Towards More Accessible and More Inclusive PrEP to Break the Cycle of HIV in France.

Abstract

Introduction: Pre-exposure prophylaxis (PrEP) represents a major advance in HIV prevention, but its rollout in France remains limited, particularly among women, migrants and socially vulnerable populations. Despite full reimbursement by the national health system, oral PrEP is still rarely prescribed outside hospital settings, hindered by organizational constraints, inaccurate medical perceptions and persistent access inequalities. In this paper, we discuss the current limits of PrEP implementation in France, identify structural and individual barriers to its uptake and highlight possible strategies to make HIV prevention more accessible for all vulnerable populations across the country.

Discussion: The goal of eliminating HIV transmission by 2030 in France continues to be jeopardized by insufficient PrEP coverage. The current prevention model remains overly hospital-centred and primarily focused on a group of men who have sex with men (MSM), which limits its broader impact. In addition to structural barriers, the insufficient diversity of prescribers and the lack of inclusive communication continue to reinforce inequalities in access. The arrival of long-acting injectable PrEP offers an important opportunity to ensure greater discretion and better adherence. However, its success will depend on expanding the range of authorized prescribers to include gynaecologists, general practitioners and family planning clinics, supported by specific training and outreach consultations. Equally critical is strengthening public awareness campaigns and extending them beyond MSM and urban centres such as Paris, to reach diverse populations across the country. Durable improvements in PrEP uptake and retention also depend on close collaboration with community-based organizations, building trust with marginalized populations and participatory approaches that actively listen to individuals' concerns and lived experiences.

Conclusions: France, which is lagging behind its objective of ending the HIV epidemic, has the opportunity to rethink its prevention strategy to address unmet needs and move beyond a hospital- and MSM-centred model. A structural, coordinated and inclusive response is essential to expand PrEP uptake and ensure equitable protection for all populations at risk.