The long wait for the HIV prevention pill revives the black market

BarcelonaHIV emerged as an epidemic 40 years ago, and today, 32,579 people are living with the virus in Catalonia alone. In 2019, a treatment called pre-exposure prophylaxis (PrEP) was approved in Spain that prevents it; however, as reported by the ARAThere are waiting lists of up to 30 months, and infections are being recorded while patients wait to receive the drug. This Wednesday, the BCN Checkpoint community center—one of the few authorized to distribute it—asked the Catalan Health Department for more resources to reduce the wait and curb the unregulated black market for PrEP. BCN Checkpoint has 40,000 people waiting to receive the drug and only 40 new slots available per month. This causes the waiting list to climb to two and a half years. The center's coordinator of studies and manager of the waiting list, Félix Pérez, stated that since the treatment's approval, 20 infections have been detected among people on the waiting list, and he attributes this to administrative inaction. "It is unacceptable that there are new infections due to negligence on the part of the system. There are people who want to take care of their health, but they are waiting," denounced the center's director, Ferran Pujol.

Another effect of the access difficulties is that it is encouraging the purchase of the drug on the black market, as was the case before it was included in the public healthcare system. Many are forced to acquire it online and take it on their own. "People are looking to protect themselves, but they are doing so without medical supervision, with the risks that this entails," adds Pujol.

Risks on the black market

The closure of other STI clinics in the region has forced BCN Checkpoint to expand to meet the rising demand. "We've invested three million euros in a new center that will allow us to increase treatments by 40%, but we haven't seen any help from the Catalan Health Department. We need professionals and for them to stop being evasive," Pujol insists. Furthermore, not all 19 centers with HIV protocols offer PrEP. "A patient from Manresa shouldn't have to travel to Barcelona. We need to expand the facilities," Pujol adds.

The center's medical director, Àngel Rivero, warns of an "absolute collapse" of the system and fears that UNAIDS' goals to eradicate HIV by 2030 are unattainable. Since 2006, this community center has diagnosed 2,000 cases, and Pérez points out that for every diagnosis, eight infections are prevented. "We have a very powerful tool to eradicate HIV, and we can't abandon it due to a lack of resources," Rivero emphasizes.

The BCN Checkpoint insists that "PrEP is for people who are sexually active and want to take responsibility for their health and their community," and that considering infection "a lack of responsibility or fear is stigmatizing and offensive," says Pujol. Pérez is emphatic about the idea that prejudice affects resource allocation: "If HIV affected a more vulnerable segment of the population, we wouldn't be in the same situation."