accessed PrEP, despite estimates suggesting 100,000–140,000 could benefit. By June 2024, cumulative PrEP initiations across all populations surpassed 100,000 after prescribing rights expanded to general practitioners in 2021, showing how increased access points can increase uptake.
However, uptake remains concentrated among older, urban and financially stable men. Women accounted for 32% of new HIV diagnoses in 2023 but represented less than 5% of PrEP initiations. Young adults and migrants also remain underrepresented.
Researchers identified oral-only PrEP delivery as another challenge. Between 20% and 30% of users discontinue treatment within six months, particularly younger people and those facing socioeconomic hardship. This is important as effectiveness falls substantially when adherence declines.
Injectable PrEP Could Widen HIV Prevention Reach
Long-acting injectable PrEP was highlighted as a potential way to improve adherence, discretion and convenience. Clinical trials reported coverage rates exceeding 90% with injectable formulations, alongside lower HIV incidence compared with oral PrEP.
Researchers cautioned, however, that injectable PrEP alone would not resolve inequities unless prescribing expands beyond specialist HIV settings. They called for greater involvement from gynaecologists, family planning centres, pharmacies and general practitioners, alongside broader public awareness campaigns targeting populations outside major urban centres.
Examples from London, Spain and Germany provide evidence that integrated prevention strategies combining rapid testing, TasP and widespread PrEP provision can reduce new HIV diagnoses when supported by coordinated national systems.
Reference
Ghosn J, Chaix M. Towards more accessible and more inclusive PrEP to break the cycle of HIV in France. J Int AIDS Soc. 2026;DOI:10.1002/jia2.70118.
Featured image: stevanzz on Adobe stock
