Universal PrEP – No More Barriers: A Demonstration at the ICAR Inauguration
“"Universal PrEP – No more barriers." This was the slogan with which activists welcomed the medical and scientific community to the opening of ICAR 2024, the Italian conference on AIDS and antiretroviral research. This demonstration addressed the many obstacles that still limit access to PrEP, the drug used for pre-exposure prophylaxis against HIV, in Italy.
It's been over a year since AIFA finally approved a resolution making PrEP free, marking a major step forward in the fight against HIV and a victory for activists who have been calling for this measure for years. However, implementation of the AIFA resolution nationwide has been slow and uneven, creating disparities between regions and placing unnecessary barriers and bureaucratic obstacles for those seeking access to this service.
“"We demand," the HIV associations declare, "universal access to PrEP, which is one of the most important tools we have to combat the spread of the virus. We demand that the many barriers that still exist to accessing treatment be overcome. We demand access to free PrEP even for those not enrolled in the National Health Service, the demedicalization of the process, and distribution of the drug through community pharmacies. PrEP users are not sick; they are people who are actively helping to stop the spread of the virus. Implementing policies to combat HIV means promoting access to free PrEP for everyone!"”
Obtaining free PrEP is currently a challenging process. For example, only in some regions does free PrEP come with free visits and periodic testing (the healthcare protocol requires PrEP users to be tested every three months). Furthermore, in many cases, the tests required by the healthcare protocol are performed in departments and/or hospitals other than those where the drug is dispensed, increasing the time and resources required to access and administer PrEP correctly.
Furthermore, there are obstacles and barriers that remain constant throughout the country and, paradoxically, make it even more difficult for those in less well-equipped regions to travel to access prophylaxis: since the drug is not dispensed by prescription but with an AIFA prescription card, it can only be collected from hospitals, and only in the same city where the prescription was issued. Furthermore, the AIFA resolution stipulates that only infectious disease specialists can prescribe PrEP, while to increase access points, it would be more useful to broaden the pool of prescribers, particularly healthcare professionals accustomed to working in the sexual health and STI fields, or who have received training in these areas. This has also created numerous problems for community checkpoints, which, after years of compensating for the state's absence by launching free PrEP programs and fighting to obtain free PrEP, have been excluded from the protocols and are not involved in drug distribution.
The presence of all these obstacles is particularly serious if we consider the fact that access to testing and drugs such as PrEP is already very difficult for many people, both due to the stigma that still surrounds HIV and the lack of correct sexual education and information on STIs.
Stigma, misinformation, and moralism mean people don't get tested frequently enough, if at all, thus contributing to the spread of the virus. In Italy, 58.11 TP3T of new HIV diagnoses are late diagnoses, a much higher rate than the European average. This means that more than half of people are diagnosed when they already have AIDS or are close to it. Receiving a late diagnosis delays the achievement of undetectable levels of the virus through treatment and decreases the chances of having a life expectancy comparable to that of the general population.
In a country that evidently has a serious problem even convincing people to get tested regularly, it seems absurd to us that the use of a tool like PrEP is not only not encouraged, but is actually systematically hindered.
Arcigay
Rainbow AIDS
ASA
CICA
LILA
Mario Mieli
Milan Checkpoint
Nadir
NPS Network for HIV-Positive People
PLUS LGBT+ HIV-Positive People Network
