Ahead of AIDS 2026 and as part of the Rethink. Rebuild. Rise. campaign, VirusOFF continues its series on what HIV prevention looks like “on the ground” in Central and Eastern Europe and Central Asia — in the context of migration, war, stigma, unstable funding, criminalization and unequal access to services.
One of the key topics in this conversation is pre-exposure and post-exposure prophylaxis, better known as PrEP and PEP. Both are part of modern combination HIV prevention. Yet for many people in our region, they are still not an everyday reality but a difficult pathway: a person needs to know that these options exist, understand where to go, not fear judgement, have documents, money, time, insurance, access to a doctor and trust in the system.
This is where the principle of prevention choice becomes not an abstract slogan but a very practical question. Does a person have a real opportunity to choose the prevention tool that fits their life? Can they access PrEP before a possible exposure to HIV? Can they receive PEP in time after a situation that may have led to HIV transmission? Will they be heard without moral judgement, stigma and unnecessary bureaucratic barriers?
These questions are especially important for Central and Eastern Europe and Central Asia. According to UNAIDS, in Eastern Europe and Central Asia the number of new HIV cases continues to rise: in 2024, it reached approximately 130,000, a 7% increase since 2010; around 2.1 million people are living with HIV in the region, but only 51% are receiving treatment. Viral load was suppressed among 43% of people living with HIV.
This means that HIV prevention cannot be treated as secondary. It must be available before a person is in crisis and after they urgently need help.
What is PrEP?
PrEP, or pre-exposure prophylaxis, is the use of antiretroviral medicines by a person who does not have HIV to prevent HIV transmission before a possible exposure.
WHO defines PrEP as the use of antiretroviral medicines by people who do not have HIV to reduce the likelihood of HIV transmission, and recommends offering PrEP to people for whom it may be relevant as an additional prevention option within comprehensive HIV prevention.
In simple terms: PrEP is prevention “before”. It can be important for people who, for different reasons, have a higher likelihood of exposure to HIV or cannot always control the conditions of their own safety.
PrEP is not a “medicine for one group”. It can be relevant to different people in different life situations: people from key communities, people in serodifferent relationships, people who cannot always negotiate condom use, people experiencing violence or economic dependence, people in migration and people who do not have stable access to other forms of prevention.
Importantly, PrEP does not replace testing, condoms, harm reduction, HIV treatment, peer support or sexual and reproductive health services. It is part of prevention choice, not the only answer to every situation.
What is PEP?
PEP, or post-exposure prophylaxis, is a short course of antiretroviral medicines after a situation that may have led to HIV transmission.
PEP is prevention “after”. It may be needed after sex without a condom, sexual violence, condom breakage, sharing injecting equipment or occupational exposure to blood or other body fluids.
The key word here is time. WHO emphasizes that PEP is most effective when started as soon as possible, ideally within the first 24 hours and no later than 72 hours after a possible exposure to HIV. PEP usually lasts 28 days; WHO’s 2024 guidelines prefer three-drug regimens.
This is why access to PEP cannot be complicated, slow or humiliating. If a person first has to prove that they “deserve” help, find a doctor, wait for an appointment, explain intimate details to different professionals or fear judgement, critical time may be lost.
PEP is not a “routine consultation for later”. It is urgent medical support.
How are PrEP and PEP different?
The simplest explanation is this: PrEP is prevention before a possible exposure to HIV, while PEP is prevention after a possible exposure to HIV. PrEP can be part of a regular prevention strategy for a person who wants additional protection. PEP is used in an emergency situation, when a potential exposure has already happened. PrEP is planned in advance, with consultation, testing and follow-up care. PEP needs to be accessed quickly, because effectiveness depends on how soon it is started.
PrEP and PEP do not compete with each other. They respond to different situations. That is why HIV prevention systems need to ensure access to both.
Myth 1. “PrEP is only for one community”
This is one of the most common myths. Historically, in many countries PrEP has often been developed as a tool for LGBTIQ+ community. But that does not mean that only these people may need PrEP.
In real life, the likelihood of exposure to HIV is not only about sexuality. It can be linked to inequality in relationships, violence, economic dependence, migration, criminalization, lack of access to condoms, drug use, sex work, lack of information, stigma or the inability to talk safely with a partner.
If PrEP is offered only to one group, other people remain invisible. This is especially true for women, people in migration, people without documents, people with experience of violence, people who use drugs and people who do not see themselves in narrow medical “categories”. PrEP should be available not according to whether a person fits a familiar image of a user, but according to need, safety and the right to prevention.
Myth 2. “If PrEP exists in a country, access is already guaranteed”
The presence of PrEP in a country does not mean that a person can actually use it.
The most recent ECDC report on PrEP in Europe and Central Asia was published in November 2025 and is based on 2024 data. According to the report, 38 of 52 countries reported having national PrEP guidelines in place, while 14 countries lacked guidelines or had not implemented them.
In 2024, 344,596 people received PrEP across 36 countries in the WHO European Region. This is approximately 60,000 more than in 2023, but still below the regional target of 500,000 people on PrEP by 2025. In the EU/EEA, 203,223 people received PrEP, also below the target of 300,000 by 2025.
