Asa Radix

The Politics of PrEP session included discussions on political barriers and facilitators to PrEP implementation. Many countries have been slow to implement PrEP, due to financial concerns or competing priorities, including restricting ART to people living with HIV. The session provided valuable lessons in addressing controversies and navigating political roadblocks.

In France, PrEP was approved after a lengthy process of community and government consultations, in-country clinical trials and guidelines changes. PrEP is now approved and fully reimbursed and can be prescribed in various clinical settings. In the first year 2774 people (98% MSM) initiated PrEP (57% on-demand). Ian Green discussed the UK roll-out, which required a legal challenge for the NHS to pay for PrEP. Many officials still question the cost when other health services are underfunded. Alejandra Trossero discussed challenges to rolling-out PrEP in Latin America and the Caribbean youth. 1/3 of new infections occur among 15-24 year-olds, predominantly MSM and transgender people. A significant epidemic also exists among cisgender heterosexual people in the Caribbean. PrEP is available in the Bahamas, Barbados and Brazil though the public sector, but only for adults. Barriers to adolescent PrEP include age of medical consent.

Despite research describing the efficacy of PrEP to prevent new infections, global oral PrEP roll-out has been slow. This is in part due to financial realities and competing priorities but also due to lack of government buy-in. Strong political support is an essential component for successful programs. The session demonstrated that building community awareness is essential and that campaigns need to build on community partnerships. Materials should be relevant to the communities they serve. Unfortunately, many programs miss populations at risk, including transgender people and youth. Youth require additional adherence support, welcoming services and tailored messaging.