Pre-Exposure Prophylaxis (PrEP) has been widely accepted as an effective method to prevent HIV infections, but high costs precluded a widespread use in Germany. A novel distribution pathway of tenofovir-disoproxil fumarate and emtricitabine PrEP was implemented, which reduced monthly PrEP costs by 16-fold in Germany. Over a period of 6 months, we recorded prescription data, demographics, and sexual behavior of PrEP users, including self-reported sexually transmitted infections (STIs), alcohol and drug use. Within a month, prescriptions almost doubled from 585 to 1,009 and reached a cumulative number of 6,059 at the end of the 6-month observation period. Extrapolation of the data suggests an estimated maximal number of PrEP users of the order of 10,000. PrEP users demonstrated to be a population of well-educated men (407/686) who have sex with men (629/686), median age 38 (range:18–71), and of German descent (571/686). The majority used PrEP to compensate for risk of HIV infection when having condomless anal intercourse (372/686). At start of PrEP implementation, the majority perceived their own risk to acquire HIV as none to medium (78.6%; n = 539), while only a subset (18.8%; n = 129) considered themselves to be at high or very high risk for HIV infection. In contrast, within the last 6 months, 28.4% of the PrEP users had an STI diagnosis and over 70% had condomless anal intercourse with more than 6 partners. Taken together, our data from PrEP implementation in Germany demonstrate a large uptake once it became affordable in individuals who wish to compensate for HIV risk when having condomless anal intercourse.

中文翻译：

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德国大幅降价后暴露前预防措施的迅速普及凸显了暴露前预防措施可及性的重要性。

暴露前预防 (PrEP) 已被广泛接受为预防 HIV 感染的有效方法，但高昂的成本阻碍了其在德国的广泛使用。实施了富马酸替诺福韦-地索普西和恩曲他滨 PrEP 的新分配途径，这使德国的每月 PrEP 成本降低了 16 倍。在 6 个月的时间里，我们记录了 PrEP 使用者的处方数据、人口统计数据和性行为，包括自我报告的性传播感染 (STI)、酒精和药物使用。一个月内，处方几乎翻了一番，从585张增加到1009张，在6个月的观察期结束时累计达到6059张。数据的推断表明估计最大数量的 PrEP 用户为 10,000。PrEP 用户被证明是一群受过良好教育的男性 (407/686)，与男性发生性关系 (629/686)，中位年龄 38 (范围：18-71)，德国血统 (571/686)。大多数人在无安全套肛交时使用 PrEP 来补偿感染 HIV 的风险 (372/686)。在开始实施 PrEP 时，大多数人认为他们自己感染 HIV 的风险为无到中等（78.6%；n  = 539），而只有一个子集（18.8%；n  = 129）认为自己感染 HIV 的风险很高或非常高。相比之下，在过去 6 个月内，28.4% 的 PrEP 使用者被诊断为性传播感染，超过 70% 的人与超过 6 位伴侣进行了无安全套肛交。总而言之，我们在德国实施 PrEP 的数据表明，一旦在无安全套肛交时希望补偿 HIV 风险的个人负担得起，就会有大量吸收。