Haoyi Wang

Chemsex, defined as the intentional use of psychoactive substances before or during sexual activity [1,2], has emerged as an important public health concern among men who have sex with men (MSM) in...

Transgender women and transgender men are disproportionately affected by HIV (Baral et al., 2013; Stutterheim et al., 2021) and remain priority populations for prevention. Meta-analyses estimate gl...

Italy has recently expanded access to oral pre-exposure prophylaxis (PrEP) and made rapid progress in long-acting PrEP (LA-PrEP) availability. These developments create a unique opportunity to assess population-level readiness for LA-PrEP and identify gaps that may limit its public health impact. To assess an extended PrEP cascade, quantify unmet prevention needs that LA-PrEP could mitigate, and identify determinants of LA-PrEP intention across key populations (KPs) in Italy. We analysed data from the PROTECT cross-sectional survey (October 2023-April 2024), including participants without HIV in Italy (n = 2215): 1707 MSM, 32 trans* individuals, 267 cis-men, and 209 cis-women. We described PrEP cascades (oral PrEP awareness, uptake, adherence, discontinuation; LA-PrEP awareness, interest, intention), unmet prevention needs potentially addressable by LA-PrEP ( defined as no current oral PrEP use or suboptimal oral PrEP adherence combined with LA-PrEP intention), and regional differences. Open-ended responses on LA-PrEP perceptions were analysed. Determinants of LA-PrEP intention and unmet PrEP needs were explored using multivariable logistic regression. Overall, 19.0% (95%CI = 17.3-20.6) reported current oral PrEP use, of whom 19.8% (95%CI = 15.8-24.3) reported suboptimal adherence and 10.0% (95%CI = 8.3-13.9) had discontinued. Nearly half (47.0%, 95%CI = 44.9-49.8) expressed LA-PrEP intention. Unmet prevention needs potentially addressable by LA-PrEP were identified in 34.8% (95%CI = 32.8%-36.8%). MSM showed the highest PrEP engagement, whereas cisgender men had the lowest; unmet needs were greater in less-urbanised areas. Qualitative data reflected a positive outlook, framing LA-PrEP as safe, convenient, and empowering sexual freedom. Among MSM, unmet prevention needs potentially addressable by LA-PrEP were substantial among PrEP-naïve and discontinued users, although intention to use LA-PrEP was comparatively lower in these groups, indicating a mismatch between prevention need and acceptability. Despite low awareness, LA-PrEP intention is high in Italy, indicating strong readiness for rollout. However, a mismatch between prevention need and intention, particularly among PrEP-naïve individuals, may limit population-level impact. Yet, these findings should be interpreted considering the potential for selection bias associated with online convenience sampling and recruitment through social media and dating applications. Targeted, equity-oriented implementation strategies are required to ensure that LA-PrEP reaches populations experiencing substantial unmet HIV prevention needs.

Background: Long-acting injectable cabotegravir (CAB-LA) as pre-exposure prophylaxis (PrEP), given once every eight weeks, has been found to have superior efficacy over oral PrEP among men who have sex with men (MSM). We compared the epidemiological impact of expanding CAB-LA to current oral PrEP users with different levels of adherence, and non-PrEP users among MSM in the Netherlands. Methods: An MSM HIV transmission model was calibrated to the Dutch MSM HIV epidemic. The real-world effectiveness of daily oral-PrEP was assumed to decrease by users’ adherence levels: High (defined as >75% of the days covered, 93% effectiveness), medium (50–74% covered, 69%), and low (<50% covered, 18%), respectively. CAB-LA effectiveness was assumed as 91%. CAB-LA was targeted to current oral-PrEP users by their use adherence and non-PrEP-using MSM in 2025. The epidemiological impact of CAB-LA targeting strategies was evaluated over five, 15, and 25 years. Results: Assuming 100% coverage, providing CAB-LA to MSM with low oral PrEP adherence would avert 862 (19.7%) new HIV infections among all MSM over 25 years. Expanding CAB-LA to MSM with medium/high oral PrEP adherence and non-PrEP users did not show a substantial epidemiological impact. Moreover, our model suggested that the epidemiological impact would decrease with a lower real-world CAB-LA effectiveness. Conclusions: Our model showed that CAB-LA can be an important addition to ending the HIV epidemic by 2030. To optimise the full potential of CAB-LA at the beginning stage of CAB-LA introduction, we suggest prioritising the transition of current oral PrEP users with low adherence to CAB-LA to reduce HIV transmissions more efficiently.

