PrEP is a way to reduce a person’s risk of becoming infected with HIV through sex. It involves taking anti-HIV drugs, either daily or around the time of sexual activity.
We want to end HIV transmission in the UK. We believe that this is achievable, but only if we use all of the tools available to us. That includes promotion of condom use, regular testing, effective treatment, PEP (post-exposure prophylaxis), encouraging behaviour change, and PrEP.
The evidence that PrEP works
Clinical trials have shown that PrEP is highly effective at reducing an individual’s HIV risk. There is an increasing body of evidence that it is effective too from a public health perspective, as well as being cost-effective.
The World Health Organisation has recommended that PrEP should be made available immediately for those at greatest risk of sexually acquired HIV, such as gay and bisexual men, trans women, heterosexuals from black African communities, and any HIV negative person with an HIV positive partner who is not on effective treatment.
PrEP in England
In December 2016, NHS England promised a large-scale PrEP trial to take place across the country, looking at the demand for PrEP and how long people stay on it in a real-world setting.
The PrEP Impact Trial launched across England in October 2017 with a total of 10,000 places. Due to soaring demand for the drug, the trial places were increased by an extra 3,000 in September last year. Even so, many trial sites became full quickly and closed to men who have sex with men.
In January of this year, the Secretary of State Matt Hancock committed the UK Government to get to zero new HIV transmissions by 2030, and as part of that he promised to double the number of places on the PrEP Impact Trial. NHS England agreed to fund the cost of PrEP for these extra places.
An estimated 103,800 people were living with HIV in the UK in 2018, with 7,500 of those unaware of their infection. When taken daily, PrEP is highly effective at preventing HIV from sex or injection drug use. Studies have shown that PrEP reduces the risk of getting HIV from sex by about 99% when taken daily.
PrEP works. PrEP saves the NHS money in treatment costs. PrEP will help us end HIV transmissions.
PrEP Impact Trial
We were advised by the PrEP impact trial that over 21,000 people across 154 clinics (as of October 2019) have now received PrEP through the trial, protecting themselves from acquiring HIV as a result.
The trial comes to an end at the end of September 2020.
Routine commissioning of PrEP
PrEP is currently provided in England through the three-year PrEP Impact Trial. Recruitment to the PrEP Impact Trial is currently scheduled to conclude by the end of July 2020, or earlier if all 26,000 places are filled before then.
The Secretary of State for Health and Social Care announced on Sunday March 15 that from April 2020, the drug PrEP will be routinely available in England for the first time – benefitting tens of thousands of people at risk of HIV.
This is a historic announcement in the context of the HIV epidemic. It’s a real moment to stop and celebrate a hard fought victory for PrEP access in England. This announcement comes at the end of years of fighting, campaigning and lobbying to ensure proper access to this game-changer for HIV prevention. We know PrEP is highly effective at stopping HIV and now it can be properly utilised to make good on the Government’s commitment to ending HIV transmissions by 2030
£16 million will be made available in 2020/21 for local authorities to deliver the preventative HIV treatment to the people who need it most. This will ensure anyone who is at a high risk of contracting HIV will receive PrEP from their local sexual health clinic to reduce their risk of getting the virus.
The current British HIV Association (BHIVA) and British Association for Sexual Health and HIV (BASHH) guidelines on use of PrEP, which set out eligibility criteria, will apply to this service.
Eligibility will be decided by clinicians via patient history taking and risk assessment.
Clinicians will need to make pragmatic decisions with patients about future HIV risk, their need for PrEP and individual‐level assessments.
There's still also a lot of work to do to ensure PrEP isn’t just seen as something for gay and bisexual men and that it's clear benefits reach other groups affected by HIV, including women, trans people and BAME communities.
As the country’s leading HIV and sexual health charity, we're fully committed to playing our role to ensure no-one is left behind when it comes to PrEP – because we’re not making real progress if it’s not felt by everyone.
PrEP access in Wales
PrEP is available throughout all sexual health services in Wales as part of an uncapped study that has been running since July 2017.
As of July 2019, more than 1000 people have accessed PrEP, none of whom have subsequently been diagnosed with HIV, demonstrating its effectiveness at preventing transmission.
We remain concerned that a significant proportion (24 per cent) of people who were eligible to receive PrEP declined it. Research into this is underway and we look forward to the findings of this work. As part of the PrEP steering group, we will contribute to action to increase the acceptability of PrEP among all groups in Wales.
PrEP access in Scotland
PrEP is already available in Scotland via local sexual health clinics.
In April 2017, Scotland became the first country in the UK to approve PrEP to all those at risk, and has been prescribing PrEP to those at risk of HIV since July 2017.
We are working with other Scotland-based HIV organisations, including HIV Scotland and Waverley Care, to ensure access to PrEP in Scotland is fair and that all local health boards provide access to PrEP for those who need it.
Unlike in England or Wales, NHS Scotland chose a full roll-out of PrEP without a trial or pilot first. It has also agreed to use generic versions of the drugs to reduce costs. This has been possible due to a relatively smaller predicted demand for PrEP in Scotland compared to England, as well as different funding and legal arrangements in NHS Scotland compared to NHS England.
PrEP access in Northern Ireland
From Autumn 2018, all sexual health clinics in Northern Ireland will be offering an initial PrEP consultation and assessment appointments. Those eligible will then be referred to a centralised service in Belfast. This project will run for 2 years. It is open to anyone in Northern Ireland who meets the eligibility criteria. There is currently no cap on numbers.
If you take PrEP as part of the pilot, you will need to visit a sexual health clinic four times a year for as long as you are taking part. You will also have a first assessment or consultation.