Stephan Walter
HIV is one of the world’s biggest killers. The virus has claimed more than 44 million lives, sparking fears around sex and immense stigma towards those most at risk, particularly men who have sex with men. But drugs that prevent the sexually transmitted infection have drastically cut this threat, enhancing sexual freedom for millions.
The virus spreads via sex when infected bodily fluids enter the blood of someone who is HIV-free, but it can also be transmitted by sharing needles or breastfeeding. If left untreated, HIV infects and wreaks havoc on the immune system, leading to acquired immunodeficiency syndrome, or AIDS.
Early on in the HIV epidemic, it became clear that condoms provide protection. But these can fail and they make sex less pleasurable, meaning many prefer not to use them, says Benjamin Weil at The Love Tank, a not-for-profit organisation in London that promotes the sexual well-being of communities underserved by the healthcare system.
It wasn’t until 2010 that a landmark trial revealed the power of pre-exposure prophylaxis, or PrEP, for HIV prevention. People who took a daily antiviral pill were substantially less likely to catch HIV than those taking a placebo. Two years later, the US Food and Drug Administration approved PrEP for HIV.
Soon after, a slew of studies showed that, when used correctly, PrEP cuts the risk of HIV transmission by more than 90 per cent. The World Health Organization recommended PrEP in 2015 and, in the following years, more than 150 countries adopted the approach. “The advent of PrEP really was an enormous revelation for lots of people because it allowed them to have the kind of sex they wanted to have, where bodily fluids could be exchanged and you could actually feel the contact of another’s skin,” says Weil. In 2023 alone, more than 3.5 million people worldwide took PrEP at least once.
Together with antiretroviral therapy, or ART – drugs that suppress the virus to undetectable levels in infected people, so they can’t transmit the virus – PrEP has slashed HIV rates. In 2024, there were 1.3 million new cases of HIV, a 61 per cent reduction compared with the peak of 3.4 million seen in 1996. “Those two things together certainly have played the lion’s share in reducing HIV rates,” says Weil.
Today, PrEP comes in many forms. Oral pills can be taken just before and after sex, while injectable drugs provide longer-lasting protection. Yet HIV rates are still rising in certain groups, such as Black African and Asian populations in the UK, partly due to stigma and poor healthcare access. Ironing out such inequalities will be crucial to unlocking the true potential of PrEP – and eliminating HIV entirely.
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