These figures show that access is expanding, but the pace remains insufficient.
ECDC also highlights inequalities in access. Only 21 countries, including 13 in the EU/EEA, offered PrEP to all people with an increased likelihood of exposure to HIV regardless of gender or sexual orientation. In many countries, men who have sex with men represented over 90% of PrEP users, while women represented only 3% of all people receiving PrEP, and 1% in EU/EEA countries. Data on other key communities, including people who use drugs, people engaged in sex work and migrants, remain limited and show low uptake.
Another important barrier is the service delivery model. In most countries, PrEP is primarily provided through infectious disease clinics or other medical facilities. Few countries reported providing PrEP through community-based or NGO settings. Costs also vary widely: in some countries PrEP is free, in others it is insurance-based or paid out of pocket; in EU/EEA countries monthly costs ranged from EUR 0 to EUR 187.80, with a median of EUR 56.70.
For a person, this means something very simple: “access” at the policy level may not mean access in real life.
Myth 3. “PEP can be accessed later, when it is convenient”
No. PEP requires rapid action. WHO emphasizes that PEP should be started as soon as possible, ideally within 24 hours and no later than 72 hours after a possible exposure to HIV.
This is why PEP must be available through clear and rapid pathways: emergency care, infectious disease services, sexual health services, crisis centres, services for people after sexual violence, community organizations or other points where a person can quickly receive counselling and referral.
If a person does not know what PEP is, does not know where to go, fears judgement or waits several days, the prevention system has failed. PEP is not only about medicines. It is about the system’s ability to act quickly, without stigma and without unnecessary barriers.
Myth 4. “PrEP and PEP solve everything”
PrEP and PEP are important tools, but they do not replace combination prevention. They do not replace condoms and lubricants, which also help prevent other sexually transmitted infections. They do not replace HIV testing, access to HIV treatment, the principle of undetectable = untransmittable, harm reduction for people who use drugs, psychological support, peer counselling, social support, protection from violence or legal support.
This is why PrEP and PEP must be part of a broader system — one that sees the whole person, not only one “risk” or one contact.
Myth 5. “It is the person’s own fault if they did not seek help”
This myth is especially dangerous. People often do not seek help not because they “do not care”. They may not know about PrEP or PEP. They may fear doctors. They may not have documents or insurance. They may not speak the local language. They may live far from a large city. They may have had a negative experience in the healthcare system. They may fear that information about their life will become known to family, an employer, a partner, the police or migration authorities.
In a region where stigma, criminalization and discrimination remain real barriers, responsibility cannot be placed only on the individual. If prevention is inaccessible, unclear or humiliating, this is not a “personal mistake”. It is a system failure.
Why access in CEECA is unequal
In Central and Eastern Europe and Central Asia, access to PrEP and PEP depends on many factors: country, city, legal status, insurance, income, community belonging, level of stigma, presence of community organizations and the readiness of the healthcare system to work without judgement.
For people in large cities, the pathway may be relatively clear. For people in small towns, rural areas or remote regions, it may be almost invisible. For people with documents, access may be complicated but possible. For people without documents or with unstable legal status, it may be almost unreachable.
In 2024, ECDC specifically highlighted challenges in migrants’ access to HIV prevention, testing and treatment in EU/EEA countries. The report notes that access to health services for undocumented migrants is not universally guaranteed in the EU/EEA, hindering HIV prevention, testing and treatment services for this group.
Access to PrEP for people without documents also remains unequal. According to ECDC, restrictive PrEP eligibility criteria particularly affect migrants, people engaged in sex work and trans* people. This is not a technical detail. It is a question of who has the right to prevention — and who remains invisible to the system.
PrEP, PEP and people living with HIV: why U=U matters here
A conversation about PrEP and PEP should not create the impression that people living with HIV are a source of danger. On the contrary, modern science gives us language that helps dismantle stigma.
The principle of undetectable = untransmittable means that a person living with HIV who is on effective treatment and has an undetectable viral load does not transmit HIV sexually. UNAIDS emphasizes that understanding this can be transformative for people living with HIV: it restores a sense of quality of life, future, sexual health, relationships and their own role in prevention.
That is why PrEP, PEP, testing, treatment and U=U must be parts of the same conversation — not a conversation about fear, but a conversation about science, dignity, access and choice.
Why access often does not work without community organizations
For many people, the first step towards PrEP or PEP does not begin in a doctor’s office. It begins with a message to a peer counsellor, a conversation with an outreach worker, a post by a community organization, a call to a service organization or a consultation with someone who can explain things without judgement.
Community organizations often do what the system does not: explain PrEP and PEP in plain language; help a person understand where to go; accompany people to services; explain what documents are needed; help overcome fear; work with people whom the state system often does not see; and create a safe space for questions people are afraid to ask a doctor.
This is why funding community-led work is not an “additional component”. It is prevention infrastructure. If this link is removed, PrEP and PEP may remain in protocols but fail to reach people.