Background: Migrant women account for a substantial proportion of new HIV diagnoses in Europe, yet remain underrepresented in HIV prevention research. Little is known about how legal status and national policy context shape engagement with PrEP among migrant women, particularly those without secure documentation. We assessed the PrEP cascade and HIV prevention preferences among migrant women, examining how legal status, sex work engagement and national reimbursement policies drive inequities in access. Methods: We conducted a community‐led, cross‐sectional survey (June–July 2025) of 521 HIV‐negative migrant women recruited offline via community‐based organisations. Multivariable logistic regression examined associations between legal status, sex work, country‐level PrEP reimbursement policies and PrEP cascade outcomes. Results: Among 521 participants, 259 (49.7%) lacked secure legal status (119 asylum seekers, 89 refugees and 51 undocumented migrants) and 90 (17.3%) were engaged in sex work. Overall, 40.1% (95% CI 35.9–44.5) were aware of PrEP and 24.6% (20.9–28.6) intended to use it, yet only 6.0% (4.1–8.4) were current users; 36.7% (23.8–51.7) of PrEP‐experienced women had discontinued use. Compared with naturalised citizens or documented residents, undocumented migrants (aOR = 2.57, 95% CI = 1.19–5.64), asylum seekers (3.67, 1.98–6.93) and refugees (2.28, 1.22–4.31) had higher odds of PrEP awareness. Sex workers had higher odds of current PrEP use (5.50, 1.61–20.42). Residing in countries with full PrEP reimbursement was independently associated with higher uptake (4.96, 1.30–26.11). Although condoms were the most preferred method (60.3%), interest in daily oral and long‐acting injectable PrEP was evident, particularly among undocumented women and sex workers. Conclusion: A four‐fold gap between PrEP intention and actual uptake among migrant women reflects a failure of universal health coverage, driven by restrictive migration governance and health financing. Achieving HIV equity requires decoupling PrEP eligibility from documentation status and expanding community‐led delivery.

The uptake and sustained use of preventive medicines are closely shaped by how they are perceived by their intended users, particularly at the point of introduction of a novel intervention [1]. Per...

Background: Long-acting injectable pre-exposure prophylaxis (LAI-PrEP) offers potentials for expanding PrEP coverage and improving public health outcomes. This study synthesizes evidence on the prevalence and determinants of interest in and preference for LAI-PrEP among men who have sex with men (MSM), trans* individuals, and heterosexual women. Methods: We conducted this systematic review and meta-analysis building on quantitative studies from a previous review and new studies published in PubMed, Web of Science, and Embase up to December 31, 2023. We used a random-effects meta-analysis to pool the prevalence of LAI-PrEP interest and preference, and narratively synthesized their determinants across all key populations. Findings: We included 41 articles. Seventy-four percentage (95% CI: 71 to 78) of MSM showed interest in using LAI-PrEP, and 37% (95% CI: 29 to 44) of them preferred LAI-PrEP over other HIV prevention methods. The prevalence of interest and preference were even higher among current oral PrEP users [77% (95% CI: 70 to 84) and 43% (95% CI: 28 to 58), respectively]. Interest in LAI-PrEP among trans* individuals was similarly high at 72% (95% CI: 67 to 78), with 1 study reporting that 57% of transgender women preferred LAI-PrEP. Cisgender heterosexual women also showed a high preference for LAI-PrEP (55%, 95% CI: 40 to 70). No significant differences were found between low-/middle-income countries and high-income countries across any key populations. Overall, people with more resources and who are already aware of and using oral PrEP are likely more interested in LAI-PrEP when it becomes available. Conclusions: Continued research is essential to effectively deploy LAI-PrEP and address HIV prevention gaps. Because more countries adopt LAI-PrEP, understanding its impact and reaching underserved populations will be critical to maximizing public health benefits.

Background Long-acting pre-exposure prophylaxis (LA-PrEP) is approved in Europe with promising HIV prevention potential. Currently, no data are available that examine intention to use LA-PrEP intention when it is not fully covered by healthcare/insurance programs. We investigated how the affordability of LA-PrEP impacts the intention to use LA-PrEP by men who have sex with men (MSM) in six European countries. Methods We included 10,592 HIV-negative MSM from an online cross-sectional survey (PROTECT, October 2023–April 2024), with participants from France (n = 1965), Germany (n = 2268), Italy (n = 1707), Spain (n = 1985), the United Kingdom (n = 1218) and the Netherlands (n = 1449). We investigated the intention to use LA-PrEP if one showed interest under different levels of affordability. For those who showed intention to use LA-PrEP when out-of-pocket copayments were required, we explored their intention by different copayments (ranging from < €50/month to €1000 + /month). We used multinomial regression to explore the impact of individual income on their intention to use LA-PrEP across different affordability/copayment scenarios. Results Of the included MSM, 59%-79% showed LA-PrEP interest in these six countries. Among them, a consistent decline in the LA-PrEP intention was observed as affordability decreased: from 44%(FR)–91%(NL) at high affordability to 10%(DE)–26%(NL) at low affordability. MSM with a high income showed significantly higher intention under medium and low affordability scenarios in all countries. Among those who showed intention with copayments, a strongly declining intention was observed and reached almost 0% when the copayment exceeded €250/month in all countries. MSM with high income showed significantly higher intention when copayment was under €250/month in all countries. Conclusions LA-PrEP would be welcomed in Europe if affordable. When LA-PrEP is not fully-covered, MSM with a high income may be the early adopters. However, LA-PrEP may not be affordable for those with a reason to use LA-PrEP once monthly copayments exceed €250, stressing the need for availability under insurance plans, or with limited copayments.