REPORT – The PrEP (Pre-Exposure Prophylaxis) consultation at Saint-Louis Hospital (Paris) is running at full speed. But the other populations targeted by Truvada for the prevention of HIV infection have not yet gone there.
In four hours, ten men succeeded in Diane Ponscarme’s office. This infectious disease specialist at Saint-Louis hospital (Paris) receives them as part of her consultation dedicated to pre-exposure prophylaxis (PrEP), prescribed for the prevention of HIV infection. Since it opened in the infectious diseases department on November 10, 2015, only men have come forward.
A very exposed public
These PrEP users all correspond to the first eligibility criterion for prescribing Truvada (emtricitabine / tenofovir): they are men who have sex with men (MSM). “I have been in an open relationship with an HIV-positive man for five years,” explains Lionnel, who is consulting for the first time. If the young man protects himself often, he sometimes abandons the condom with occasional partners. A practice considered risky but frequent in the MSM population.
Lional, user: ” With my companion, we allow ourselves to look elsewhere. I gave up the condom with him. I see PrEP as an addition to the accountability of the act. “
Lionnel de facto belongs to a population exposed to an increased risk. In 2014, MSM accounted for 42% of HIV positive findings. It is this observation that pushes many men to join the various PrEP consultations open in France, a card of which is available. on the website of the AIDES association.
“We know that HIV is no longer a fatal disease, but it remains chronic with repercussions on daily life,” explains Romain, another ‘beginner’ of PrEP. The reason I take Truvada is because for some practices I don’t always use a condom. This is particularly often the case for fellatio.
#Truvada in prevention of #HIV: PrEP does not (yet) reach all of its targets – Report from Saint-Louis hospital (Paris) An AIDES user and support worker testify …
Posted by Why doctor on Saturday 20 February 2016
The absence of women
Doctors deplore that very few young adults come to the consultation. They are however affected by a marked increase in new contaminations, according to the latest data from the Institute for Health Watch. “Young people who take risks, we do not see them”, regrets Diane Ponscarme. The message of prevention is difficult to pass in this age category. In the Saint-Louis clinic, the average age is significantly higher.
Khafil Moudachirou, AIDES guide: ” In terms of age, we are more about 30-40 years old. The public is rather educated, the people rather take care of themselves. “
However, PrEP is not intended exclusively for MSM. Prof. Philippe Morlat’s report served as a basis for the examination of the Temporary Recommendation for Use (RTU) of Truvada by a committee of the National Medicines Safety Agency (ANSM). It designates four other populations that may benefit from this prescription by infectious disease specialists. Among them are transgender people who have high-risk sex.
The other three populations are determined on a case-by-case basis: injecting drug users, people in prostitution and vulnerable people exposed to unprotected sex. This definition therefore implies that PrEP is also intended for women. “I haven’t seen any at all,” admits Diane Ponscarme. It is a public that is difficult to sensitize and reach, since they are people in situations of precariousness and social vulnerability. This is the weak point of these consultations which are confined to the hospital. But they are still recent and community associations, AIDES in the foreground, have undoubtedly not yet had the time to reach these populations.
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