1887
  1. Home
  2. Eurosurveillance
  3. Volume 30, Issue 34, 28/Aug/2025
  4. Article
Research Open Access
Like 0
Download

SDG 3: HIV/AIDS

Abstract

BACKGROUND

Pre-exposure prophylaxis (PrEP) provision routes across Europe differ notably between governmental and non-governmental pathways. The introduction of long-acting (LA)-PrEP may further diversify provision dynamics.

AIM

We investigated disparities in PrEP access and whether access pathways determine oral PrEP use patterns and LA-PrEP intention among PrEP-experienced men who have sex with men (MSM).

METHODS

Using data from 7,505 PrEP-experienced MSM from a cross-sectional survey (PROTECT; 20 European countries, October 2023–April 2024), we used latent class analysis (LCA) to identify MSM's latent socioeconomic positions (SEPs), and logistic regression to compare the likelihood of accessing governmental/non-governmental pathways, and compare oral PrEP adherence, discontinuation and LA-PrEP intention between governmental/non-governmental pathways.

RESULTS

Most MSM accessed PrEP via governmental pathways (n = 6,671; 88.9%), 11.1% (n = 834) used non-governmental pathways. The LCA identified three groups: employed MSM with more advantaged SEPs, younger MSM with less advantaged SEPs, and older MSM with more advantaged SEPs. Compared with the first group, younger MSM with less advantaged SEPs were significantly more likely to access PrEP via non-governmental pathways (aOR = 1.27; 95% confidence interval (CI): 1.04–1.55). Accessing PrEP via non-governmental pathways was associated with suboptimal adherence (aOR = 1.28; 95% CI: 1.03–1.58), discontinuation (aOR = 3.55; 95% CI: 2.99–4.21), but also higher LA-PrEP intention (aOR = 1.28; 95% CI: 1.06–1.56).

CONCLUSIONS

Inequalities exist in PrEP access among MSM in Europe. While non-governmental pathways offer opportunities to engage MSM with less advantaged SEPs, oral PrEP use patterns via this pathway were not optimal. Tailored efforts should ensure that PrEP is accessible and affordable to enhance current use and prepare for future LA-PrEP modalities.

© Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Loading

Article metrics loading...

/content/10.2807/1560-7917.ES.2025.30.34.2500122
2025-08-28
2025-09-02
/content/10.2807/1560-7917.ES.2025.30.34.2500122
Loading
Loading full text...

Full text loading...

/deliver/fulltext/eurosurveillance/30/34/eurosurv-30-34-4.html?itemId=/content/10.2807/1560-7917.ES.2025.30.34.2500122&mimeType=html&fmt=ahah

