Call to action: A roadmap for HIV prevention and PrEP adoption in the Gulf region

Abstract

Background: Pre-exposure prophylaxis (PrEP) is a highly effective biomedical intervention for preventing HIV transmission. However, despite its proven efficacy, PrEP uptake in the Gulf Cooperation Council (GCC) countries remains suboptimal due to multiple systemic, legal, and sociocultural challenges.

Purpose: This expert opinion review aims to present a strategic roadmap to enhance HIV prevention and support the integration and scale-up of PrEP adoption across the GCC region.

Research Design: This narrative review synthesises insights from regional and international literature, expert panel discussions, and public health frameworks to develop practical recommendations for improving PrEP implementation in GCC countries.

Study Sample: The review draws upon the perspectives of infectious disease specialists, public health policymakers, and HIV prevention advocates with expertise in the GCC region, alongside selected peer-reviewed and grey literature addressing HIV and PrEP in similar sociopolitical contexts.

Data Collection and/or Analysis: Qualitative synthesis of the existing barriers and facilitators of PrEP adoption was conducted. The authors applied a framework-based approach to identify core pillars for effective policy, clinical, and public health interventions relevant to the GCC context.

Results: Four strategic pillars were identified: (1) establishing a legal and regulatory framework with national PrEP guidelines; (2) improving risk identification and expanding access for individuals at heightened HIV risk; (3) enhancing healthcare provider education and capacity-building; and (4) conducting culturally sensitive public awareness campaigns. Financial accessibility and patient-provider communication were also highlighted as key to improving adherence and uptake.

Conclusions: A coordinated, multi-sectoral approach is essential for advancing PrEP integration into national HIV prevention efforts across the GCC. By addressing structural and societal barriers, this roadmap provides actionable guidance to reduce new HIV infections and promote equitable access to PrEP for at-risk populations.

Keywords

HIV pre-exposure prophylaxis barriers gulf cooperation council Saudi Arabia United Arab Emirates

Introduction

The global population of people living with human immunodeficiency virus (PLHIV) remains a significant concern, with an estimated 1.3 million new infections in 2024.¹ The Middle East and North Africa (MENA) region experienced a 24% increase in new HIV infections and a 12% increase in AIDS-related deaths compared to 2015, with an estimated 420,000 PLHIV in the region, including 14,000 children.² Despite the increased burden of HIV in the MENA region, challenges remain with regard to diagnosis and treatment.³ In 2020, only 42% of the PLHIV were diagnosed, and of those diagnosed, only 27% were receiving antiretroviral therapy (ART). Furthermore, among those on treatment, just 27% had achieved viral load suppression.²

Pre-exposure prophylaxis (PrEP) has emerged as a cornerstone intervention in global HIV prevention strategies, offering a highly effective means of reducing the risk of HIV acquisition among at-risk populations.⁴ PrEP involves using ART by at-risk individuals to prevent infection, and its efficacy has been demonstrated in multiple pivotal clinical trials across diverse populations and settings. Landmark studies, such as the iPrEx trial, showed that a daily oral combination of tenofovir disoproxil and emtricitabine (TDF/FTC) significantly reduced HIV transmission risk among gay, bisexual, and other men who have sex with men (GBM) and transgender women, with efficacy rates exceeding 86% when adherence was high.^5–7 Similarly, the Partners PrEP study in serodiscordant couples demonstrated a marked reduction in HIV transmission.⁸ More recently, the DISCOVER trial confirmed the non-inferiority of tenofovir alafenamide (TAF)/FTC compared to TDF/FTC, with a better tolerability profile in individuals with renal impairment or reduced bone density.⁹ The long-acting injectable lenacapavir has also demonstrated 100% efficacy in preventing HIV infection among cisgender women with a well-tolerable safety profile.¹⁰ Based on these findings, the World Health Organization (WHO) strongly recommended the use of PrEP as a key component of comprehensive HIV prevention efforts.¹¹

