The biggest barrier to HIV pre-exposure prophylaxis (PrEP) becoming more available and more widely used is not cost so much as widespread acceptance of the status quo in HIV prevention, the first-ever European PrEP Summit, held in Amsterdam earlier this month, heard.

Ignorance – among politicians, among healthcare workers, and among potential users of PrEP – was the main reason Europe lags far behind the USA in PrEP provision, despite there being a possibly more favourable climate in terms of potential drugs costs.

The decision by Dean Street clinic in London to start selling generic, off-patent Truvada – a decision given a you-heard-it-here-first announcement at the Summit by activist Greg Owen of I Want PrEP Now – is just one of a number of innovative solutions countries have had to take to meet rising demand – a demand exemplified by the fact that I Want PrEP Now is now catering for about 25,000 users a month.

And yet the Summit also heard that PrEP provision in many parts of Europe has scarcely started. In eastern Europe, despite international agencies like the World Health Organization (WHO) having given PrEP their full backing for several years, small pilot studies are only just now starting or planned to start this year.

These countries, of course, still face difficulty in providing treatment to people who already have HIV. But the fact that PrEP provision is even being contemplated in Russia, where a pilot study amongst men who have sex with men is planned to start in September, and is already underway in Ukraine and Georgia, may be a hopeful sign that PrEP-using gay men have something to contribute not only to HIV prevention but to addressing the stigma that surrounds gay men, trans people and other populations at risk of HIV.