EU countries have set 2030 as the target date to end AIDS in their populations. The provision of the HIV prevention medication, PrEP, is key to achieving this goal. However, half a million vulnerable people in the EU have no access to the drug. On World AIDS Day, we look at what governments need to do to make PrEP accessible for all.
Ending the AIDS epidemic by 2030 is the ambitious goal set by the United Nations eight years ago, to which EU countries committed along with many others. PrEP, or pre-exposure prophylaxis, is a vital component of this plan.
According to UNAIDS, 38.4 million people in the world were living with HIV in 2021. There 1.5 million new HIV infections last year and 650,000 deaths due to AIDS. In Europe and Central Asia, there is a persistent increase in annual HIV infections. Because it is highly effective in preventing infection, it is essential that PrEP is available for all those at risk. But the thorny truth is that this is far from the case.
Who can access PrEP? Who cannot?
Despite the efforts in the fight against AIDS, PrEP is still not accessible for many. In the EU, 500,000 gay, bisexual, and other men who have sex with men (MSM) who would like to take PrEP don’t have access to it. This represents a 17% gap, according to a 2019 study by the ECDC. The differences in price are also striking: generic PrEP can be found for €5 per month in some countries that include it in their national insurance coverage, while some brands cost up to €6,041 when national insurance does not provide coverage.
According to AIDS Action Europe, PrEP is more accessible in urban areas, information campaigns are often led by NGOs who might not have enough financial support, and as a result services and information target young educated gay, bisexual, and other MSM. Migrants, bisexual men, women (particularly women with migrant backgrounds), trans people and sex workers are left behind. Other populations at risk are people who inject drugs, prisoners and undocumented migrants, because they are not eligible for PrEP in many European countries, as reported by UNAIDS. So, what’s the way forward if the ambitious 2030 target is to be met?
The Top 6 Recommendations
Here are some key recommendations for governments in order to make PrEP available to everyone who might benefit from it, following the research by UNAIDS and AIDS Action Europe:
- Include PrEP as an HIV combination prevention
- Make the eligibility criteria more inclusive
- Develop awareness-raising campaigns that better target communities that are currently left behind
- Promote collaboration between communities and medical health providers
- Share experiences and best practices of implementation with those countries that have not implemented national PrEP guidelines yet
- Encourage strong data collection and add informal online access to PrEP and the relevant health outcomes to existing monitoring
For many years, ending AIDS in Europe was just a hope, but as time has gone on and medications have improved, this hope has turned into a real possibility. At ILGA-Europe, we will continue to work with governments and institutions to ensure equity in access to PrEP, as part of a whole package of measures to ensure the end of AIDS by the set target date.
Check out the Parliamentary Dialogue on Equitable Access to Oral PrEP within the EU and Beyond celebrated on November 25, 2022 to learn more.