In regions such as the MENA, where HIV rates continue to rise, the expansion of PrEP access and its integration into public health frameworks present critical opportunities to mitigate the epidemic and achieve the UNAIDS prevention targets for 2030. However, several MENA countries face a unique set of challenges in addressing HIV prevention and the adoption of PrEP.^12–15

The Gulf Cooperation Council (GCC) region—comprising Saudi Arabia, the United Arab Emirates (UAE), Kuwait, Bahrain, Qatar, and Oman—forms a subset of the broader MENA region. The GCC countries are among the wealthiest and most urbanised, with advanced healthcare infrastructures and distinct sociopolitical contexts that influence HIV prevention strategies. The GCC represents approximately 10–15% of the total MENA population.¹⁶ In recent years, Saudi Arabia and the UAE have made concerted efforts to enhance HIV surveillance, prevention, and treatment services. Nevertheless, a substantial gap remains, particularly in the context of access to preventative measures such as PrEP.

In this expert-opinion review, we propose a strategic roadmap for enhancing HIV prevention and promoting the adoption of PrEP within the GCC countries. This review aims to analyse the current regional barriers to PrEP adoption and propose tailored, evidence-based strategies to overcome these barriers and improve health outcomes in the region.

Methods

This manuscript is presented as an expert opinion review developed in response to the growing need for context-specific guidance on HIV prevention and PrEP adoption in the GCC countries. A systematic review approach was not feasible due to the limited volume and scope of empirical literature addressing country-level implementation strategies, socio-cultural factors, and health system readiness in this region.

To address these knowledge gaps, this expert-based review combines insights from two multidisciplinary advisory boards held in Saudi Arabia and the UAE. The advisory board meetings involved 19 healthcare professionals (HCPs), including infectious disease (ID) specialists, dermatologists, urologists, and nurses, who provided critical perspectives on current HIV prevention strategies, barriers to PrEP adoption, and regional public health challenges. The advisory board discussions were structured to elicit expert insights through guided questions, focusing on the epidemiological context of HIV, existing prevention and treatment programmes, and potential pathways for enhancing PrEP utilisation. Key themes and consensus points emerging from these discussions were documented and synthesised to inform practical recommendations.

In parallel, a bibliographic literature search was conducted using Medline via PubMed. Search terms included “HIV epidemiology,” “PrEP adoption,” “Saudi Arabia,” “United Arab Emirates,” “HIV prevention strategies,” and “Gulf Cooperation Council.” Peer-reviewed studies, grey literature, and public health data were included to capture a broad perspective on the topic. Data from the literature search were integrated with the advisory board insights to identify current gaps and actionable strategies tailored to the unique socio-cultural context of the GCC countries.

HIV epidemics and key populations

The incidence of HIV infection has maintained an upward trajectory in the MENA region, including the GCC countries. Compared to 2015, there was a 42% increase in the number of PLHIV in the MENA region, approaching 420,000 PLHIV.² Such a pattern was consistent across the GCC countries. For instance, a recent review of the six GCC countries found that the incidence of HIV infection gradually increased over the past three decades in Saudi Arabia (from <0.01% in 1990 to 0.05% in 2021), UAE (from 0.04% in 2011 to 0.13% in 2020), and Qatar (from 0.02% in 1990 to 0.07% in 2020). Likewise, despite the low prevalence (<0.1%), the number of PLHIV in the region increased to reach 42,015 individuals, with the majority of individuals from Saudi Arabia (65%), followed by Oman (24%) and UAE (6%).¹⁷

The UNAIDS incidence-to-prevalence ratio is a key metric used to evaluate the trajectory and control of the HIV epidemic within a given population.¹⁸ A benchmark of 3% is an indicator of long, healthy lives among PLHIV and reductions in new infections. The MENA region, including the GCC countries, continues to struggle with a ratio of 8%.¹⁹ In Saudi Arabia, there is an even higher ratio of 13%.²⁰

