“I could see that nobody put on condoms… then they explained to me why and it changed my life”. For Dimitri, there is no longer any question of protecting himself with a condom despite a multiple sex life. The 23-year-old student has benefited for three years from Pre-Exposure Prophylaxis (PrEP), a preventive treatment against the transmission of HIV. A real revolution when more than 40 million people around the world are currently living with the virus.
The treatment, deployed in France since 2016 and covered by health insurance, consists of taking a daily tablet, either continuously, or the day before sexual intercourse and then for two days. It allows HIV-negative people to be protected from possible contamination. While the latest figures available show that in 2018, 6,200 people discovered their HIV status in France, the effects of PrEP are very clear on the evolution of the epidemic.
“The impact is very positive, the figures show that there is finally a shift in the contamination curve,” rejoices Patrick Papazian, doctor-sexologist at the Pitié-Salpêtrière hospital (Paris 13th district). Not to mention that PrEP is not just a drug. It includes a follow-up every three months, screenings, education… It is a virtuous circle. The possible side effects are mild, in the order of less than 10% of cases of digestive disorders, and regular biological monitoring prevents any more troublesome complications, since we are 100% protected if the treatment is taken correctly ”.
A treatment that does not protect against other STIs
“I waited a bit before I started because I wanted to see how it worked. But now that we have perspective, I have more confidence, explains Saïd, who started the treatment not long ago. My sexual behavior had changed. I date more boys and I am more passive. This increased the risk of accidents, even if I do not intend to completely rule out the condom ”.
The latter makes it possible to remove the fear of sexually transmitted infections (syphilis, gonorrhea, chlamydia, hepatitis). These STIs, the frequency of which has been increasing in recent years, hamper some people when they start taking PrEP. Theo tried several months ago but changed his mind after contracting syphilis: “I stopped right away”. At 45, the Grenoblois considers it safer to continue using condoms. “In over 25 years, I’ve never caught anything with it,” he argues. Today, it’s complicated when you refuse to fuck without. But I do not think it is trivial to fall ill several times a year and to have systematic recourse to antibiotics ”.
“My life has changed and my sexuality has nothing to do with it”
The argument does not convince the doctor. “The priority is to reduce the circulation of HIV,” recalls Patrick Papazian. We are able to cure other STIs, so it’s secondary. The objective is still to make the treatment known and to extend it ”. Since its inception, 32,000 people have benefited from PrEP. But 97% are men and more than 70% live in large cities, including 43% in Ile-de-France. “We need to be able to offer PrEP to many more women, sex workers and populations in difficulty,” warns Dr Papazian.
While waiting to be further expanded, the spread of PrEP is changing the daily lives of many men who have sex with men. On dating applications, the use of treatment is displayed as well as the dates of the last tests. “Most boys are looking for unprotected sex,” confirms Said. This behavior has become more pronounced in recent years with the arrival of PrEP ”. “My life has changed and my sexuality has nothing to do with it, because I felt nothing with a condom, says Dimitri. We do it to have more pleasure. STIs don’t scare me that much, it’s not that much more serious than a cold. For me, the treatment is a revolution ”.
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Its increase was however slowed down by the containment measures and the saturation of hospitals. The Council of State also sent back to the ropes at the end of January the Ministry of Health, which wishes to give the possibility to city doctors to directly initiate PrEP, today only delivered in hospitals or in specialized care places. (CeGIDD). A refusal which can be explained by an error in the drafting of the decree, but which still rejects a long-standing government promise. What anger the associations. “Over the period from March to September 2020, compared to the same period in 2019, a decrease of 27,435 prescriptions was observed,” indicates Aides. We must make up for this delay! “
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