AIDES and PLUS announced to conference attendees from the world over results from the biggest European survey ever to be conducted regarding knowledge, interest and utilisation of PrEP, Flash! PrEP in Europe. This presentation revealed the principal barriers, both individual and structural, regarding access to this new HIV prevention tool. It also advocated for harmonised access to PrEP throughout the continent.
First, a quick glance at the current situation regarding PrEP access in Europe: authorised and available in the United States since 2012 and in France since 2016, PrEP has struggled to find a place in European public health policy. Despite international recommendations, its recent integration by the WHO on the essential medicines list, and the authorisation by the European Medicines Agency in August 2016, only 4 countries in Europe have currently authorised PrEP (Belgium, Scotland, France and Norway).
Flash! PrEP in Europe aimed to evaluate among key populations (MSM, women, transgender people…) knowledge, level of interest and informal PrEP use throughout Europe. Conducted by AIDES and Coalition PLUS in partnership with the University of Amsterdam and 15 European associations involved in the fight against HIV/AIDS, the study was carried out simultaneously in 12 countries and in 10 languages between 15 June and 15 July 2016. Close to 16 000 people responded to the survey, from Ireland to Romania and from Portugal to Denmark.
What do the study results tell us?
“This survey reveals a real problem of information concerning PrEP among those who are the most exposed. But it also shows that when people know about this new tool and have quality information on it, they say that they are interested in using it”, explains Aurélien Beaucamp, president of AIDES. The Flash! PrEP in Europe study revealed that only 55% of respondents with behaviours that expose them to HIV know about PrEP. It is urgent to increase this level of information because among those who did know about PrEP, 73% reported an interest in using PrEP. Those who know of PrEP clearly expressed the will to protect themselves. With limited authorised access in Europe, some of these people have to obtain it via the internet, from HIV+ friends or by using Post-Exposure Prophylaxis prescriptions to get Truvada.
PrEP uptake is still very weak due to a lack of authorised access and quality information. This is the figure to remember from the study: Only 8% of those who declared risk behaviours use or have already used PrEP and half of these did so within the framework of research studies.
Clearly identified barriers at individual and structural levels explain this weak uptake. Barriers identified at the individual level in the study included price issues and non-reimbursement, fears related to side-effects and having to go the hospital to get the tablets. These barriers can be quite easily lifted by improving the quality of the information and changing delivery methods (e.g. by promoting GP prescription). However, the principal barrier to the uptake of PrEP is structural. Without official authorisation in more European countries, without reimbursement within the health insurance systems and without care provision that is sufficiently oriented to the needs of populations, access to PrEP will remain extremely complicated. As Aurélien Beaucamp declared “If we want to have a real impact on the epidemic, European policy on HIV needs to be rapidly harmonised, integrating this new tool everywhere.”
For AIDES and Coalition PLUS it is essential to eliminate all obstacles standing in the way of PrEP access for the populations that need it most. The European continent should lead the way.
This is why AIDES and Coalition Plus are calling for :
- Rapid harmonisation of PrEP access in Europe for the most vulnerable populations within a global care framework and in user-friendly conditions.
- European authorities and public authorities in each European country to take the necessary steps to provide information that is objective, clear and of quality to all populations.