Informal PrEP: Rethinking approaches to pharmaceutical access and HIV prevention pathways

Informal access to HIV pre-exposure prophylaxis (PrEP) is often represented as risky and marginal to formal HIV prevention services. Yet this framing obscures what informal PrEP makes possible and how it functions. This article explores 'informal' PrEP practices, which encompass (i) strategies through which people obtain and use PrEP outside formal medical channels and (ii) networks that facilitate such access. Drawing on recent empirical and theoretical studies, we interrogate informal PrEP as generative practices that challenge binaries between legal/illegal, regulated/unregulated, and formal/informal access. Some informal PrEP practices not only respond to systemic exclusions but also gesture toward alternative models of sexual public health. Although informal PrEP access raises public health concerns, particularly around suboptimal dosing and the potential emergence of antiretroviral resistance, we argue that focusing solely on these type of risks obscures its political and infrastructural significance. We first clarify the concept of informal PrEP and then situate the analysis through dimensions of pharmaceutical capitalism and logistics, the entanglement of social infrastructures with biomedical technologies, and the biopolitics of biomedical surveillance. Taken together, these dimensions reveal how informal PrEP practices refuse exclusion, assert the right to self-managed care, and generate insights that can shape more than just sexual health provision.