HIV Pre-Exposure Prophylaxis (PrEP) is a way to reduce a person’s risk of becoming infected with HIV through sex.
Alongside other HIV prevention tools such as condoms and HIV treatment as prevention, PrEP has been a factor in the incredible reductions in HIV cases seen in gay, bisexual men and other men who have sex with men (GBMSM) in the UK.
But awareness of, and uptake of PrEP, is unequal with not all communities equally benefiting. This includes women, heterosexual men and people in Black African communities.
Challenges in accessing PrEP
Since the routine commissioning of PrEP through sexual health services in England, Scotland and Wales, we have regularly heard from people who have struggled to access PrEP.
With this in mind, in 2022 we conducted UK-wide PrEP surveys to gain a clearer picture of access to PrEP. Our research included surveys to community members and service providers in the UK as well as a Freedom of Information request to local authorities in England. Our partners on the research were NAT, Prepster, One Voice Network and Sophia Forum.
The Not PrEPared report revealed two thirds (65%) of people who want PrEP are unable to access it. Over half (57%) of people who could access PrEP had to wait more than 12 weeks for an appointment.
In August 2023, the English HIV and Sexual Health Commissioners Group (EHSHCG) released a report on its PrEP Insight Project [PDF]. It found low PrEP awareness among Black African women, trans communities, and sex workers and recommended increasing awareness in settings already accessible to these populations, such as pharmacies, to increase uptake.
The latest Government data showed that, in Scotland, 7% of those accessing PrEP via sexual health services were heterosexual. In England, of the 4,156 heterosexual women and 4,602 heterosexual men who had PrEP need, that need was only met in 36% and 39% of people in each group.
Government commitment to ensure equitable access to PrEP
In the 2021 HIV Action Plan for England, the Government committed to improving access to PrEP for key population groups most at risk of HIV and in settings outside sexual health services.
To support the effective delivery of the English HIV Action Plan, task and finish subgroups of the HIV Action Plan’s Implementation Steering Group (HIVAP ISG) were created. This included a PrEP Access and Equity task and finish group which was charged with identifying challenges to PrEP access, scale up and equity in England and making recommendations for improving this.
The group met three times between September and December 2022, with secretariat provided by Terrence Higgins Trust. The recommendations of the task and finish group have been presented to the HIVAP ISG and will inform the development of a roadmap to improve PrEP access and equity due to be published by the UK Government by the end of 2023.
In Scotland, PrEP has been a success story in Scotland’s route to zero new transmissions and expanding access is vital. Scotland does not yet have a national HIV Action Plan. The Scottish Government has however committed to an e-PrEP pilot.
It’s time to expand PrEP access beyond sexual and reproductive health services
We're calling for the governments in England and Scotland to fund pilot programmes of PrEP via settings outside of sexual health services in order to improve equity in access.
This should include PrEP in community pharmacies, GP practices, online and in prisons.
Leading HIV charities and pharmaceutical bodies have backed our call
In 2020 we worked with 55 HIV and sexual health charities to highlight the need for equitable access to PrEP, publishing our PrEP4All community statement.
In November 2021, we joined forces with National AIDS Trust (NAT), Prepster, and the National Pharmacy Association to call for the expansion of PrEP access in pharmacies.
This was soon followed by a call from the Royal Pharmaceutical Society for the Government to expand access to PrEP in community pharmacies.