Informal PrEP use in Greece: The long, hard road to formal programmatic implementation

Objectives Pre‐exposure prophylaxis (PrEP) with antiretroviral drugs (ARVs) is a highly effective HIV prevention strategy. Although the European Medicines Agency approved oral PrEP in 2016 and the World Health Organization (WHO) has since recommended simplified and person‐centred delivery models, implementation remains inconsistent across Europe. In Greece, national PrEP guidelines were issued in 2022, but public sector access has not yet been established. Methods We report on informal PrEP use in 2024 among men who have sex with men (MSM) and transgender women (TGW) attending a private sexual health clinic in Athens. Results Among 547 MSM and TGW (mean age 36 ± 9 years), 308 (56.3%) were suitable for PrEP, 47 were already on PrEP and 134 initiated PrEP using generic formulations purchased online (39.6% daily, 60.4% on demand). Among 181 individuals on PrEP, 79.6% were retained in care, and no seroconversions were recorded over 2423 person‐months of follow‐up. Sexually transmitted infections (STIs) were diagnosed in 30.3%, indicating elevated HIV risk. Barriers to uptake included cost, online procurement concerns and limited awareness. Conclusions These findings highlight the urgent need for formally implemented, accessible PrEP services in Greece. Integration within broader sexual health frameworks, aligned with WHO recommendations, is essential to improve access, monitoring and HIV prevention in high‐risk populations.