It’s not hard to convince people that PrEP works.
“We have great data from studies that show its effectiveness. It’s indisputable. What’s difficult is getting people to adhere to the regimen”, Ricardo Werner tells me. Werner is a consultant dermatologist and venereologist at Berlin’s Charité University Hospital, and the lead author of an important PrEP study in Berlin.
PrEP is a blue pill taken once daily that provides high levels of protection against HIV infection when taken properly. For many, it is an alternative to using condoms.
Werner’s PrEP study, with health-policy expert Matthew Gaskins as a co-author, has been receiving attention in the press.
There are a few reasons.
Many of the findings––from a sample of five hundred gay, bisexual, and queer men in Berlin––are surprising, and some are even worrying.
“More than 90% of our respondents in Berlin were aware of PrEP”, Gaskins tells me, “This is an encouraging number. But less than half stated they were well informed about it. The findings of our study suggest that people need more information about whether PrEP is the right choice for them. They also want to know more about potential side effects, how to use PrEP properly, and the kind of tests they will need, like regular screening for other sexually transmitted infections”.
Also worrying was that almost two-thirds of users had obtained at least some of their supply informally (from overseas mail-orders, or taking from friends’ HIV medication, for example).
“This is a real problem, as PrEP requires proper supervision by a doctor,” says Werner.
Additionally, 24% of those not using PrEP stated they had unprotected sex without a condom with two or more partners in the last six months.
“This number might be even higher”, Gaskins adds, “As respondents often underreport risk behaviour in surveys, especially if they feel it is socially undesirable”.
Another aspect has gripped the press. The study’s publication coincides with the legislation meant to ensure that PrEP in Germany is covered by the public health care scheme (as a “Kassenleistung”), perhaps as early as this coming April.
It’s perhaps no surprise, given the study’s findings, that the Federal Ministry of Health moved so quickly to support PrEP coverage at the moment when the study was first drafted and circulated. Indeed, Minister Jens Spahn promised to put an end to the “Wildwuchs”, or the uncontrolled informal use of the drug.
The situation for PrEP-users in Berlin has been difficult up until now. I know many people who––simply wishing to protect themselves and others––have sourced their PrEP from Africa and Asia, never feeling completely sure what they were getting in the post was effective or safe. PrEP is very well tolerated, but nonetheless, blood tests to monitor that tolerance are necessary. These tests come at an expense, as the German health care system has been unwilling to pick up these associated costs, passing them on to patients. It seems to me ridiculous that people simply interested in protecting their health should be subjected to a costly rigmarole. Hopefully, all this will change soon.
“By integrating patients’ use of PrEP into a programme of regular STI testing and supervision by a doctor, one can encourage adherence to the drug as well,” Werner tells me, adding that a new “Checkpoint BLN Initiative”––an integrated sexual health centre––will open to provide precisely that kind of oversight.
Werner adds, “The problem is that many start taking a prescription drug rigorously at the beginning, but after six months might get lax and miss doses, putting themselves at risk of infection”.
It’s a risk not worth taking, given PrEP’s potential powers of protection. One London clinic, for example, has reduced new HIV infections by 90% (a statistic attributed, among other things, to a large increase in PrEP use).
“We’re not trying to convince people to take PrEP”, says Werner, “But when it comes to how to protect yourself, there should be a choice and good information about that choice. We want Berliners to have this informed choice, and ensuring that PrEP is available through regular health services is an important step in that direction”.
by Joseph Pearson