Public awareness, attitudes and perceptions of community pharmacy-based HIV pre- exposure prophylaxis: a large cross- sectional survey of 14,678 adults in England
A large cross-sectional survey of 14,678 adults in England reveals that while public awareness of HIV pre-exposure prophylaxis (PrEP) remains limited, there is substantial interest in obtaining PrEP information and strong support for accessing it through community pharmacies, particularly among younger and sexual minority populations.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
HIV, the virus that causes AIDS, has long been a formidable public health challenge, but modern medicine has developed a powerful tool to stop it before it starts. This tool is called pre-exposure prophylaxis, or PrEP. It is a daily medication taken by people who do not have HIV but are at risk of catching it. When taken correctly, the drug acts as a shield, preventing the virus from establishing an infection even if a person is exposed to it. For years, the primary way to get this medication in England has been through specialized sexual health clinics. While these clinics are effective, they can be difficult to reach for some people due to distance, long wait times, or the stigma of visiting a clinic dedicated to sexual health. This has led health officials to wonder if community pharmacies, the local drugstores found on almost every high street, could serve as a more accessible gateway to this life-saving protection.
To understand if this idea would work, a team of researchers from Imperial College London and other institutions decided to ask the public directly. They wanted to know if people had heard of PrEP, if they understood how it worked, and most importantly, if they would be comfortable getting it or information about it from their local pharmacist. The researchers conducted a massive online survey, asking nearly 15,000 adults across England about their knowledge and feelings regarding PrEP and pharmacy-based access. The goal was not to test who needed the medicine, but to gauge the public's readiness for a new way to access it.
The results revealed a significant gap between what people know and what they want to know. Only about one-third of the respondents said they had previously heard of PrEP, and an even smaller portion knew specifically that it could prevent HIV. Despite this lack of prior knowledge, a large majority of the people surveyed expressed a strong interest in learning more. When asked if they would seek information about PrEP, nearly two-thirds said yes. This suggests that while the public is not currently well-informed about this prevention method, there is a genuine appetite for education and guidance.
When the researchers asked about the specific idea of using pharmacies, the response was surprisingly positive. More than half of the participants said they would be happy to obtain PrEP from a local pharmacy, and nearly two-thirds said they would feel comfortable getting information about it there. Many also rated pharmacies as the most convenient place to access this care, scoring them higher than sexual health clinics or online websites. This indicates that the public sees the local drugstore as a familiar, accessible, and less intimidating place to engage with HIV prevention.
However, the survey also highlighted that awareness and attitudes are not the same for everyone. The researchers found that younger people were much more likely to have heard of PrEP and more likely to support pharmacy access than older adults. Similarly, people who identified as gay, bisexual, or pansexual were far more aware of the medication and more supportive of pharmacy access than those who identified as heterosexual. There were also differences based on ethnicity; for instance, people of Asian descent were less likely to have heard of PrEP compared to white respondents, while people of Black descent were more likely to have heard of it. These findings suggest that a single message might not reach everyone equally, and that communication efforts may need to be tailored to different groups to ensure everyone has the chance to learn about and access this protection.
The study also looked at what stops people from getting PrEP. The most common barriers cited were a lack of information, the high cost of the medication, and the difficulty of finding it easily. Stigma and concerns about side effects were also mentioned, though less frequently. The fact that so many people expressed interest in learning more, combined with their willingness to use pharmacies, suggests that the main hurdle is not a lack of desire for protection, but rather a lack of clear pathways to get it.
It is important to note what this study did not find. The researchers did not measure who actually needed the medication based on their personal health risks, so these numbers do not tell us how many people in England currently need PrEP but are not getting it. The survey also relied on people's own reports of their knowledge and feelings, rather than testing their actual medical eligibility. Furthermore, the group of people who answered the survey was not a perfect mirror of the entire English population; it included more people with university degrees and was concentrated in certain regions. Because of this, the results show what this specific group of people thinks, rather than proving exactly what the entire country thinks.
Despite these limitations, the picture that emerges is clear. There is a substantial opportunity to expand access to HIV prevention by involving community pharmacies. The public appears ready for this change, viewing pharmacies as a convenient and acceptable place to get help. The challenge now lies in turning this public willingness into reality. Health officials will need to design systems that allow pharmacists to provide information and referrals while ensuring that medical checks and prescriptions remain safe and effective. By listening to the public's desire for easier access, health services can potentially build a bridge that connects more people to the protection they need, ensuring that the shield of PrEP is available to those who need it most, regardless of where they live or who they are.
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