In February 2018, the first European PrEP event “PrEP In Europe Summit 2018” took place in Amsterdam, uniting over 100 activists. Despite the numerous delegations from Eastern Europe and Central Asia attending the event, few people know about the opportunities offered by PrEP in our countries, and we may only discuss (dream) about the possibility of introducing PrEP in our countries.
To clarify this question, first of all, please tell us what is this PrEP?
Answering the question of what PrEP is, we should first refer to the source; according to the WHO definition, oral pre-exposure prophylaxis of HIV infection (PrEP) means the daily taking of ARVs by HIV-negative individuals to prevent the transmission of HIV infection.
According to a WHO guide published in September 2015, an oral form of pre-exposure prophylaxis (hereinafter referred to as PrEP) containing tenofovir disoproxil fumarate (TDF) was suggested as an additional method of HIV prevention among people at high risk of HIV infection.
Avoiding excessively formal and bureaucratic approach, it can be said that PrEP is a new effective way of HIV prevention, where antiretroviral drugs (ARVs) are used to protect HIV-negative people from HIV infection.
Numerous studies conducted around the world have proven that PrEP is an effective prevention method among serodiscordant couples, heterosexual men and women, men who have sex with men (MSM), people who inject drugs and transgender women, regardless of age, gender or type of sexual contacts.
Why PrEP is not widespread in our country?
Leaving alone many complicated issues related to the prospects of PrEP implementation in our countries, we would like to focus on one of the most important and challenging issues hindering the possibilities of PrEP in our region – the availability of drugs for PrEP.
As we know, the primary drug recommended and approved for use in PrEP is a combination of TDF + 3TC (under the trade name of Truvada) manufactured by Gilead. Furthermore, WHO documents refer to the strong recommendations of this prevention method and the high quality of evidence base.
To date, community efforts were carried out with the financial support of the ECUO to monitor the availability of ART, one of the sections of this study entailed observing the registration, price and quality of ARVs in 15 countries.
The results of the study, unfortunately, clearly demonstrate the differences in the cost of drugs in each individual country, and it should be noted that the difference in the cost of TDF + 3TC drug can radically differ from USD5 per a package of the generic analogue of Truvada in Georgia to more than USD900 for branded drug in Lithuania.
In addition, even if the medication prices are affordable in most EECA countries, it is not possible to receive drugs for PrEP. Most countries have not yet registered official indications for PrEP and there is no legal framework for prescribing pre-exposure prophylaxis.
What are the disadvantages?
Certainly, those who criticize the introduction of PREP, present very solid arguments and highlight the benefits of using condoms, because pre-exposure prophylaxis does not protect against other sexually transmitted diseases, such as gonorrhea and syphilis, and the government finds it much cheaper to distribute condoms to the key populations.
It should be noted that in its recommendations the WHO pays attention to these issues and explicitly provides that PREP should not replace or substitute effective and widely used HIV prevention measures, such as comprehensive condom use programs for sex workers and MSM and harm reduction programs for people who inject drugs.
Meanwhile, I still would like to say that PrEP is a systemic intake of drugs in order to prevent the occurrence of a disease after contact with a HIV-positive person, which is easy to use, allows everyone to maintain control over the situation (for example, in the case of sex workers) and safeguards the personal limits during sex.
Summarizing all the information about the PrEP, it must be said that today the matters related to the PrEP implementation feasibility in our countries cause a lot of concern, especially in circumstances where the rights of people are violated due to legal mechanisms, and the society maintains an extreme level of stigma and discrimination.
We suggest that each reader researches PrEP in a more detailed way in order to answer the question for themselves whether the PREP is needed in his country, and to decide, which punctuation mark should be placed the title of this article!