References

  1. Grant RM, Lama JR, Anderson PL, McMahan V, Liu AY, Vargas L, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med. 2010;363(27):2587-99.  https://doi.org/10.1056/NEJMoa1011205  PMID: 21091279 
  2. Molina J-M, Capitant C, Spire B, Pialoux G, Cotte L, Charreau I, et al. On-demand preexposure prophylaxis in men at high risk for HIV-1 infection. N Engl J Med. 2015;373(23):2237-46.  https://doi.org/10.1056/NEJMoa1506273  PMID: 26624850 
  3. Jourdain H, de Gage SB, Desplas D, Dray-Spira R. Real-world effectiveness of pre-exposure prophylaxis in men at high risk of HIV infection in France: a nested case-control study. Lancet Public Health. 2022;7(6):e529-36.  https://doi.org/10.1016/S2468-2667(22)00106-2  PMID: 35660214 
  4. European Centre for Disease Prevention and Control (ECDC). HIV pre-exposure prophylaxis in the EU/EEA and the UK: implementation, standards and monitoring. Stockholm: ECDC; 2021. Available from: https://www.ecdc.europa.eu/en/publications-data/HIV-PrEP-eueea-and-uk-implementation-standards-monitoring-guidance
  5. Vanhamel J, Wijstma E, Deblonde J, Laga M, Vuylsteke B, Nöstlinger C, et al. Developing evidence-informed indicators to monitor HIV pre-exposure prophylaxis programmes across EU/EEA countries: a multi-stakeholder consensus. Euro Surveill. 2023;28(23):2200546.  https://doi.org/10.2807/1560-7917.ES.2023.28.23.2200546  PMID: 37289428 
  6. Hoornenborg E, Krakower DS, Prins M, Mayer KH. Pre-exposure prophylaxis for MSM and transgender persons in early adopting countries. AIDS. 2017;31(16):2179-91.  https://doi.org/10.1097/QAD.0000000000001627  PMID: 28991023 
  7. Coleman R, Prins M. Options for affordable pre-exposure prophylaxis (PrEP) in national HIV prevention programmes in Europe. Euro Surveill. 2017;22(42):17-00698.  https://doi.org/10.2807/1560-7917.ES.2017.22.42.17-00698  PMID: 29067904 
  8. AIDS Action Europe (AAE). Rapid assessment on access to PrEP in EU/EEA countries. Berlin: AAE; 2022. Available from: https://www.aidsactioneurope.org/en/news/rapid-assessment-access-prep-eueea-countries
  9. Van Landeghem E, Dielen S, Semaan A, Rotsaert A, Vanhamel J, Masquillier C, et al. Insights into barriers and facilitators in PrEP uptake and use among migrant men and transwomen who have sex with men in Belgium. BMC Public Health. 2023;23(1):712.  https://doi.org/10.1186/s12889-023-15540-y  PMID: 37076823 
  10. Tieosapjaroen W, Zhang Y, Fairley CK, Zhang L, Chow EPF, Phillips TR, et al. Improving access to oral pre-exposure prophylaxis for HIV among international migrant populations. Lancet Public Health. 2023;8(8):e651-8.  https://doi.org/10.1016/S2468-2667(23)00105-6  PMID: 37421969 
  11. Wang H, Molina J-M, Dray-Spira R, Schmidt AJ, Hickson F, van de Vijver D, et al. Spatio-temporal changes in pre-exposure prophylaxis uptake among MSM in mainland France between 2016 and 2021: a Bayesian small area approach with MSM population estimation. J Int AIDS Soc. 2023;26(5):e26089.  https://doi.org/10.1002/jia2.26089  PMID: 37221971 
  12. Wang H, Shobowale O, den Daas C, Op de Coul E, Bakker B, Radyowijati A, et al. Determinants of PrEP uptake, intention and awareness in the Netherlands: a socio-spatial analysis. Int J Environ Res Public Health. 2022;19(14):8829.  https://doi.org/10.3390/ijerph19148829  PMID: 35886681 
  13. Holt M, Chan C, Broady TR, Mao L, MacGibbon J, Rule J, et al. Adjusting behavioural surveillance and assessing disparities in the impact of COVID-19 on gay and bisexual men’s HIV-related behaviour in Australia. AIDS Behav. 2023;27(2):518-34.  https://doi.org/10.1007/s10461-022-03788-1  PMID: 35895148 
  14. Gokengin D, Bursa D, Skrzat-Klapaczynska A, Alexiev I, Arsikj E, Balayan T, et al. PrEP scale-up and PEP in Central and Eastern Europe: changes in time and the challenges we face with no expected HIV vaccine in the near future. Vaccines (Basel). 2023;11(1):122.  https://doi.org/10.3390/vaccines11010122  PMID: 36679967 
