Buying it online

At present, most people taking PrEP in Europe are buying it themselves. Some buy it privately from their doctor, some buy or are given PrEP from friends, but the most common source is via online pharmacies.

Online pharmacies sell generic tenofovir/emtricitabine in the form of pills similar to Truvada – one brand is Ricovir and another Tenvir-EM. They sell antiretroviral drugs made by generic companies for the low-income market, which are generally available at about 10% of the list price of Truvada in high-income countries – from about €29 to €54 for 30 days’ supply, depending on the country it is being ordered from.

Buying generic PrEP online is only possible due to ‘loopholes’ (exceptions) in individual countries’ medicines laws. It is only legal at all in certain countries, such as the UK or Switzerland, that allow a certain amount to be ordered for personal use – the UK, for instance, allows one month’s supply and some other countries three months. Some countries such as Hungary allow a personal supply only to be ordered once. Other countries do not have these legal exceptions for online purchase of PrEP drugs and may apply customs regulations more, or less, stringently.

Dynamix International (http://www.purchase-prep.com) is a Bangkok-based pharmaceutical ordering company run by PrEP activists that enables online purchase. It also has a very informative page on restrictions in other EU countries at http://www.purchase-prep.com/european-union/.

Dynamix and other online pharmacies generally have a good reputation and a programme at London’s Dean Street clinic that offered to test people’s drugs found no examples of counterfeit drugs.

People buying PrEP should ensure that they access regular HIV testing and medical monitoring; every three months is recommended. Taking PrEP if you already have HIV will not cure or control it, and could lead to the development of drug-resistant HIV. Monitoring for side-effects, especially kidney function, is essential – and cheap. People who have condomless sex should be getting regular checkups for other STIs too.

Two different European surveys in 2016 – a collaboration between the gay social website Hornet and the European Centre for Disease Prevention and Control (ECDC), and a study called Flash! PrEP – found quite high levels of use of PrEP among respondents: 10% in the Hornet/ECDC survey and 5% in Flash! PrEP, a larger study that included women.

The Flash! PrEP survey found that about 70% of people who said they were taking ‘informal’ or online PrEP were having no regular medical monitoring.

The website www.iwantprenow.co.uk has been helping people in the UK and elsewhere to buy PrEP for a couple of years now. In early 2016, they came to a pioneering agreement with the 56 Dean Street clinic in London (see http://dean.st/prep/) that enabled people buying online PrEP to have regular kidney function, HIV and STI testing provided free of charge.

Not many European countries have the same network of free, anonymous sexual health clinics as the UK but a few other clinics are following suit. An example is Barcelona Checkpoint, which has recently set up its own clinic for PrEP users.

It is very difficult to establish how many people in Europe are actually buying PrEP online, especially as the number is growing. The two PrEP surveys above were answered by about 800 people each who were taking PrEP. Iwantprepnow’s database of contacts contains several thousand people. A recent unpublished survey suggests that throughout all of Europe, the number could be at least 5000.