Resum
While recent advancements in antiretroviral therapy (ART) continue to improve the
outlook for people living with HIV (PLHIV), new infections remain a concern for health
authorities around the world. A clinically proven intervention holds the potential to dra-
matically reduce new infections: Pre-exposure prophylaxis (PrEP) is a once-daily pill for
high-risk populations, including men who have sex with men (MSM), that substantially
reduces HIV infection risk. However—much like rates of new infection—public provision
of PrEP varies considerably among OECD countries. This case study thus seeks to answer
the question: What might explain the disparate timeline of adopting public reimbursement
for PrEP in Spain and Italy? Through the cases of Italy and Spain, I find that a combination
of institutions, culture, interest group organization, framing, and leadership help us to un-
derstand why Spain approved PrEP reimbursement considerably sooner than Italy.
