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. However, to date (by May 2019) only 67% of trial sites outside of London have agreed to double the number of places, while London has only agreed to 60% extra places.
We are urgently calling on local authorities, both inside and outside of London, to provide the promised doubling of places on the PrEP Trial now.
More than 200 sexual health clinics are participating in the PrEP Impact Trial.
Our goal remains to ensure that PrEP is routinely commissioned, available for all those individuals at risk of HIV infection with no-one at risk of HIV left behind. This needs to happen immediately as the trial is not fit for purpose as supply is constantly being stripped by demand, with people still being exposed to acquiring HIV.
In July 2018, we published a community statement alongside 31 other organisations calling for PrEP to be made routinely commissioned from April 2019 - you can download this below. This has not happened, so we continue to call upon the Secretary of State, NHS England and Local Authorities to work together to achieve the routine commissioning of PrEP in England as soon as possible.
Our Chief Executive, Ian Green, wrote for Huffington Post about the launch of the trial.
PrEP access in Wales
In April 2017, the Cabinet Secretary for Health announced a three-year study to provide PrEP to anyone in Wales who was eligible. Unlike in England, there is no cap on the number of people who can access PrEP.
The study began in July 2017 and to date no-one who has been prescribed PrEP has been diagnosed with HIV, demonstrating its effectiveness at preventing transmission. There are, however, some areas of concern.
First, a significant proportion (28 per cent) of people who were eligible to receive PrEP declined it [PDF]. Further research is needed to understand why and increase the acceptability of PrEP among all groups in Wales.
Second, gaps in demographic data mean we don’t have the full picture of who is – and more importantly who isn’t - accessing PrEP in Wales. These gaps need to be addressed so services and health promotion messages can be evaluated and targeted more effectively.
Third, there is the matter of resources. There are considerable waiting times for PrEP in some areas and some people are having to travel out of area to access PrEP. Sexual health services need to be fully funded to ensure that all who can benefit from the PrEP study have access to it.
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.