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.
Find sites currently open to recruitment.
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.
In July 2019, NHS England announced five steps towards better access to PrEP:
- Chelsea and Westminster NHS Trust has confirmed that they will be making more PrEP places available.
- NHS England has written to London councils asking for confirmation by end August that they will accept a full doubling of PrEP trial places.
- NHS England has also written to councils outside of London to again ask confirmation on whether they will accept full doubling of PrEP trial places by end of July.
- NHS England will recommend removing the capped number of places on the ongoing IMPACT Trial.
- NHS England re-confirmed their commitment to seamless transition from the trial to routine commissioning of PrEP and confirmed that they are exploring routes to funding future PrEP provision.
The steps NHS England has outlined are extremely welcomed. However, there remain serious barriers to getting PrEP to those who need it and still a lot of work to be done.
Working towards a future national PrEP programme
It is a significant step forward that NHS England has committed to ensuring that there is a 'seamless' transition between the PrEP trial and full access to PrEP. Any cliff-edge in access to PrEP once the trial ends in September 2020 must be avoided at all costs. We believe that routine commissioning of PrEP should begin from April 2020 and roll out alongside the PrEP trial if needed.
There is no firm commitment yet on funding for the full roll out of PrEP. We need the Department of Health and Social Care, NHS England and local councils to commit the necessary funding for routine commissioning.
Planning for a national PrEP programme must begin in earnest. It will take time to ensure everything is in place to roll out PrEP. Planning for this must be accelerated.
England has made huge strides in reducing HIV transmissions. With 12 diagnoses of HIV in the UK every day in 2017, PrEP is a critical tool for reducing HIV transmissions. The Government is not going to achieve its 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 and being put at increased risk of HIV. We are calling on the Secretary of State for Health, NHS England and Local Councils to take action over this unacceptable postcode lottery that is access to PrEP.
We will continue to fight for this game-changing drug to be available to all who need it.
There is no excuse for any gay or bisexual man being turned away from being placed on the impact trial. We need routine commissioning to be fully implemented before September 2020!
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.