The current evidence indicates that certain key populations are at risk of HIV infections, including persons who inject drugs (PWID), GBM, sex workers, and those with recurrent sexually transmitted infections (STIs). However, surveillance data regarding the prevalence of key populations in the GCC countries is often limited, and data are mainly driven from the other MENA countries. The prevalence of PWID in the MENA region is estimated at approximately 638,602 individuals.¹² By 2022, data from the GCC countries indicated that the HIV prevalence rates were reported as 4.6% in Bahrain, 0.8% in Kuwait, 11.8% in Oman, and 9.8% in Saudi Arabia.¹⁷

On the other hand, estimating the size of the GBM population in the MENA region is challenging, with limited data available for GCC countries. Scattered evidence suggests that 1–3% of men in the region engage in same-sex behaviour, consistent with global estimates.¹² However, some studies have reported lower prevalence rates,²¹ which could be attributed to hidden networks not captured by these studies due to stigma and social discrimination.¹² Among the countries for which data are available, the median HIV prevalence among GBM from the MENA region has been approximately 4% since 2010.¹² Female sex workers (FSWs) constitute a small proportion—less than 1%—of women of reproductive age in the MENA region. The HIV epidemic among FSWs varies widely across the region, with a prevalence rate of 2–4%.²²

The expert panel identified several gaps regarding HIV epidemiology and public health strategies in the GCC countries. While efforts were made to provide detailed epidemiological insights across the Gulf region, the availability of country-specific data remains limited. In both Saudi Arabia and the UAE, the true burden of HIV is likely significantly higher than officially reported figures, with notable geographic clustering of cases. The lack of standardised routine HIV screening contributes to missed cases and data gaps. The panel emphasised the need for strengthening data collection and reporting systems, implementing routine HIV screening for individuals at increased risk of HIV exposure, and enhancing public health transparency to better capture the true burden of HIV.

Additionally, limited intersectoral collaboration and the absence of a cohesive data-sharing system across healthcare sectors present significant barriers to accurately assessing HIV prevalence and trends in both countries. Establishing a national electronic health record (EHR) system to facilitate real-time data sharing among HCPs, government agencies, and insurers was recommended to enhance data accuracy, improve care coordination, and inform public health strategies.

The experts also noted that both countries face challenges related to undiagnosed HIV cases among younger populations, particularly those aged 20–30 years, who are less likely to undergo regular screening. The expert panel highlighted the need for targeted public health campaigns focused on raising HIV awareness and promoting voluntary testing among young adults. Such initiatives could play a pivotal role in reducing stigma, enhancing prevention, and improving health outcomes in this demographic group.

Barriers to PrEP uptake in the GCC counties

To date, PrEP policies in the MENA region are limited, with only 15 countries —representing approximately two-thirds of the region’s nations and including Saudi Arabia, UAE, and Qatar from the GCC countries— reporting the adoption of national PrEP guidelines. Few countries (only Qatar from the GCC region) have officially incorporated PrEP into their national HIV prevention policies. The implementation of PrEP in the region faces numerous challenges, compounded by poor regulation and practices. The expert panel identified several challenges towards scaling up PrEP uptake in the GCC region, which are detailed below (Figure 1).

Figure 1.

Barriers to PrEP Uptake in the GCC Counties. GCC, Gulf Council Cooperation; PrEP, Pre-exposure prophylaxis. Created with BioRender.com.

HCP-related barriers and public awareness

The notable progress in PrEP innovations has resulted in highly effective HIV prevention programmes. Despite the high efficacy of PrEP, limited knowledge and awareness of PrEP among HCPs, particularly among non-ID specialists, have been widely demonstrated in recent reports.²³ Several reports from North America, Europe, and Southeast Africa showed that HCPs’ knowledge and awareness were independent predictors of willingness to prescribe PrEP.^23–26 While data regarding PrEP knowledge among HCPs in the GCC region is limited, studies from other MENA countries showed that HCPs, including those working in HIV clinics, have little or no awareness of PrEP uses and efficacy.²⁷

The expert panel confirmed that a critical barrier to broader implementation in the GCC region is the limited knowledge and awareness of PrEP among HCPs, particularly among non-ID specialists, who often play a critical role in primary care and general health services. In our opinion, the limited understanding of PrEP’s benefits and appropriate use among non-ID specialists may result in missed opportunities to educate and prescribe PrEP to at-risk individuals. This knowledge gap is partly due to a lack of targeted education and training on HIV prevention strategies within medical curricula and continuing professional education. Many HCPs in the region remain unfamiliar with the indications, dosing regimens, and long-term benefits of PrEP, contributing to reluctance to discuss and recommend it for key populations.

