Oral HIV pre-exposure prophylaxis (PrEP) in Belgium

Over the past decade, the HIV prevention landscape has evolved substantially with the advent of oral HIV pre-exposure prophylaxis (PrEP). Although this biomedical tool represents a promising development for primary HIV prevention, its full potential in ending the HIV epidemic has not yet been realised. To understand how PrEP implementation can be optimised, it is essential to explore behaviours, attitudes, and care needs of (potential) PrEP users. Therefore, in this thesis, we aimed to explore the PrEP user’s perspective in Belgium.

First, we analysed PrEP use in Belgium based on social health insurance data, which revealed that early discontinuation of PrEP is common, especially among young and financially vulnerable users. The estimated HIV incidence indicated missed opportunities for HIV prevention. Next, we examined PrEP and condom use patterns, sexual behaviour, and attitudes towards condoms and sexually transmitted infections among PrEP users. We identified different categories of PrEP use and demonstrated that PrEP users can adjust their PrEP use to their needs. We highlighted the complexity surrounding decision-making about condom use and the variation in attitudes towards sexually transmitted infections. We also found that not everyone has sufficient knowledge about starting and stopping PrEP. Finally, we found high satisfaction with PrEP care among PrEP users, but challenges were also identified, such as limited interaction with healthcare providers, difficulties in scheduling follow-up visits, and financial burdens. This thesis underscores the need for a personalised and client-centred approach to PrEP care to meet the diverse needs of PrEP users and to enhance the effectiveness of PrEP programs.