Florian Vock, Swiss AIDS Federation

The problem is not its effectiveness, but rather the fact that many people who need and want PrEP do not have access to it. This is due to health and care systems that unnecessarily complicate matters and medical professionals who take excessive precautions.

A Canadian study (P012 PrEP cascade improvement through same-day PrEP initiation) with gay, bisexual and other MSM shows impressively: in a traditional system with several appointments before PrEP start and frequent check-ups during the course, after 6 months only 19% of MSM who were originally identified as suitable are still on PrEP. If PrEP is offered, accepted and started on the same day, 69% of MSM are on PrEP after 6 months. One-stop clinics with same-day initiation are absolutely essential for PrEP to be effective in real life.

Missed opportunities for vaccination

Conversely, however, it is also apparent that access to PrEP is not being sufficiently utilised to achieve holistic healthcare and reduce health inequalities. Data from SwissPrEPared (P016 Low uptake of mpox and HPV vaccination among PrEP users in Switzerland) show a different picture here – it can probably also be explained by how different (complicated) access to the various vaccinations is. From April 2019 to May 2024, the vaccination rates for the recommended vaccinations for MSM increased:

• Hepatitis A: 54% > 65%
• Hepatitis B: 65% > 88%
• HPV (for those under 27 years of age): 26% > 57%
• Mpox: 51%

Ready for the future?

In the next few years, various products will come onto the market in which PrEP no longer needs to be taken daily, but is only needed every few months in the form of injections.

To make these methods easily accessible, they must be offered to MSM in particular where access is available. European data (P014 Preparing for long-acting PrEP delivery) show that preferences vary widely here – and that it is therefore necessary to proactively offer PrEP in different contexts: MSM prefer sexual health centres (35%) to general practitioners (22%) or specialists (20%), while heterosexual people prefer general practitioners (48%).