France just became the second country – and the first country with a public health system – to approve the use of PrEP (pre-exposure prophylaxis) to those who need it. But the French are handling it very differently than Americans. The drug Truvada will be free, unlike in the United States, where it currently can cost an uninsured person upwards of $1,300 a month. (Manufacturer Gilead does offer payment assistance to qualifying individuals, but that doesn’t cover office visits or blood work.)
French Minister of Health Marisol Touraine says that Truvada will become available before Christmas, and will be reimbursable as of January 1. Only physicians with a specialty in HIV will be allowed to prescribe PrEP, and it will only be offered to certain high-risk groups. Because PrEP use can contribute to global HIV reduction, Mme. Touraine says, the government will make it available for free. However, the health minister was quick to note that PrEP is still not as effective as condoms. “We can never say often enough that condoms are the best protection against HIV and other STIs,” she says. “PrEP does not stop other STIs and, as a medicine, is not without adverse events.”
A recent two-year study of American men on PrEP showed that half of participants contracted either syphilis or gonorrhea during the first year of the study. Side effects of Truvada, the only PrEP drug currently approved by the FDA, can include vomiting and nausea in the short-term, and lead to liver troubles and potentially fatal levels of lactic acid in the bloodstream. Nevertheless, the Centers For Disease Control recently announced that 1 in 4 HIV negative gay men ought to be on the drug.
PrEP won’t be available to everyone in France. The pills will only be available “to individuals who cannot, for diverse reasons, use condoms systematically and who belong to groups where HIV incidence is very high.” PrEP will be offered in two ways: daily doses of Truvada for those who need it, or also intermittent doses for those who have frequent condomless sex. In France, an estimated 48% of HIV-positive people have detectable vital loads which can be transmitted to partners via condomless sex.