^{Florent Jouinot from Aids-Hilfe Schweiz reports on AFRAVIH 2026 in Lausanne.}

Through two data-driven presentations (ERAS and ANRS-PREVENIR), Clément Boutet offered a detailed analysis of protection trajectories and the use of PrEP. The results paint a more nuanced picture than a simple dichotomy between ‘adherence’ and ‘dropouts’. Above all, they show that PrEP use evolves over time, depending on life circumstances, relationship trajectories and individual attitudes towards HIV risk.

Stopping PrEP is not always a failure

The effectiveness of HIV PrEP obviously depends on its use. However, the discontinuation rates observed in several cohorts regularly raise questions for public health professionals.

But why do people actually stop taking PrEP?

An analysis of over 4,800 MSM who have previously used PrEP in the ERAS 2023 survey provides new insights. Among participants who discontinued their treatment, the reasons given fall mainly into three categories:

• changes in sexual behaviour,
• personal desire to stop,
• clinical or medical reasons.

The first key finding is significant: stopping PrEP does not automatically mean exposure to HIV. In many cases, people report having changed their sexual practices and/or protection strategies.

In other words, prevention remains dynamic and adaptive.

The first few months on PrEP are crucial

However, the results show a high level of vulnerability at the start of treatment.

The more experience people gain with PrEP, the less likely they are to stop taking it. Conversely, experiences during the initial stages of use appear to be key to continuing with this strategy.

The groups most at risk of discontinuation are:

• the youngest;
• people who are disconnected from gay community networks;
• people living in regions with low HIV prevalence;
• people who are more disconnected from the healthcare system.

Proximity to the gay community (measured indirectly, for example, via Mpox vaccination) appears to be an important factor, certainly linked to inclusion in HIV-related culture (history of the epidemic, knowing someone living with HIV or taking PrEP themselves, with whom it is possible to discuss the matter or who can even provide support with adherence).

These results highlight the central role of community networks in sustaining prevention.

Intermittent PrEP changes trajectories more significantly

The second presentation, from the ANRS-PREVENIR cohort, focused not only on stopping PrEP, but on transitions between different prevention strategies:

• personally controlled protection (PrEP for oneself, condoms);
• partner-dependent protection (partner stating they do not have HIV, are taking PrEP or are on antiretroviral therapy);
• no reported protection.

Overall, the majority of participants remain with their initial strategy. However, certain transitions appear more frequent among specific profiles.

Users of ‘on-demand’ PrEP are more likely to change their strategy over time, particularly towards forms of protection dependent on the partner or towards periods with no declared protection.

People starting PrEP (‘PrEP-naïve’) also face a higher risk of transitioning to situations where they have no individual control over their protection, or even to unprotected sex.

These results do not necessarily imply an increase in the objective risk of transmission. Rather, they illustrate ongoing adjustments to prevention strategies within sexual and emotional relationships.

The central role of partners and relationship dynamics

One of the particularly interesting points raised during the discussions concerns “reverse” transitions towards greater (control over one’s) protection.

In the field, some people who report that they did not use, or no longer use, personal protection explain that they were referred to PrEP or reassured by partners who were themselves on PrEP or had an undetectable viral load.

Knowledge and skills thus circulate within community networks.

This observation challenges traditional models focused solely on individual behaviour. HIV prevention is increasingly seen as a collective practice driven by interpersonal relationships, influenced by community norms and discussions around sexual health.

Moving beyond a binary approach to prevention

This research also encourages us to move beyond a moralistic interpretation of interruptions in PrEP use.

Stopping PrEP does not automatically mean:

• abandoning all prevention;
• “taking risks”;
• being “less adherent”.

Prevention practices evolve according to:

• life stages;
• relationships;
• mental health;
• sexual practices;
• perceived risk;
• access to care;

Analyses show, for example, that depressive symptoms play a complex role: they reduce certain transitions but also increase the likelihood of periods without individually controlled protection.

These psychological and social dimensions therefore appear essential in supporting people on PrEP.

What lessons can be drawn for Switzerland?

For Swiss AIDS Aid, these results highlight several important issues.

Firstly, strengthening support during the initiation of PrEP. The first few months appear to be a critical period requiring:

• information and support;
• follow-up that is flexible, available and appropriate.

Secondly, greater consideration must be given to those with fewer connections to community networks. Historical models of HIV prevention have often relied on strong community engagement, but some people today remain more distanced from these spaces.

This research also highlights the importance of a non-judgemental approach to changes in prevention strategies. Prevention pathways are rarely linear, much like life trajectories.

Finally, they show that HIV prevention cannot be reduced to biomedical prescriptions alone. Relational, community and psychological dimensions remain decisive in the actual use of PrEP.

Prevention that is more fluid than expected

Ultimately, these studies show that PrEP does not merely transform prevention tools. It also transforms the ways in which we think about risk, sexual relations and autonomy in health.

Prevention pathways now appear more fluid, more flexible and more negotiated than in the ‘condoms-only’ era.

The challenge for community and/or prevention organisations, as well as for healthcare providers, is therefore not merely to get people onto PrEP. It is also to support them along evolving prevention pathways, without reducing every change to an individual ‘failure’.