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 in October 2017 with a total of 10,000 places. More than 200 sexual health clinics are participating in the trial.
A list of trial sites that are open to recruitment can be found here.
Our goal remains to ensure that PrEP is part of routine service provision on the NHS, available for all those individuals at risk of HIV infection with no-one at risk of HIV left behind.
We are therefore monitoring the rollout of the trial to make sure it reaches as many people at risk of HIV infection as possible, and to ensure that it is rolled out speedily across the whole country.
In July 2018, we published a community statement alongside 31 other organisations calling for PrEP to be made routinely available via NHS England from April 2019 - you can download this below.
The trial was increased by 3,000 places to 13,000 from September 2018 following reports of several of England’s sexual health clinics turning people away due to being oversubscribed. We welcomed the increase in places but know this is not a long-term solution and there is a risk places for gay and bisexual men will become full once again.
It's also crucial that there is agreement following the trial on a clear process for routinely commissioning PrEP on the NHS. We are working with the Department of Health and Social Care and other organisations to do this.
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.