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 access 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 and has been rolled out across England. 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.
The trial will help at least 10,000 people dramatically reduce their risk of HIV. However, demand for the trial is extremely high and likely to exceed the places on the trial – we know that there are more than 10,000 people in England at risk of HIV.
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 - download this below.
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 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 March 2017, the All Wales Medicines Strategy Group (AWMSG) reported that it did not believe that PrEP was cost-effective and as such recommended against the use of PrEP on the NHS in Wales.
However, a month later the Cabinet Secretary for Health, Well-being and Sport announced a study to look at how best to provide PrEP to reduce risks of HIV transmission in Wales and answer some of the questions raised by the AWMSG around incidence rates.
The three-year study started in July 2017 and is open to all Welsh residents for whom PrEP is clinically appropriate. Unlike in England, there is no cap on the number of people who will have access to PrEP, so anyone at increased risk of HIV and who wants to should be able to.
A Welsh Government steering group, of which Terrence Higgins Trust is a member, has been established to oversee the pilot.
Our next steps in Wales are to monitor progress via the steering group, and potentially support promotion activity to ensure that all groups who could benefit from PrEP know about the study and 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.