No one left behind: How are we doing in the roll-out of PrEP as part of combination HIV prevention?

Abstract

Abstract: This editorial examines the global progress and persistent challenges in the implementation of pre-exposure prophylaxis (PrEP) as part of combination HIV prevention strategies following the 2015 World Health Organization recommendations supporting universal antiretroviral treatment and PrEP for individuals at substantial risk of HIV infection. The authors review emerging evidence demonstrating the real-world effectiveness of PrEP, particularly among men who have sex with men, while addressing concerns related to adherence, risk compensation, cost, and sustainability. The article highlights regional disparities in PrEP implementation across sub-Saharan Africa, Asia-Pacific, Latin America, and Europe, emphasizing barriers such as limited access, stigma, insufficient healthcare infrastructure, restrictive legal frameworks, and lack of provider training. Special attention is given to vulnerable populations including transgender women, adolescents, and people who use drugs, stressing the importance of tailored, rights-based, and community-centered approaches. The editorial concludes that expanding equitable access to PrEP within broader HIV prevention frameworks is essential to achieving the UNAIDS goal of ending the AIDS epidemic by 2030 and ensuring that no population is left behind.