Terrence Higgins Trust, National AIDS Trust and PrEPster have written a joint letter to the Secretary of State for Health & Social Care, Matt Hancock MP urging him to take action to solve the chaotic provision of PrEP (pre-exposure prophylaxis).

It has been five months since Matt Hancock promised to double places on the PrEP trial to a total of 26,000 and this has still not been fully delivered. As a result many trial sites are closed, with gay and bisexual men being put at increased risk of HIV.

We have again requested a meeting with the Secretary of State to fix this current situation and ensure PrEP is put in the hands of those who need it. We cannot afford any more delays. We need PrEP access now!

The text of the letter is below.

Dear Secretary of State,

We are writing to share our concerns regarding the continued failings in access to the HIV prevention intervention PrEP and to request a meeting with you to discuss the situation further. We are disappointed that our previous letter of 14 January on this issue has still not resulted in the requested meeting either with yourself or with another Minister from your Department.

On 30th January 2019 you made the welcome commitment to a doubling of the number of places available on the PrEP Impact Trial to a total of 26,000 places. We also very much welcomed the commitment made by NHS England to fund the drug costs associated with that increase in PrEP places on the trial.

However, the situation since has been chaotic and the commitment to double the number of places has still not been delivered. Even last week we see reference in an official answer to a parliamentary question from your Minister that suggests that the number of places on the trial is 26,000. Yet this is not the reality.

These places have not been made available locally. Looking at the official trial website today suggests that 40 trial sites are currently closed to men who have sex with men (MSM) – both in London and outside the capital. This is nearly a quarter of trial sites. We are also hearing that some trial sites, and all of those in London – including the largest provider of sexual health services in the capital – are not accepting the full allocation of places. London Councils have only agreed to an increase of 60% in trial places. This is simply not good enough. Inequality in access to PrEP has now widened further.

As the person with the duty in law to provide a comprehensive health service in England we urge you to act to overcome the systemic barriers to the joined-up commissioning of the PrEP trial.

This underlines the need for England to move as soon as possible to routine commissioning of PrEP. The limited number of additional trial places will soon be used up in many areas and all recruitment will end in July next year. The trial itself ends in September 2020. Yet we still have no clarity on plans for routine commissioning of PrEP, which really must commence at the latest by April 2020 to ensure the smooth transition to a national programme promised in NHS England’s announcement of 4 December 2016.

All three of our organisations were involved in a Commissioning Planning working group of the Programme Oversight Board but have yet to see the promised final version of the resulting document. Nor have we been given any information on next steps in the planning process. We need urgently to discuss with you plans for PrEP commissioning, how the different commissioning bodies will work together, and funding options. In particular, we wish to talk through the option of a programme resourced in part by section 7a funding.

With 12 diagnoses of HIV in the UK every day in 2017, PrEP is critical for reducing HIV transmission. We are not going to achieve your commitment to end HIV transmissions in England by 2030 without adequate access to PrEP. In the absence of a national PrEP programme people are being turned away from clinics who need PrEP, some as a result acquiring HIV. In the absence of any clarity over future commissioning, those on the trial face uncertainty as to how they can avoid HIV acquisition once the trial ends.

There is now a growing anger in the community at the unacceptable postcode lottery that is access to PrEP. It is Pride month, yet gay and bisexual men across the country are being denied this essential prevention option.

We are seeking an urgent meeting with you to discuss the current unacceptable lack of access to PrEP in England.

We look forward to hearing from you.

Your sincerely

Ian Green, Chief Executive, Terrence Higgins Trust
Deborah Gold, Chief Executive, National AIDS Trust
Will Nutland, Co-Founder, PrEPster