PrEP in Ghent: Is It Right for You? | HAP.GENT

PrEP in Ghent: eligibility, access and reimbursement Dr. D. Hebberecht — HAP.GENT PrEP can prevent HIV infection. Heterosexual men and women may also be eligible. As a GP at HAP.GENT, I want to explain when PrEP may be helpful, which checks are needed and how to access it in Ghent. I assess your actual risk of exposure to HIV. Your sexual orientation alone does not determine whether you need PrEP. What is PrEP? PrEP stands for pre-exposure prophylaxis: taking HIV medicines before a possible exposure. It consists of one tablet combining two HIV medicines: tenofovir disoproxil and emtricitabine. When taken correctly, it provides a very high level of protection against HIV. PrEP does not protect against other sexually transmitted infections (STIs) and does not prevent pregnancy. Condoms and appropriate contraception therefore remain relevant. [1,2] Who is eligible for PrEP reimbursement in Belgium? The Belgian reimbursement scheme covers eligible HIV-negative people aged 16 and over, following an assessment of their HIV risk. For men who have sex with men and transgender people at very high risk, the criteria include condomless anal sex with at least two partners in the past six months; multiple STIs in the past year; more than one course of PEP in the past year; or the use of psychoactive substances during sex. There are also individual high-risk criteria that can apply to heterosexual people: condomless sex carrying a high risk of HIV infection, sex work involving condomless sex, having a partner with HIV whose viral load is not suppressed, and sharing injecting needles. [3] Having multiple partners or having sex without a condom does not automatically qualify someone for reimbursement. I therefore discuss your individual circumstances with you and consider whether a specialist assessment is appropriate. Examples to help explain the criteria I use fictional examples to illustrate the criteria. A man who has had condomless anal sex with at least two different men within six months may meet a specific criterion. A heterosexual woman whose partner has HIV and has recently started treatment, but has not yet achieved viral suppression, may also qualify. This may be particularly relevant when planning a pregnancy. A heterosexual man who repeatedly has condomless sex in circumstances carrying a high risk of HIV infection can receive an individual assessment. Being heterosexual does not exclude reimbursement. These examples illustrate the criteria; they do not guarantee approval. [2,3] If a partner with HIV has a sustained undetectable viral load on effective treatment, HIV is not sexually transmitted: undetectable equals untransmittable (U=U). That relationship in itself is therefore not a reason to take PrEP. I discuss any other potential exposures with you separately. [2] How to access PrEP in Ghent step by step 1. Raise your question during a consultation. Together, we review possible exposures, your questions and previous test results. You can also contact an HIV reference centre directly. 2. Arrange an assessment of whether PrEP is suitable for you. I can refer you to an HIV reference centre. In Ghent, you can contact the HIV Reference Centre at Ghent University Hospital (UZ Gent), C. Heymanslaan 10, 9000 Gent. The department lists 09 332 23 50, available from 8 am to 5 pm, and algemene.inwendige@uzgent.be. Ask for an initial PrEP appointment. [4] 3. Discuss the initial tests. I explain which tests are needed and coordinate with the reference centre on where they will be performed. These include an HIV test, kidney function tests, hepatitis testing and a syphilis test. Chlamydia and gonorrhoea testing depends on symptoms, exposure and the agreed screening policy. For women, the initial assessment also includes a pregnancy test. I check protection against hepatitis B and discuss vaccination if needed. A very recent HIV infection must be adequately ruled out. Report any recent exposure and symptoms such as fever, a rash or a sore throat following a possible exposure. [2] 4. Have the reference centre arrange the reimbursement application. It is important to understand that both the application and the prescription needed for reimbursement must come through a doctor affiliated with a recognised HIV reference centre operating under an agreement with Belgium's national health insurance institute, RIZIV/INAMI. The health insurance fund's medical adviser grants authorisation for up to twelve months, with renewal if PrEP remains necessary. An ordinary GP prescription alone is not sufficient for this reimbursement pathway. [3] 5. Collect the medication with your prescription and valid reimbursement authorisation. I recommend asking the pharmacy about your co-payment beforehand. Reimbursement of the medication does not mean that all consultations and tests are entirely free. [1,5] 6. Agree on follow-up arrangements. I discuss how