PrEP in Sweden 2024
RFSL has released a report around the access to PrEP and the experiences with PrEP care in Sweden. It shows that the accessibility is unequal over the country and that the target group don't know where to turn for PrEP.
In March 2024 RFSL sent out a survey to homosexual and bisexual men and trans people who use or want to use PrEP. At the same time RFSL sent questions to the regions infection control units. We asked about the regions routines around prescribing PrEP. 20 of 21 regions replied. RFSL has now released a report that shows that the access to PrEP is unequal over the country.
Based from the report RFSL now demand that:
Every person whose sexual health would be improved by PrEP should have access to it, without having to be placed on a long waiting list, no matter where in Sweden one live. The health care need to ensure LGBTQI competence in the meeting with the patient. This requires several efforts.
- The government have to give the National Board of Social Affairs and Health, the Public Health Agency of Sweden and IVO the assignment to increase the LGBTQI competence within the health care system, especially regarding PrEP. This needs to happen in collaboration with SKR and the regions with the highest request for PrEP.
- The government need to give the Public Health Agency of Sweden the mission to improve necessary information and communication to these regions to ensure access to PrEP and that the target group knows where to get PrEP.
- The government need to take action to make sure that the access to PrEP is equal in Sweden, no matter where you live.
- All regions need to make sure that there are enough resources, to introduce guidelines and routines to make PrEP more accessible.
- Region Stockholm, Skåne and Västra Götaland – the regions with the highest request for PrEP – must take and follow up measures to shorten queue times. Anyone who wants PrEP should receive an initial assessment within the care guarantee.
- The National Board of Social Affairs and Health need to initiate an overview of new alternatives to oral daily PrEP.
Pre-expositions profylaxis (PrEP) is a HIV medicine that a HIV negative person can take to prevent getting HIV. In Sweden PrEP has been available since the autumn 2017.
Almost 5000 people have gotten PrEP since 2017 – but gay men in Skåne is left without it
In total, in this survey, the regions report that approx. 4,944 people have been prescribed PrEP since 2017, and in March 2024, approx. 3,890 people is still prescribed PrEP via healthcare.
PrEP is prescribed to the largest number of people in the big cities, Stockholm (2,250 people), Skåne (approx. 500 people) and Västra Götaland (412 people). In other regions, the number varies between 6 people (Kronoberg) and 160 people (Uppsala).
According to the regions’ respondents, people who want PrEP are rarely refused. On the other hand, some who wanted PrEP have themselves chosen to refrain after talking to the doctor about their risk taking and about the drug. A few people have been denied PrEP for medical reasons. At the same time, among the respondents in the target group survey, the perception has been that they were denied PrEP because they were not considered to live sufficiently risky.
In Malmö, the queue was closed and removed completely in November 2023 due to a lack of resources. The 70 people who were in the queue and others who want PrEP have therefore been referred to Helsingborg, which refers back to Malmö and, in other words, nothing. There is currently no information on when the queue will open up again. So, 70+ gays, bi guys and transgender people who want to take responsibility for their and others’ sexual health experience great frustrations and anger about the current situation.
Stockholm currently has a queue of around 900 people and a queue time of about 1 year. From September 1, 2024, the mission for prescribing PrEP in Region Stockholm will be expanded to 5 more clinics, which will hopefully shorten the queue time significantly. In the Västra götaland region, 50 people are queuing for Gayhälsan in Gothenburg.
The target group don’t know where to go to ask for PrEP
62% of gay, bisexual and transgender people who want PrEP do not know where to go to get PrEP. That number looks roughly the same regardless of where in the country you live, in a big city or in a small town.
Of those who either stand in line or receive PrEP, 40% experienced the wait as long. The queue time in Stockholm is currently about 13 months. 16 of the regions that responded state that they have no queue time.
85% of all who take PrEP have been prescribed it via an infection clinic, STI clinic or similar, 2% via a family doctor, 9% via a private doctor and 4% in another way (via friends or via healthcare abroad).
LGBTQI competence is good – in the big cities
The target group who go to clinics with pronounced LGBTQI competence feel that they are treated with respect and without questioning their sexual habits.
In smaller towns you experience that:
- some doctors are uncomfortable talking about sex or lack knowledge about PrEP
- you get questions that are perceived as irrelevant in the context
- you felt you had to lie or exaggerate when you talked about your risk-taking around sex to be sure you met the criteria for getting PrEP
- trans competence is missing
- the general knowledge of the needs of the target group and of PrEP is lacking, and that there are prejudices about those who take PrEP