Informal PrEP use in Greece: The long, hard road to formal programmatic implementation

Area of Science:

• Public Health
• Infectious Disease Prevention
• Sexual Health

Background:

• Pre-exposure prophylaxis (PrEP) is a key HIV prevention strategy recommended by the WHO.
• Despite European approval and WHO recommendations, PrEP implementation is inconsistent across Europe.
• Greece has national PrEP guidelines but lacks public sector access, hindering uptake.

Purpose of the Study:

• To report on informal PrEP use among men who have sex with men (MSM) and transgender women (TGW) in Athens.
• To identify barriers to PrEP uptake and retention in care.
• To highlight the need for formal PrEP services in Greece.

Main Methods:

• A cross-sectional study of 547 MSM and TGW attending a private sexual health clinic in Athens in 2024.
• Data collected on PrEP eligibility, current use, initiation, and procurement methods (online generic formulations).
• Follow-up data on retention in care, seroconversions, and sexually transmitted infections (STIs).

Main Results:

• 56.3% of participants were suitable for PrEP; 134 initiated PrEP using online generic drugs (daily or on-demand).
• High retention in care (79.6%) and no HIV seroconversions over 2423 person-months.
• High STI diagnosis rate (30.3%) indicates elevated HIV risk; barriers included cost and limited awareness.

Conclusions:

• Informal PrEP use is prevalent, but barriers to access persist in Greece.
• Urgent need for formally implemented, accessible PrEP services aligned with WHO recommendations.
• Integration into sexual health frameworks is crucial for improving HIV prevention in high-risk populations.