PrEP in Greece... last!

Over the course of this blog, we have touched upon the issue of HIV/AIDS many times while discussing the history of the queer movement, the discriminatory against gay men restrictions on blood donation, and the history of HIV/AIDS politics in Greece, Ecce Homo’s motherland, among other instances. One could say that HIV/AIDS is a constant preoccupation for us, and they would have been right. The reason why? First of all, despite the relatively recent biomedical and pharmaceutical advancements in the field of HIV/AIDS, such as the introduction of PrEP (Pre-Exposure Prophylaxis) and TasP (Treatment as Prevention) as two additional means of prevention in many countries around the globe according to the Global PrEP Tracker by PrEP Watch, the social stigma is prevent resulting in serophobic forms of discrimination against people living with HIV/AIDS, especially those who are also queer. In this case, queerphobia and serophobia are historically mutually reinforcing as a set of homophobic stereotypes about gay male sexuality, such as the excessiveness and perversity of anal eroticism, keep on fuelling the phobic representations of HIV positive persons as a threat to the healthy heteronormative social body. Secondly, the sexual health of LGBTIQA+ individuals is one of the most important pillars of Ecce Homo’s extensive Corporate Social Responsibility program

On this occasion, we would like to remind you that 5% of the price of each purchase (before VAT) is donated to a charity of the consumer’s choice devoted to the advocacy, empowerment, and support of the queer community in major European cities. To be clear, this amount does not fall on our customers in any way, and it is rather withheld from the firm’s income. One of those invaluable community allies of ours is Positive Voice – the Greek Association of People Living with HIV/AIDS which was founded in 2009 with the purpose of fighting against the spread of HIV and the minimization of the latter’s social and financial impact. The Association aims at securing better prevention and counseling practices, healthcare services, and social care for seropositive persons and groups vulnerable to HIV. Also, Positive Voice works towards social acceptance, solidarity, and support of the abovementioned groups in order to tackle violations of their human rights. And this leads us to this blog article’s topic, a success of our community partner’s tireless advocacy and lobbying, that is the introduction of PrEP in Greece…at last!

With article 6 (see the image below) of an amendment released by the Hellenic Ministry of Health, the Greek state approved two months ago the use of PrEP as part of a policy of public health to focus on preventive healthcare and following this way the recommendation proposed in the National Strategy for the Equality of LGBTQI+ people in Greece. With the approval of PrEP, both of the recommendations of this report regarding the fight against the HIV/AIDS-related stigma and discrimination have been met since January 2022 when Health Minister Thanos Plevris signed a ministerial decree that lifts the decades-old ban on Greek gay and bisexual men giving blood. Needless to say that this stigmatizing clause was a historic and scientific relic coming straight out of the moral panics of the 80s when the risk of contaminating blood supplies was high in the wake of the HIV/AIDS pandemic that affected disproportionally gay and bi men and the blood safety procedures were not as advanced as today. According to the abovementioned amendment, in the near future, PrEP is going to be free under public health insurance for certain groups of the population that have a high risk of HIV infection, while the rest could have access to it by legally buying it, an option that has not been available up until now.

But what is PrEP to begin with, and why this approval is so important after all? Pre-exposure prophylaxis or PrEP is the use of an antiretroviral medication by HIV-negative people to reduce the risk of HIV acquisition. Regarding the history of PrEP, as of September 2015, WHO, the World Health Organization, recommends that people at substantial risk of HIV infection should be offered tenofovir disoproxil fumarate (TDF)-based oral PrEP as an additional prevention choice, as part of comprehensive prevention. Oral PrEP is highly effective at preventing HIV when used as directed. In 2021, WHO recommended that the dapivirine ring may be offered as an additional prevention choice for women at substantial risk of HIV and, in 2022, that long-acting injectable cabotegravir (CAB-LA) may be offered as an additional prevention choice for people at substantial risk of HIV. Other products (e.g., multipurpose prevention products that combine antiretroviral drugs with contraception) are currently studied as additional PrEP options. However, according to WHO’s guidelines, ‘PrEP should not replace or compete with effective and well-established HIV prevention interventions, such as comprehensive condom programming for sex workers and men who have sex with men and harm reduction for people who inject drugs.’ One should also keep in mind that PrEP is less effective when not taken as prescribed, and, since PrEP only protects against HIV, condom use is still important for the protection against other STDs.

The importance of PrEP cannot be stated enough. Nikos Dedes, the president of Positive Voice, askes rhetorically: ‘if the research for the vaccine against COVID-19 had failed and there had been available an inexpensive medicine, would you have taken it? We are at the same point in the fight against HIV. PrEP, which constitutes a revolution in the prevention of HIV, has been adopted in Greece with delay. Science has moved on and the time has come for society to move on as well.’ At Positive Voice’s annual event ‘I am Positive’ in 2018, Stefanos was one of the first persons who publicly spoke about his experience as a PrEP user in a time when information on PrEP was scarce and one could only buy PrEP online ‘unofficially’. As he stated back then, ‘PrEP is not a luxury nor a lifestyle pill, but rather my right to health.’ His words seem to function pre-emptively given the timing and they urge us to keep an eye on the moral and sexual panics that are present -as we speak- in countries where access to PrEP has already been well-established for quite some time now. In many cases, the right to PrEP is under attack via rhetoric that revamps the over-rehearsed moralizing narrative about gay men’s hypersexuality and irresponsible sexual behavior. In this context, PrEP is characterized as ‘a lifestyle pill’ that allows gay men to indulge themselves carelessly following an immoral lifestyle of hedonism unrestrained by the condom code. PrEP users themselves are further stigmatized as ‘PrEP whores’ in a sex-negative logic that proves that we are far from ending HIV-related stigma, even though this injurious term has been proudly reclaimed. Fortunately, we have not witnessed such a backlash against PrEP in light of its recent approval in Greece so far, something that might have to do with the widespread lack of awareness surrounding the issue of HIV/AIDS in general.