  15. World Health Organization (WHO). Differentiated and simplified pre-exposure prophylaxis for HIV prevention. Geneva: WHO: 2022. Available from: https://iris.who.int/bitstream/handle/10665/360861/9789240053694-eng.pdf?sequence=1
  16. Brisson J, Ravitsky V, Williams-Jones B. Informal PrEP: an emerging need for nomenclature. Lancet Public Health. 2019;4(2):e83.  https://doi.org/10.1016/S2468-2667(18)30254-8  PMID: 30578132 
  17. Brisson J. Ethical public health issues for the use of informal PrEP. Glob Public Health. 2018;13(10):1382-7.  https://doi.org/10.1080/17441692.2017.1373139  PMID: 28868979 
  18. Green KE, Nguyen LH, Phan HTT, Vu BN, Tran MH, Ngo HV, et al. Prepped for PrEP? Acceptability, continuation and adherence among men who have sex with men and transgender women enrolled as part of Vietnam’s first pre-exposure prophylaxis program. Sex Health. 2021;18(1):104-15.  https://doi.org/10.1071/SH20167  PMID: 33653505 
  19. Wang Z, Mo PKH, Ip M, Fang Y, Lau JTF. Uptake and willingness to use PrEP among Chinese gay, bisexual and other men who have sex with men with experience of sexualized drug use in the past year. BMC Infect Dis. 2020;20(1):299.  https://doi.org/10.1186/s12879-020-05024-4  PMID: 32321442 
  20. Li C, Xiong Y, Liu H, Luo D, Tucker JD, Maman S, et al. Multifaceted barriers to rapid roll-out of HIV pre-exposure prophylaxis in China: a qualitative study among men who have sex with men. Int J Behav Med. 2024;31(2):252-62.  https://doi.org/10.1007/s12529-023-10177-y  PMID: 37156941 
  21. Wang H, Delnoij M, Zimmermann HML, Jonas KJ. The disparities of PrEP adherence among men who have sex with men between the Global South and the Global North: An updated determinantal global meta-analysis. J Acquir Immune Defic Syndr. 2025;99(1):1-8.  https://doi.org/10.1097/QAI.0000000000003635  PMID: 39878582 
  22. Zhang J, Li C, Xu J, Hu Z, Rutstein SE, Tucker JD, et al. Discontinuation, suboptimal adherence, and reinitiation of oral HIV pre-exposure prophylaxis: a global systematic review and meta-analysis. Lancet HIV. 2022;9(4):e254-68.  https://doi.org/10.1016/S2352-3018(22)00030-3  PMID: 35364026 
  23. Wang H, Popping S, van de Vijver D, Jonas KJ. Epidemiological impact and cost-effectiveness analysis of PrEP provision expansion among MSM in the Netherlands. J Int AIDS Soc. 2025;28(6):e26516.  https://doi.org/10.1002/jia2.26516  PMID: 40462500 
  24. van Dijk M, de Wit JBF, Kamps R, Guadamuz TE, Martinez JE, Jonas KJ. Socio-sexual experiences and access to healthcare among informal PrEP Users in the Netherlands. AIDS Behav. 2021;25(4):1236-46.  https://doi.org/10.1007/s10461-020-03085-9  PMID: 33196938 
  25. Haberer JE, Mujugira A, Mayer KH. The future of HIV pre-exposure prophylaxis adherence: reducing barriers and increasing opportunities. Lancet HIV. 2023;10(6):e404-11.  https://doi.org/10.1016/S2352-3018(23)00079-6  PMID: 37178710 
  26. Pike C, Bekker L-G. Interrogating the promise of long-acting HIV pre-exposure prophylaxis. Trends Mol Med. 2023;29(2):93-8.  https://doi.org/10.1016/j.molmed.2022.11.003  PMID: 36435632 
  27. Henderson M, Schmidt HA, Chitembo L, Peralta H, Alaama AS, Johnson C, et al. The future of pre-exposure prophylaxis (PrEP) for HIV prevention: a global qualitative consultation on provider perspectives on new products and differentiated service delivery. AIDS Behav. 2023;27(11):3755-66.  https://doi.org/10.1007/s10461-023-04093-1  PMID: 37351685 
  28. ViiV Healthcare. European Medicines Agency validates ViiV healthcare’s marketing authorisation application for cabotegravir long-acting injectable for HIV prevention. London: ViiV; 2022. Available from: https://viivhealthcare.com/hiv-news-and-media/news/press-releases/2022/october/european-medicines-agency-validates-viiv-healthcare
  29. Bekker L-G, Das M, Abdool Karim Q, Ahmed K, Batting J, Brumskine W, et al. Twice-yearly lenacapavir or daily F/TAF for HIV prevention in cisgender women. N Engl J Med. 2024;391(13):1179-92.  https://doi.org/10.1056/NEJMoa2407001  PMID: 39046157 
