PrEP for Women: Still massive gaps
At the WAVE (Women Against Viruses in Europe) pre-conference meeting in Basel, Switzerland the group presented the findings of their 2019 survey into PrEP (pre-exposure prophyalxis) availability, use and provision across the WHO Europe region.
Whilst nearly 80% of women surveyed said that PrEP was avaiable in their country only a third said that it was available free of charge at point of care with the majority of respondants stating that they either had to buy it online, or pay in full with a prescription. This situation is compounded by the hugely varying costs of PrEP (in the form of either branded or generic TDF/3TC) across the region with prices ranging from €10 to €270 per month.
Nearly all of the countries survey have now developed Prescribing Guidelines - which offer guidance to healthcare professionals on how to safely and effectively prescripe PrEP, but less than a quarter of countries have Provision Guidelines which assist in commissioning of PrEP and associated wrap-around services.
Despite the challenges the survey showed that PrEP uptake in women is increasing with impressive figures from Scandinavian countries, whilst at the same time highlighting a lack of momentum in Eastern European and Central Asian countries.
Women surveyed reported that the major obstacles to accessing PrEP in their countries were: Lack of information (57%); Lack of political support (55%); Lack of discussion (55%); High cost of purchase (47%).
The session ended with a quote from a respondant from Croatia:
"In Croatia, women are not so eager to openly express their need for PrEP. Stigma, which is strong enough by itself, is stronger for women. There is a fear of being rejected by a family, partern, children and society, to be labeled as a "whore" (in the worst sense of the world) and so on.
"As mentioned before Croatia is a mainly traditional country and women's need for PrEP sounds absurd to the genenal population. Unfortunately these are some of the reasons why PrEP for owmen is not yet discussed in our country. I am glad to know that there are people and organizations tackling this issue because it guves me hope in a different future"