Free HIV prevention pill gains momentum in Germany

12 January 2020

The number of people taking the HIV prevention pill PrEP has soared in the past three months thanks to the subsidisation of the drug in Germany, the most recent milestone in a succession of new LGBT laws. 


On September 1, 2019, pre-exposure prophylaxis medication or ‘PrEP’, became freely available to people in Germany aged 16 and over who have a substantial risk of contracting HIV. When taken daily, the pill offers a 99% level of protection. Rates of minor side effects are low, including headaches and dizziness. 

According to the Frankfurt-based consulting company Iqvia, 7,900 packages of PrEP medication were sold in Germany in September. This is a 46% rise in comparison to the number of packages sold the month before.


Dominic Walker, a resident of Berlin, has been taking the medication since it became freely available on public health insurance in 2019: “Most of my friends in the gay community and the people that I’d meet with are on PrEP. Unfortunately, there are still STIs so you’re not completely without risk. But the main crux of my anxiety is HIV, so if I know that I’m protected from that then I feel better.”


The drug was initially rejected in Germany due to its high costs, to conservative views and due to the suggestion that PrEP could act as a gateway to other medications which would be costly to health insurance companies. When the initial patent expired and a generic patent became available, prices dropped from €819/mo ($911; £697) to €50/mo ($56; £43) and could be bought by patients. 


In 2018, CDU Health Minister Jens Spahn announced that the cost of PrEP should be covered by statutory health insurance companies. The bill was approved by the German parliament and enacted the following year. 


Spahn, who is openly gay himself, has successfully accelerated several gay rights laws in Germany. He pushed through a ban on gay conversion therapy in December 2019 and ensured that HIV self-testing kits became available over the counter in August 2018.


Before Spahn’s time in office, a cultural shift was already taking hold of the country, with same-sex couples achieving equal rights for marriage and adoption in 2017. The same year, victims of the so-called §175 ‘gay paragraph’, which criminalised homosexuality in Germany until 1994, received a pardon.


Deutsche Aids Hilfe’s Holger Wicht explained that there is still a long way to go with regards to HIV prevention: “We need more doctors who can prescribe PrEP. There are regions in Germany without any medical doctor who can prescribe it.”


While the introduction of free PrEP should help lower HIV infection rates, if Germany is to meet the UNAIDS global target of ending the AIDS epidemic by 2030, then it needs to improve upon its current rate of diagnosis, which fell short of the 2020 target goal.


“We have to fight stigma and to inform people about what living with HIV means today. Only then we can reach these goals. We have to do everything we can to make it happen. This is not a vision. It is possible already. It just takes money and political will,” Wicht said.