  30. Hillier S, Bekker L, Riddler S, Hendrix C, Badal-Faesen S, Rasmussen S, et al. Safety and pharmacokinetics of oral islatravir once monthly for HIV pre-exposure prophylaxis (PrEP): week 24 analysis of a phase 2a trial. J Int AIDS Soc. 2021;24(S4):72-4.
  31. Wang H, Zimmermann HML, van de Vijver D, Jonas KJ. Intention and preference to use long-acting injectable PrEP among MSM in the Netherlands: a diffusion of innovation approach. AIDS Care. 2024;36(sup1):89-100.  https://doi.org/10.1080/09540121.2024.2307378  PMID: 38713631 
  32. Parikh UM, Koss CA, Mellors JW. Long-acting injectable cabotegravir for HIV prevention: what do we know and need to know about the risks and consequences of cabotegravir resistance? Curr HIV/AIDS Rep. 2022;19(5):384-93.  https://doi.org/10.1007/s11904-022-00616-y  PMID: 36112336 
  33. Celum C, Grinsztejn B, Ngure K. Preparing for long-acting PrEP delivery: building on lessons from oral PrEP. J Int AIDS Soc. 2023;26(Suppl 2) Suppl 2;e26103.  https://doi.org/10.1002/jia2.26103  PMID: 37439077 
  34. Stansfield SE, Heitner J, Mitchell KM, Doyle CM, Milwid RM, Moore M, et al. Population-level impact of expanding PrEP coverage by offering long-acting injectable PrEP to MSM in three high-resource settings: a model comparison analysis. J Int AIDS Soc. 2023;26(Suppl 2) Suppl 2;e26109.  https://doi.org/10.1002/jia2.26109  PMID: 37439080 
  35. Landovitz RJ, Donnell D, Clement ME, Hanscom B, Cottle L, Coelho L, et al. Cabotegravir for HIV Prevention in Cisgender Men and Transgender Women. N Engl J Med. 2021;385(7):595-608.  https://doi.org/10.1056/NEJMoa2101016  PMID: 34379922 
  36. Kolstee J, Wang H, Zimmermann H, Schroeder M, Appiah A, Brown C, et al. Design and methods of the - understanding pre-exposure prophylaxis modalities for HIV prevention in European communities - (PROTECT) survey. medRxiv. 2024:2024.11.04.24316697 . https://doi.org/10.1101/2024.11.04.24316697 
  37. Wang H, Kolstee J, Casalini JL, Hakim S, Zimmermann HM, Jonas KJ. Likelihood of HIV and recent bacterial sexually transmitted infections among transgender and non-binary individuals in 20 European countries, October 2023 to April 2024. Euro Surveill. 2024;29(48):2400347.  https://doi.org/10.2807/1560-7917.ES.2024.29.48.2400347  PMID: 39611207 
  38. American Psychological Association (APA). Socioeconomic status. Washington: APA; 2024. Available from: https://www.apa.org/topics/socioeconomic-status
  39. American Psychological Association (APA). Fact sheet: age and socioeconomic status. Washington: APA; 2010. Available from: https://www.apa.org/pi/ses/resources/publications/age#:~:text=SES%20has%20been%20found%20to,diagnosed%20with%20a%20psychological%20disorder
  40. Luo J, van Grieken A, Yang-Huang J, van den Toren SJ, Raat H. Psychosocial health disparities in early childhood: Socioeconomic status and parent migration background. SSM Popul Health. 2022;19:101137.  https://doi.org/10.1016/j.ssmph.2022.101137  PMID: 35711725 
  41. Venturelli S, Mezzadri L, Bana N, Comi L, Borghi F, Ouabou A, et al. SC-13 Impact of PrEP cost on prophylaxis initiation in an Italian centre. Sex Transm Infect. 2024;100(Suppl 1):A80.
  42. Brandenburger M, Schwichow M. Utilizing latent class analysis (LCA) to analyze response patterns in categorical data. In: Liu X, Boone WJ, editors. Advances in applications of Rasch measurement in science education. Contemporary Trends and Issues in Science Education. 2023;57: 123-56. Cham: Springer. https://doi.org/10.1007/978-3-031-28776-3_6
  43. Liegeon G, Duffy A, Brooks C, Honour H, Pozniak A, Molina JM, et al. HIV pre-exposure prophylaxis services, provision, and delivery in the European treatment network of HIV, hepatitis and global emerging infectious diseases (NEAT ID). HIV Med. 2024;25(3):353-60.  https://doi.org/10.1111/hiv.13580  PMID: 38040445 