HIV knowledge and awareness of transmission risks are consistently low across the MENA region, including the GCC countries.¹³ For instance, data from Saudi Arabia showed a poor-to-moderate level of HIV knowledge and awareness among the public.²⁸ Likewise, university students from the UAE have a low level of knowledge regarding HIV and its risk of transmission among Emirati students.²⁹ Public awareness related explicitly to PrEP is even more limited, though data from the GCC region are scarce. For instance, a recent survey from Lebanon showed that only 22% of the general public is aware of PrEP’s existence, with an even lower awareness level of its indications and use.¹⁴ Another report found that only 42.7% of young GBM were aware of PrEP.¹⁵

The expert panel from the GCC region highlighted that many individuals, including those at higher risk of HIV infection, are unaware of PrEP’s existence and its role. We perceive this lack of awareness as particularly evident among younger populations, who are more vulnerable to new infections. School-based HIV prevention education, which could serve as a vital platform for increasing awareness and reducing stigma, remains limited in the region, further exacerbating the knowledge gap among youth.

Structural and system barriers

The current evidence consistently emphasises that the absence of clear and standardised guidelines creates ambiguity in clinical decision-making, leading to missed opportunities for preventing HIV transmission in individuals at increased risk of HIV exposure.³⁰ Without explicit protocols outlining when and to whom PrEP should be prescribed, HCPs may be less inclined to recommend this preventive measure,³¹ leaving vulnerable groups without adequate protection.

The expert panel noted that, despite the existence of national HIV guidelines in Saudi Arabia and the UAE, the absence of comprehensive local policies and national guidelines on PrEP indications presents a significant barrier. The lack of clear guidance on when and to whom PrEP should be prescribed leaves many individuals at increased risk of HIV exposure without access to this intervention. Without standardised protocols, HCPs may be hesitant to prescribe PrEP. Moreover, even in settings where PrEP-related policies and protocols exist, inconsistent implementation within clinical practice remains a major challenge. This variability can lead to gaps in PrEP availability, disparities in access, and a lack of uniformity in how patients are identified and supported in their medication use.

Financial concerns have been widely reported as barriers to PrEP uptake among at-risk populations. Cost-related concerns impact both patients and HCPs, further limiting PrEP’s accessibility and uptake.³² Mixed-method studies highlighted that participants reported a lack of insurance coverage and medication costs as major barriers to utilising PrEP or regularly using it.³³

The expert panel highlighted that, in the GCC countries, financial barriers present a critical challenge to the uptake of PrEP among individuals at increased risk of HIV exposure. Many individuals at risk, including expatriates who form a significant portion of the population in the region, often face difficulties in accessing PrEP due to insufficient insurance coverage. Moreover, national healthcare systems in both Saudi Arabia and the UAE generally do not cover PrEP for citizens, except for Dubai. This limited coverage further compounds financial accessibility issues, as out-of-pocket costs may be prohibitive for many individuals. As a result, HCPs may be hesitant to prescribe or even discuss PrEP due to concerns about affordability and patients’ ability to access or adhere to treatment.

Patient-related barriers

Social stigma and cultural barriers surrounding HIV/AIDS, both as a disease and through association with individuals at increased risk of HIV exposure, remain prevalent. Many at-risk individuals express concern that using PrEP could lead to being mistakenly identified as HIV-positive, thereby subjecting them to discrimination and social judgment, often referred to as “PrEP shaming.”³⁴

In many Middle Eastern societies, PLHIV faces considerable stigma and discrimination. Misconceptions linking HIV transmission primarily to risky behaviours contribute to social stigma.³⁵ Surveys from the GCC countries revealed that a significant proportion of the population holds negative views towards PLHIV.²⁸ Stigma within healthcare services remains a barrier in the GCC region as well, which can deter at-risk individuals from seeking PrEP, though some GCC countries, including Saudi Arabia, have taken steps to address these issues through laws that prohibit discrimination and ensure access to healthcare.³⁵

In addition, legal stigma, including criminal penalties and deportation of expatriates with HIV infections, further limits PrEP uptake in the region. In the GCC region, many key populations at risk for HIV face legal criminalisation, contributing to widespread fear of prosecution, arrest, or deportation among affected individuals.¹² These legal constraints can restrict the willingness of at-risk populations to seek testing or disclose risk behaviours to HCPs.

Beyond these structural and legal challenges, socio-cultural norms and religious sensitivities surrounding sexuality and HIV risk behaviours significantly affect both access to and uptake of PrEP. Patients at risk may avoid seeking care due to fear of judgment, legal repercussions, or breach of confidentiality.^36,37 This stigma also extends to the clinical setting, where HCPs may be reluctant to initiate discussions about HIV prevention or offer PrEP proactively, fearing professional or societal backlash.^36,37 For instance, studies have documented that GBM in Beirut, Lebanon, report reluctance to seek HIV prevention services due to anticipated stigma and discrimination from service providers.¹⁵ Similarly, research in Egypt has highlighted that a significant proportion of healthcare providers harbour stigmatising attitudes towards PLHIV, which can adversely affect the quality of care and discourage individuals from accessing prevention services.³⁷ These dynamics underscore the urgent need for provider training, confidentiality safeguards, and community-based education to normalise HIV prevention and reduce stigma in culturally appropriate ways.

A roadmap for HIV prevention and PrEP adoption in the gulf region

Establishing legal framework and national guidelines for PrEP implementation

Establishing a robust legal framework and clear national guidelines for PrEP implementation is critical to the roadmap for HIV prevention in the Gulf region. Advocacy efforts should focus on creating legal reforms that support the use of PrEP, facilitate insurance coverage, and encourage greater engagement with HIV prevention programmes. Such reforms would ensure prevention strategies are more inclusive, effective, and accessible to key populations. In this context, proposed mechanisms such as data sharing between HCPs, government entities, and insurers raise concerns regarding privacy and confidentiality. Without robust legal safeguards to protect individuals from criminal penalties based on their health or behavioural data, such practices may deter individuals from engaging with HIV prevention services. Therefore, any data-sharing framework must be designed with strict confidentiality protocols, informed consent mechanisms, and legal protections to ensure that personal health information is not used punitively.

Additionally, there is a need to collaborate with national health authorities to develop comprehensive national PrEP guidelines. These guidelines should include clear protocols for determining patient eligibility, providing follow-up care, and monitoring individuals at increased risk of HIV exposure. The process for HCPs and insurers can be simplified by reaching a national consensus, ensuring that those in need consistently receive PrEP. Incorporating these guidelines into a legally enforceable framework will help standardise PrEP prescription practices, secure insurance coverage for individuals at increased risk of HIV exposure, and improve overall access. This should be combined with developing and enforcing targeted local policies to ensure that individuals at increased risk of HIV exposure have consistent access to PrEP.

While the establishment of national PrEP guidelines and legal frameworks is a critical step toward HIV prevention, several obstacles may hinder implementation in the Gulf region. These include delays in policy approval, concerns over socio-cultural perceptions of HIV risk groups, and limited prioritisation of funding for preventive health programmes. Existing efforts, such as the inclusion of HIV services in select national health strategies, have shown that progress is possible but often gradual. To navigate these challenges, we recommend early engagement with health authorities, mobilising support from key opinion leaders and community-based organisations and exploring public–private partnerships to support PrEP implementation and education campaigns.

Insurance coverage and equitable access

Promoting insurance coverage for PrEP is equally crucial, as many individuals at increased risk of HIV exposure face financial barriers due to insufficient coverage, particularly among expatriate populations. Advocating for insurance policy reforms that mandate PrEP coverage and routine HIV testing for individuals at increased risk of HIV exposure can help bridge these gaps. Collaboration with insurance companies to recognise PrEP as a cost-effective preventive measure capable of reducing long-term treatment costs for HIV is necessary to improve access.

Although some progress has been made through initiatives to reduce stigma and promote confidentiality, ongoing efforts are needed to ensure equitable access to healthcare, employment security, and community support for PLHIV. Addressing cultural and structural barriers through legal reforms and comprehensive guidelines will enhance PrEP uptake and improve HIV prevention and care across the GCC region. Concurrently, advocating for legal reforms that protect the rights of expatriates and encourage transparent discussions about preventive measures without fear of legal repercussions is essential.

Identifying potential PrEP candidates

The identification of potential PrEP candidates is a crucial step in the successful adoption of HIV prevention strategies in the GCC countries. The expert panel highlighted that the key populations in the GCC region include discordant couples, heterosexual individuals engaging with sex workers, as well as the sex workers themselves, GBM, and PWID. However, GBM populations remain difficult to reach due to their discreet nature, which challenges targeted intervention efforts. To effectively identify and reach these groups, local and regional data collection efforts must be prioritised, as such data would be more impactful in engaging decision-makers and developing tailored strategies for HIV prevention.

Additionally, there is a need to establish clear referral pathways for at-risk individuals. Inconsistencies in the referral of individuals at increased risk of HIV exposure to ID specialists present a significant barrier to timely PrEP initiation.³⁸ Thus, establishing a standardised referral pathway with clear criteria for identifying and referring individuals at increased risk of HIV exposure to ID specialists is essential. This pathway should be broadly communicated and seamlessly integrated into both primary care and speciality practices to ensure individuals at increased risk of HIV exposure receive timely and effective interventions.

Non-ID specialists, such as primary healthcare (PHC) physicians, dermatologists, and gynaecologists, often encounter individuals at increased risk of HIV exposure but may lack the tools necessary to accurately assess their risk for HIV acquisition. Thus, it is recommended that a triage system or risk assessment tool be developed to categorise individuals into different risk categories based on their behaviours and health conditions, which would provide a standardised approach to risk stratification. Such a tool would enable non-ID specialists to identify individuals at increased risk of HIV exposure more consistently and accurately, guiding their decisions on referring patients to ID specialists or initiating PrEP.

Structured, evidence-based counselling approaches—such as motivational interviewing and tailored risk-reduction counselling—have shown success in other settings by addressing individual beliefs, readiness, and stigma-related barriers.^39,40 Adaptation of such approaches to the cultural context of the Gulf region may help foster more open and informed physician-patient dialogues. Thus, it is recommended that user-friendly counselling tools for PrEP in the GCC region be developed. HCPs often face time constraints that limit their ability to counsel individuals at increased risk of HIV exposure thoroughly. Additionally, some hospitals may restrict referrals without strong justification. Developing a user-friendly, time-efficient counselling tool for non-ID specialists can streamline the process of discussing PrEP with patients. This tool should include a quick reference guide for physicians and patients, facilitating effective risk assessment, patient counselling, and timely referrals to ID specialists for PrEP initiation.

Lastly, integrating sexually transmitted disease (STD) care into general health clinics, rather than placing it in separate facilities, can help reduce stigma and encourage higher attendance. The stigma associated with seeking sexual health services often discourages individuals at increased risk of HIV exposure from accessing care.⁴¹ Providing sexual health services alongside routine care allows individuals at increased risk of HIV exposure to seek help more discreetly, thereby increasing access to essential preventive measures, including PrEP.

