PrEP in Belgium: The ARC System bottleneck

PrEP in Belgium is heavily subsidized by the national health insurance system, making it incredibly cheap—usually under €15 for a month's supply. That is the good news. The bad news is the bottleneck: it is only reimbursed if prescribed by a specialist at a designated AIDS Reference Centre (ARC). You cannot get subsidized PrEP from your local GP, which means the system is centralized and occasionally slow.

Who Can Get It

To qualify for reimbursement in Belgium, you must be 18 or older, HIV-negative, and at increased risk. The official criteria include:

• Men who have sex with men (MSM) who have had unprotected anal sex with at least two partners in the last 6 months, had multiple STIs recently, or use psychoactive drugs during sex.
• Sex workers exposed to unprotected sex.
• People who inject drugs and share equipment.
• Partners of HIV-positive individuals who are not virally suppressed.

How to Get It

1. Book an ARC appointment: Find your nearest AIDS Reference Centre. Wait times vary heavily depending on the city—some can see you in weeks, others might have a backlog.
2. The consultation: The specialist will confirm your eligibility and run baseline blood and STI tests.
3. The authorization: If eligible, the doctor files a reimbursement request with your mutuality (health insurance fund). This authorization is usually valid for one year.
4. The pharmacy: You can pick up the medication at a pharmacy. With the authorization, you will pay between €11.90 and €15.00 for a box of 30 pills. If you have preferential insurance status, it can be as low as €7.90.

If You Can't Wait

If you are stuck waiting for an ARC appointment, your options are limited.

• The private GP route: A regular GP can technically write you a prescription, but your mutuality will not reimburse it. You will pay the full commercial price for the drug at the pharmacy, which is significantly more expensive.
• Online ordering: Ordering generic PrEP online from overseas is strictly illegal in Belgium, and packages are routinely seized by customs. It is not a reliable workaround.
• Undocumented or uninsured? Do not assume you cannot get PrEP. Contact an ARC or a local NGO directly—they have social workers who specialize in navigating access for people without standard health coverage.

Test before you start. Never start PrEP without a negative 4th-generation HIV blood test. Starting PrEP with an undetected HIV infection can cause drug-resistant HIV and makes treatment much harder.

What Happens After

Your ARC authorization lasts a year, but you are required to attend follow-up appointments every three months to keep your prescription valid.

• Every 3 months: The ARC will run a full panel: HIV, syphilis, and three-site testing (throat, rectum, genitals) for gonorrhea and chlamydia.
• Kidneys: Your creatinine/eGFR will be checked to ensure the medication isn't affecting your renal function.
• Costs: While the pills are cheap, remember you also have standard copays for the ARC consultations and lab work every three months.

What's Available

• Daily oral PrEP: Standard generic TDF/FTC.
• On-demand (2-1-1): Event-driven dosing is fully supported by Belgian guidelines for MSM.
• Injectable (CAB-LA / Apretude): Availability is highly restricted as of 2026, mostly limited to specific clinical trials or exceptions. Talk to your ARC specialist for the most current local status.