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The project will examine barriers to accessing Pr EP and other HIV prevention services for those at highest risk of HIV and aims to find the most effective strategies for implementing Pr EP so that it reaches these groups.45 The availability of Pr EP is currently extremely limited, with less than 5% of people at substantial risk of HIV infection having access to it.46National regulatory approval for Pr EP, which legalises the use of medicines, is limited to a small but growing number of countries.

The United States approved the use of Pr EP in 2012 and clinical guidelines were issued in 2014.

Pre-exposure prophylaxis (Pr EP) is a daily course of antiretroviral drugs (ARVs) that can protect HIV-negative people from HIV before potential exposure to the virus.

It found that the HIV infection rate in HIV-negative gay men who were given Pr EP was reduced by 44% compared with men taking a placebo.

They are also supported to select health insurance plans that cover at least a portion of their Pr EP costs.35 CASE STUDY: The Pr EP Brazil Study The Pr EP Brazil Study focuses on men who have sex with men and transgender women.

It uses a number of innovative ways to increase Pr EP adherence, including SMS reminders and engagement through social media.36Preliminary results of the study are promising with uptake of Pr EP over 50%, and notable increases in awareness of the service and knowledge of high-risk sexual behaviour among participants.37Growing awareness and demand for Pr EP is expected to increase its rollout.

The effectiveness of Pr EP is closely linked to adherence - if someone taking Pr EP regularly misses daily doses, their risk of HIV infection will increase substantially.

It is therefore important that any programme offering Pr EP provides it as part of a combination package of prevention initiatives, based on an individual's circumstances - with support and advice on the importance of Pr EP adherence.

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