Oral pre-exposure prophylaxis (PrEP) of HIV is the daily use of ARV drugs by HIV-uninfected people to block the acquisition of HIV. Studies have demonstrated the effectiveness of PrEP in reducing HIV transmission among serodiscordant heterosexual couples, men who have sex with men, transgender women, high-risk heterosexual couples, and people who inject drugs. Proof of concept has long been established in the laboratory by animal studies and in real world application by the prevention of mother-to-child transmission and post-exposure prophylaxis. The safety of the drugs being considered for PrEP, tenofovir and emtricitabine, has been established through their use for treatment and in safety trials in uninfected people
Five trials of effectiveness have been conducted in the last decade, both in low-income and high-income countries. These focus on effectiveness of PrEP among people who inject drugs, serodiscordant couples, heterosexual women and high risk men who have sex with men (MSM).
Oral PrEP for men who have sex with men has proved feasible in various trial settings and acceptability studies (including among young men who have sex with men). Implementation may prove challenging, however, where access to services and provision of alternative prevention tools are limited or lacking.
PrEP is best offered as one component of a comprehensive set of HIV prevention interventions. Comprehensive HIV prevention programmes should include unfettered availability of condoms and lubricants, routine HIV testing, risk-reduction counselling and adherence coaching if PrEP is offered.
Globally, awareness of PrEP among men who have sex with men continues to be limited. Willingness to use PrEP varies across studies, but the majority report that 40% to 70% of respondents are willing to use PrEP. Issues of criminalization, stigma and discrimination, and violence should be considered during implementation, especially where same-sex behaviour is illegal.
Additional reading
Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations