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Informal PrEP: Rethinking approaches to pharmaceutical access and HIV prevention pathways
Sydney Calkin1, Alvaro Martinez-Lacabe1
1Department of Geography, Queen Mary University of London, London, UK.
Global Public Health
|July 31, 2026
Summary
Informal access to HIV pre-exposure prophylaxis (PrEP) offers crucial, often overlooked, public health benefits by challenging formal systems. These practices assert self-managed care and reveal systemic exclusions in HIV prevention.
Area of Science:
- Public Health
- Sociology of Health and Illness
- Pharmaceutical Studies
Background:
- Informal access to HIV pre-exposure prophylaxis (PrEP) is frequently viewed negatively, associated with risks and marginalization from formal healthcare.
- This perspective overlooks the functional and generative aspects of obtaining and using PrEP outside of regulated medical channels.
- Existing research often focuses on risks like suboptimal dosing and antiretroviral resistance, neglecting the broader significance of these practices.
Purpose of the Study:
- To explore and define 'informal' PrEP practices, including methods of acquisition and distribution outside formal systems.
- To analyze how these informal practices challenge existing binaries (legal/illegal, formal/informal) and respond to systemic exclusions.
- To interrogate the political, infrastructural, and biopolitical significance of informal PrEP access within pharmaceutical capitalism and surveillance contexts.
Main Methods:
- Drawing upon recent empirical and theoretical studies on informal PrEP.
- Interrogating informal PrEP through the lenses of pharmaceutical capitalism, logistics, social infrastructures, biomedical technologies, and biopolitics.
- Conceptual clarification of informal PrEP practices and their relationship to formal HIV prevention services.
Main Results:
- Informal PrEP practices encompass strategies for obtaining and using PrEP outside formal medical channels, facilitated by various networks.
- These practices actively challenge dichotomies of access and respond to systemic barriers within formal healthcare.
- Informal PrEP gestures towards alternative models for sexual public health, asserting the right to self-managed care.
Conclusions:
- Focusing solely on the risks of informal PrEP obscures its political and infrastructural importance.
- Informal PrEP practices demonstrate resistance to exclusion and highlight the need for more inclusive sexual health provisions.
- Understanding informal PrEP generates critical insights for shaping future sexual health policies and service delivery.
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