your GP and the reference centre can coordinate your checks. The reimbursement scheme provides for follow-up every three months. By agreement, up to two follow-up visits per year may take place with your GP. [3] Daily PrEP or PrEP around sexual activity Daily dosing is one option. The short 2-1-1 regimen is not suitable for vaginal exposure. The 2026 Belgian guidance also describes a longer event-driven regimen for groups including women, with daily dosing continued until seven days after the last potential exposure. This requires an individually agreed starting and stopping schedule. For someone starting with one tablet per day without a loading dose, the guidance states that protection takes seven days to develop. I recommend agreeing on the exact regimen with your PrEP clinician. During a consultation, I can go through the instructions with you; do not copy someone else's schedule. People with chronic hepatitis B may need daily treatment, and stopping requires additional medical supervision. [2] Side effects and safety I also discuss possible side effects, such as temporary digestive symptoms or headaches. I pay attention to kidney function monitoring and potential drug interactions. If you have hepatitis B, stopping requires additional supervision. Tell your clinician about any other medicines and supplements you take at your initial assessment. [2] What if the exposure has already happened? I distinguish clearly between PrEP, prevention before exposure, and PEP, treatment after a possible exposure. PEP must be started as soon as possible, preferably within hours and no later than 72 hours after exposure. Contact an emergency department or HIV reference centre immediately for assessment. Do not wait for a routine PrEP appointment. [9] My advice Unsure whether PrEP is right for your situation? You are welcome to discuss it with me. Together, we can assess your risk, and I can help prepare the route to specialist assessment. Heterosexual men and women are equally welcome to raise the question. Recent Belgian literature [2] Van Praet JT, Henrard S, et al.; BREACH. Belgian Guidance on the use of Pre-Exposure Prophylaxis: 2026 update. https://breach-hiv.be/wp-content/uploads/2026/09/Van-Praet_2026_Update.pdf Belgian expert guidance, rather than a study of a cohort of PrEP users. Covers current regimens, follow-up and vaccination. [6] Van Landeghem E, Hensen B, Belloni M, Nöstlinger C. Intersecting vulnerabilities, diverging pathways: an intersectional analysis of PrEP access disparities among migrant populations in Belgium. Social Science & Medicine. 2026;407:119642. Published online 24 August 2026. https://doi.org/10.1016/j.socscimed.2026.119642 Qualitative research into barriers including health insurance, precarious living circumstances and stigma. Interviews were conducted in 2021–2022; this is not a measure of current PrEP use across Belgium. [7] Rotsaert A, Vanhamel J, Vanbaelen T, et al. HIV Pre-exposure Prophylaxis (PrEP) Care in Belgium: A mixed-methods Study on PrEP Users’ Experiences and Service Delivery Preferences. AIDS and Behavior. 2024;28(2):393–407. Published online in 2023, with the journal issue appearing in 2024. https://doi.org/10.1007/s10461-023-04232-8 Research involving 326 users, supplemented by 21 interviews. Describes satisfaction, practical barriers and willingness to involve GPs in PrEP care. It is not representative of everyone who needs PrEP. [8] Vanhamel J, Reyniers T, Vuylsteke B, et al. Understanding adaptive responses in PrEP service delivery in Belgian HIV clinics: a multiple case study using an implementation science framework. Journal of the International AIDS Society. 2024;27:e26260. https://doi.org/10.1002/jia2.26260 Research into the organisation of PrEP care in Belgian HIV clinics, with participation from Ghent University Hospital. Highlights the importance of collaboration and adapting care processes. Practical and administrative sources The following source pages and documents are in Dutch unless stated otherwise. Their original titles are retained for identification. [1] UZ Gent. Behandeling met pre-expositieprofylaxe tegen hiv. Patient information about PrEP. https://www.uzgent.be/sites/default/files/2025-09/prep.pdf [3] BCFI. RIZIV reimbursement regulations, Chapter IV, paragraph 8750000. https://a.bcfi.be/nl/ampps/199810?cat=b [4] UZ Gent. Hiv-referentiecentrum. HIV Reference Centre contact details. https://www.uzgent.be/nl/hiv-referentiecentrum [5] RIZIV. HIV: tegemoetkoming in de kosten voor de begeleiding in een gespecialiseerd centrum. Reimbursement of care at a specialised centre. https://www.riziv.fgov.be/nl/thema-s/verzorging-kosten-en-terugbetaling/ziekten/aandoeningen-van-het-bloed-en-van-het-immuniteitsysteem/hiv [9] Institute of Tropical Medicine. Hiv-PEP (post-expositieprofylaxe). Information about emergency treatment after exposure. https://www.itg.be/nl/clinics/service/hiv-pep-post-expositie-profylaxe