BACKGROUND: Pre-exposure prophylaxis (PrEP) serves as a preventive measure to reduce the risk of HIV infection among vulnerable populations. PrEP is a highly effective prevention technology, and despite its success in countries with widespread PrEP usage and coverage, most countries still fall short of uptake targets. National policies may help explain why.
METHODS: The HIV Policy Lab is a public dataset and visualization tool tracking 33 key indicators of HIV-related law and policy in 194 countries. HIV policies are identified and analyzed during a legal review of policy documents and a global survey of government officials, and benchmarked against global norms. A composite index measuring countries’ alignment to international guidance was constructed that evaluates alignment with World Health Organization normative guidance on i) population-specific eligibility and ii) regulatory approvals for PrEP technologies.
RESULTS: As of 2023, 82 countries had adopted national policies that
i) confer PrEP eligibility to all populations at substantive risk for HIV, and
ii) have issued regulatory approval for at least one PrEP technology.
This is an increase from 2017, when only 19 countries had a WHO aligned PrEP eligibility-criteria and had at least one registered PrEP technology. Prior to 2015, many countries limited PrEP eligibility to specific high-risk groups such as serodiscordant couples (SD) or men who have sex with men (MSM). As of 2023, MSM were eligible for PrEP in 94% of countries with a PrEP policy, SD in 92%, and sex workers in 82%; PrEP was available upon request in 58% of countries with a policy. In 2017, only 26 countries had registered a PrEP product; by 2023, the number had increased to 105. This analysis will show the association between Prep uptake, controlling for population and HIV rate, and the robustness and alignment of prep policies compared with WHO guidelines.
CONCLUSIONS: Most countries have adopted a PrEP policy, yet variation exists in access to an approved PrEP technology. Despite widespread eligibility for MSM, just six out of 10 countries have adopted PrEP upon request for all at risk. Early PrEP policies qualified specific populations, which may have restricted enrollment and stigmatized the technology.