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).
More than 40 years after the start of the HIV epidemic, France continues to record around 6,500 new HIV diagnoses annually, with increases persisting in some populations, particularly MSM.
Hidden HIV Infections Continue to Drive Transmission
The role of undiagnosed HIV infections cannot be overstated, with an estimated 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.
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.
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.
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.