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Belgium, Portugal and Brazil will provide PrEP through their health services; Morocco announces a PrEP study
Gus Cairns, 2017-06-05 12:10:00
In the last two weeks, several countries have announced that they will soon launch
pre-exposure prophylaxis (PrEP) programmes. On 19 May, Belgium
announced that it would start rolling out PrEP provision and had set aside
€1 million to pay for it. Aidsmap.com had learned this will be introduced gradually
from 1 June. Two hundred Belgian men who have sex with men are already enrolled
in a PrEP demonstration project, Be-PrEP-ared.
Belgium will use differential pricing, a scheme which has been dismissed as
impossible elsewhere. While Truvada (tenofovir/emtricitabine) will be
free to HIV-positive people who need it as treatment, PrEP users will pay a subsidised
price of €11.90 for a 30-day supply (the full list price of Truvada
there is €527.40 for 30 days).
On 24 May, Brazil
announced that it had given itself a deadline of six months to start
offering PrEP free of charge to those in need of it via its national Unified
At a video press conference during the World Health Assembly in Geneva,
Brazilian Health Minister Ricardo Barros said that the Ministry of Health will
invest $1.9 million to purchase 2.5 million tenofovir/emtricitabine tablets. According to
Hornet’s news blog, this could provide daily PrEP for 6849 people, implying
a price of €23 a month for generic drugs.
On 29 May, Portugal
announced that it too was taking steps to roll out PrEP. It is considering
waiving fees normally paid for consultations and examinations for people at
high risk of HIV and allowing them direct access to HIV treatment centres
without having to be referred through primary care – the same status already
accorded to people with HIV.
Deputy Health Minister Fernando Araújo said he was giving the Ministry a
deadline of one month to evaluate the cost of fee exemption for people eligible
for PrEP and to devise arrangements for monitoring and evaluating a PrEP
Meanwhile, on 26 May, Morocco
announced an implementation trial of PrEP. Initially, PrEP will be provided
to 300 people judged to be at high risk of HIV – 100 each in the three
highest-prevalence cities, Agadir, Casablanca and Marrakech. PrEP will be
financed by the Ministry of Health with the support of the Global Fund, which
has negotiated a price for generic drugs of only $5 a month. Although this is
only a small study initially, Morocco is the first country in the Middle East
and North Africa region to authorise PrEP.
These announcements underline the fact that the introduction
of PrEP will look very different in different countries, varying according to
national resources and how health systems work. So far, Scotland and Norway
have announced PrEP free at point of demand; France provides PrEP but requires
some co-payments; in the US PrEP is dependent on the agreement of public or
private insurers. In the lower-income world, PrEP in countries like South
Africa and Kenya
is initially being provided to specific high-risk populations; in Thailand,
users have to buy PrEP, which is available for about $1 a day, but clinics
provide monitoring and testing for free.
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