Improve HCPs knowledge and foster multidisciplinary collaboration

As previously mentioned, many non-ID specialities are unfamiliar with PrEP and may not prescribe it or refer individuals at increased risk of HIV exposure for PrEP consultations. Thus, improving HCP’s knowledge and fostering a collaborative approach to PrEP implementation within the GCC countries is crucial. Facilitating a multidisciplinary collaboration between ID specialists and other HCPs can ensure that PrEP is consistently considered a preventive option for all individuals at increased risk of HIV exposure. Routine screening for STIs should serve as a critical touchpoint for initiating discussions about PrEP availability, with clear referral pathways established to guide at-risk individuals to ID specialists when appropriate.

To further strengthen this collaborative effort, expanding training opportunities for physicians in sexual health clinics—both locally and internationally—can significantly enhance their competencies in addressing sensitive topics and delivering preventive care, including PrEP counselling. Exposure to specialised training environments focused on sexual health equips HCPs with the skills needed to communicate effectively, navigate cultural sensitivities, and provide comprehensive, patient-centred guidance on HIV prevention.

Targeted awareness campaigns

The last key aspect of the proposed roadmap is to establish targeted awareness campaigns, ensuring individuals at increased risk of HIV exposure in the GCC countries understand the benefits of PrEP and its high efficacy when used consistently. Raising awareness about PrEP and normalising discussions around sexual health and HIV prevention requires culturally sensitive approaches that respect local norms and reduce stigma. This strategy can help reduce stigma and facilitate more open conversations about HIV prevention.

Given that younger generations increasingly seek information through digital platforms, it is vital to create approved, reliable digital resources tailored to individuals at increased risk of HIV exposure. Collaboration with the local authorities could enable the development of websites, applications, and social media campaigns that provide evidence-based information about PrEP, HIV prevention, and sexual health. Such platforms would offer accessible, confidential avenues for learning and engagement, empowering individuals at increased risk of HIV exposure to make informed health decisions. Effective campaigns should leverage the influence of social media personalities, celebrities, and community leaders to disseminate public health messages, particularly among younger populations.

Encouraging physician-patient dialogue is another critical component of targeted awareness efforts. Individuals at increased risk of HIV exposure may not fully grasp the significance of HIV prevention strategies, and time constraints during medical consultations can limit physicians’ ability to counsel patients on Prep thoroughly. Data from the MENA region show a strong positive association between PrEP discussions, information availability, and willingness to take PrEP.¹⁴ To foster greater uptake of PrEP, extended counselling sessions for high-risk HIV-negative patients should be encouraged. Providing training for healthcare providers on best practices for discussing HIV prevention—including addressing stigma—can further enhance their ability to engage patients effectively and promote PrEP use among individuals at increased risk of HIV exposure (Figure 2).

Figure 2.

A roadmap for HIV prevention and PrEP adoption in the gulf region.

Conclusion

Several regional barriers exist towards the PreP adoption, including social stigma, regulatory hurdles, limited insurance coverage, and economic constraints. In this manuscript, we provided a comprehensive roadmap to guide and accelerate the efforts of adopting HIV preventive measures, including PrEP, in the GCC region. This roadmap emphasises several evidence-based strategies, including educational campaigns for HCPs and the public, targeted policy reforms, and culturally sensitive awareness initiatives to reduce stigma. The roadmap also calls for multisectoral collaboration to foster a coordinated response. Furthermore, we advocate for establishing policy and regulatory frameworks to broaden PrEP access in the region. Measurable success indicators should be established to evaluate the progress and impact of these initiatives over time.

Footnotes

Acknowledgements

Dr Ahmed Elgebaly from MedDots FZC provided medical writing and editorial support for this manuscript. The author retains the editorial process, including the discussion, at all times. The views and opinions expressed are those of the authors.

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: MedDots FZC provided medical writing and editorial support for this manuscript; this support was funded by Gilead Sciences, Inc. The authors retained full editorial control over the content and final approval of the manuscript.

Disclamier

The views and recommendations expressed are solely those of the authors and were developed independently of the sponsor. All medical writing activities followed the 2022 Good Publication Practice (GPP 2022) guidelines update.

ORCID iDs

Ahmed A. AlHammadi

Roaa Sultan Alosaimi

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