PrEP is available free of charge or largely reimbursable through the national health system in only four European countries so far, with others set to join soon.
These countries are France, Norway, Belgium and Scotland (which runs its own health service, as do England, Wales and Northern Ireland).
In all countries, PrEP is available only to men who have sex with men at high risk of HIV and to other people at equivalent risk. How ‘risk’ is defined varies. Having had recent condomless sex, having had a recent diagnosis of a sexually transmitted infection (STI), or having an HIV-positive partner with a detectable or unknown viral load are among the indicators often used. These may not apply to everyone, though; some discretion for doctors is usually included, for cases where risk is strongly suspected but people do not fall into the usual criteria.
Initially at least, most countries will be offering PrEP only at specialist sexual health clinics or their equivalent. France has a programme whereby clinics need to qualify to prescribe PrEP.
France started offering PrEP through a network of sexual health clinics at the beginning of 2016. Although there may be initial charges, most are fully reimbursable to most people. So far, nearly 3000 people have started PrEP, all but a handful of them men who have sex with men. There are French PrEP information sites at http://prep-info.fr and http://sexosafe.fr/la-prep. A good community Facebook page on PrEP in France is at www.facebook.com/groups/PrepDial
In November 2016, Norway announced it would start offering PrEP through its Olafia sexual health clinic in Oslo. As of July 2017, at least 150 people have either started PrEP or are waiting to start it. While this may not sound many, proportionally this would be the equivalent of 1900 people in a country with the population of France. Olafia’s Facebook page is here and for an article about the service see here.
In April 2017, Scotland announced it would start providing PrEP. The first PrEP prescription was dispensed on 5 July 2017. For information on PrEP in Scotland, see www.prep.scot.
Belgium announced in May 2016 that it would start prescribing PrEP and on 1st June it did so. Note that in Belgium PrEP is not completely free: it is available at the greatly reduced price of €11.90 for 30 days’ supply. For more information, including eligibility criteria and where to go for it, see www.be-prep-ared.be/en/prep-in-belgium.
Portugal announced in May 2017 that it intended to start providing PrEP. The latest information PrEP in Europe has had is that the Ministry of Health has finished writing its PrEP guidelines but that they were not yet out for consultation. An opinion from Portugal’s medicines regulator Infarmed was also awaited.
The generic company Mylan has announced that it intends to launch generic tenofovir/emtricitabine in August 2017. In central and eastern Europe, the situation is different from western Europe, as in many cases the patent laws that restrict the sale of generic drugs do not apply. A launch is planned in Poland and other central and eastern European countries: we will update as we get more news.