Brussels Appeal

On the occasion of the 8th international HIV/hepatitis francophone conference ‘AFRAVIH’, scientific, medical, associative and community-based groups have issued a joint call for universal access to PrEP.

Pre-exposure prophylaxis or PrEP – using antiretroviral treatment containing tenofovir disoproxil fumarate (TDF) – has proven its efficacy in reducing sexual transmission of HIV through several clinical studies including randomized trials. The protection rate is higher than 85% (IPERGAY study) and if PrEP observance is good, reduction of transmission reaches 92% (iPrEx study), with a very low risk of acquiring treatment resistance in these trials.

As a major contribution to the global effort to control HIV infection, these results led the World Health Organization to integrate PrEP as a prevention tool into its guidelines in November 2015. As a high impact intervention for “people at substantial risk of HIV infection”, PrEP is an integral part of UNAIDS strategy to end the epidemic in 2030.

Several countries have already approved the use of PrEP in their national strategies, like the United States, Brazil, Australia, South Africa, Kenya, Canada, and France where it is provided free of charge within the framework of a temporary regulatory approval. Furthermore, PrEP is being integrated in a growing number of countries’ guidelines.

Yet, and despite all available evidence, PrEP remains unauthorized in most countries of the world. Without authorization, PrEP is self-prescribed and used outside of any framework, with all the risks entailed by this informal use – or “PrEP in the wild”.

PrEP is one of the most promising prevention tools for people most exposed to HIV infection, who fail to use traditional prevention methods that are usually not tailored to their needs. For example, condom use remains far from systematic among some populations at substantial risk of HIV infection, such as sex workers or men who have sex with men. Yet, among the latter, PrEP efficacy has revealed extremely high, with a very good observance.

At a time when so many therapeutic milestones regarding HIV/AIDS have been achieved and when, for the first time, the end of the epidemic is possible if we combine prevention, early diagnosis and immediate treatment, it should be the responsibility of health stakeholders to implement all the tools available, including PrEP, to reach the goal of a world without AIDS.

We therefore call on :

  • Policy makers around the world to commit to making PrEP available for people at substantial risk of HIV infection who want to take it, and to remove all legislative, political and financial barriers impeding such access;
  • Health authorities and professionals to integrate PrEP into national recommendations, as part of a combined prevention package, and to undertake, if needed, the implementation of pilot projects to tailor PrEP supply and meet specific needs;
  • The actors in the fight against HIV to advocate for PrEP access in every country, so that all people at high risk of contracting HIV infection can have equal rights in terms of access to effective prevention means;
  • Donors to increase funding dedicated to supporting access to and scale-up of PrEP programs in the South, as well as to prevent tradeoffs between prevention and treatment, which would be unethical and contrary to recommended strategies to end the HIV epidemic;
  • Pharmaceutical companies to ensure affordable and effective antiretroviral therapies and to support research on the preventive effectiveness of other ARVs.

We now have all the tools we need to end the HIV/AIDS epidemic. We must use them.

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Brussels Appeal

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