  44. Roussos S, Pantazis N, Protopapas K, Antoniadou A, Papadopoulos A, Lourida G, et al. Missed opportunities for early HIV diagnosis in Greece: The MORFEAS study, 2019 to 2021. Euro Surveill. 2024;29(48):2400138.  https://doi.org/10.2807/1560-7917.ES.2024.29.48.2400138  PMID: 39611208 
  45. Stutterheim SE, Sicking L, Brands R, Baas I, Roberts H, van Brakel WH, et al. Patient and provider perspectives on HIV and HIV-related stigma in Dutch health care settings. AIDS Patient Care STDs. 2014;28(12):652-65.  https://doi.org/10.1089/apc.2014.0226  PMID: 25459231 
  46. McBryde-Foster M, Allen T. The continuum of care: a concept development study. J Adv Nurs. 2005;50(6):624-32.  https://doi.org/10.1111/j.1365-2648.2005.03447.x  PMID: 15926967 
  47. European Centre for Disease Prevention and Control (ECDC). HIV pre-exposure prophylaxis in the EU/EEA and the UK: implementation, standards and monitoring. Operational guidance. Stockholm: ECDC; 2021. Available from: https://www.ecdc.europa.eu/sites/default/files/documents/HIV-Pre-Exposure-Prophylaxis-in-the-EU-EEA-UK.pdf
  48. Patel R. Why Is cabotegravir rollout so slow? Conference on Retroviruses and Opportunistic Infections (CROI); Denver, United States, 2–6 March 2024. Available from: https://www.croiconference.org/abstract/why-is-cabotegravir-rollout-so-slow
  49. Marcus JL, Weddle A, Kelley CF, Agwu A, Montalvo S, Sherman E, et al. policy recommendations to support equitable access to long-acting injectables for human immunodeficiency virus prevention and treatment: a policy paper of the Infectious Diseases Society of America and the HIV Medicine Association. Clin Infect Dis. 2025;ciae648.  https://doi.org/10.1093/cid/ciae648  PMID: 39873495 
  50. Wang H, Kolstee J, Zimmermann HM, Jonas KJ. The unseen impact of affordability: copayment sensitivity for long-acting PrEP among MSM in Europe. SSRN5159860. 2025 . https://doi.org/10.2139/ssrn.5159860 
  51. van Dijk M, de Wit JBF, Guadamuz TE, Martinez JE, Jonas KJ. Slow uptake of PrEP: behavioral predictors and the influence of price on PrEP uptake among MSM with a high interest in PrEP. AIDS Behav. 2021;25(8):2382-90.  https://doi.org/10.1007/s10461-021-03200-4  PMID: 33611697 
Oral PrEP use and intention to use long-acting PrEP regimens among MSM accessing PrEP via governmental and non-governmental provision pathways, 20 European countries, October 2023 to April 2024
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Haoyi+Wang&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Wang Haoyi</a>, <a href="/search?value1=Alejandro+Adriaque+Lozano&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Adriaque Lozano Alejandro</a>, <a href="/search?value1=Johann+Kolstee&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Kolstee Johann</a>, <a href="/search?value1=Hanne+ML+Zimmermann&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Zimmermann Hanne ML</a>, <a href="/search?value1=Jonathan+Tosh&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Tosh Jonathan</a>, <a href="/search?value1=Melanie+Schroeder&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Schroeder Melanie</a>, <a href="/search?value1=Ama+Appiah&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Appiah Ama</a>, <a href="/search?value1=Kai+J+Jonas&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Jonas Kai J</a></span>. Oral PrEP use and intention to use long-acting PrEP regimens among MSM accessing PrEP via governmental and non-governmental provision pathways, 20 European countries, October 2023 to April 2024. <a href="/content/ecdc">Euro Surveill.</a> 2025;30(34):pii=2500122. <a href="https://doi.org/10.2807/1560-7917.ES.2025.30.34.2500122" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2025.30.34.2500122</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 20 Feb 2025;&nbsp;&nbsp; <span class="generated">Accepted</span>: 21 May 2025 </span> </p>
/content/10.2807/1560-7917.ES.2025.30.34.2500122
/content/10.2807/1560-7917.ES.2025.30.34.2500122
Loading

Data & Media loading...

Supplementary data

Submit comment
Close
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error