PrEP is the regular or intermittent use of antiretroviral drugs by HIV negative people to prevent HIV acquisition. It should be offered to all MSM, especially key populations at high risk of HIV infection. For some subgroups of MSM in particular, this method has meant that they are for the first time able to protect themselves reliably from HIV infection. France was the first European country to provide PrEP to all who need it, and more and more countries are now implementing PrEP strategies.
Discussions about whether, how and where to provide PrEP, policy development and trials are under way in many other European countries. There are strong arguments why CBVCTs, as community-based services for MSM, are well placed to play a central role in providing access to PrEP. The Barcelona Checkpoint has articulated these reasons:
Why a community centre for the delivery of PrEP?
- Persons who are HIV negative are not used to going to hospitals
- Easy to talk to peers about sexuality, (not) using condoms, risk perception and risk reduction
- 10 years of experience with HIV rapid testing and linkage to care
- Promoting regular testing for people at highest risk (4 times/year)
- New technologies and fast results for viral load testing
- STI screening (Syphilis, gonorrhoea, chlamydia, HCV) already implemented
- Long-term collaboration with HIV clinics and physicians
- Experience with patient preparedness for treatment and adherence issues
- Community outreach, awareness and information on PrEP.
(Source: bcn Checkpoint)
Expanding CBVCT operations to include PrEP does not necessarily depend on PrEP being provided through the health system. Even if MSM still source PrEP medication privately, information, support and health monitoring are important services that CBVCTs can offer. In the following checklist, we have listed the main elements of a comprehensive PrEP service. Depending on local conditions, not all of these can be provided by CBVCTs in every case. You could consider starting with information/counselling and cooperation with external PrEP prescribers and then add more components over time, up to providing a ’One-Stop-Shop’ that offers everything from testing and counselling to PrEP prescription and monitoring.