It's a scandal that England continues to withhold PrEP.
PrEP is the missing part of HIV prevention: it’s a scandal England continues to withhold it
We have a drug that has been proven to be almost 100% effective at preventing a life-long condition and is taken in the form of a single daily pill. This drug could help to unlock the realisation that we could finally end the HIV epidemic within a generation when used alongside other prevention measures.
Yet, access to this HIV game-changing drug remains a postcode lottery in England.
It has now been one year since the 10,000 place PrEP Impact Trial started enrolling people across England. This was in stark contrast to Scotland where the drug has been routinely available via the NHS and via an uncapped pilot in Wales, both since July 2017. With Northern Ireland also now providing uncapped access to PrEP. The decision to have a capped trial in England followed a legal battle that saw NHS England try to shirk its responsibilities to provide the drug, arguing it was down to local councils to pay for PrEP as part of routine sexual health services.
HIV, sexual health and wider equalities organisations cautiously welcomed the start of the PrEP trial but noted with concern that a trial – and a capped trial at that- was flawed and would never measure real demand and ensure access to PrEP for all who needs it. Less than 10 months into the three year trial, our fears were realised when of the near 9,000 places that had been allocated for gay and bisexual men, several trial sites were having to turn people away due to being completely full. This saw the UK Government include a commitment to extend the trial by 3,000 places as part of the LGBT Action Plan and NHS England take action to make this a reality.
But this temporary solution is not sustainable and it’s now estimated that all places for gay and bisexual men will be filled as soon as January 2019. As things stand this means that no one in this population will be able to access PrEP via the NHS in England for the foreseeable future – potentially until the end of the trial in late 2021. This is a crisis waiting to happen.
This is a crisis waiting to happen.
We know PrEP works. In Wales, there has been no new HIV infections among people accessing PrEP as part of the national PrEP study pilot. It’s also been shown that PrEP provides a unique opportunity to engage people in sexual health services who may have never done so in the past, this is good for diagnosing and treating potential STIs, but also to ensure that people can make informed choices about their sex lives.
And it’s not just gay and bisexual men who are being let down. Trans people who remain a population disproportionally impacted by HIV and could benefit from taking PrEP, yet there have been low number of this community enrolling in the trial. It’s vital there are properly funded community services that inform people about PrEP across the whole country, not just in the larger cities. Otherwise we risk leaving people behind in HIV prevention.
But it does not have to be like this.
The solution is very simple: we need to give PrEP a proper home on the NHS. To get there, two things must happen. The first being an immediate removal of the cap on the trial, there is no reason why this cannot happen and it would remove the artificial scramble that has ensued across clinics. This must also include a commitment to step up funding for community engagement so every one who could benefit from PrEP knows about it.
We need to give PrEP a proper home on the NHS.
Secondly, NHS England and local government must agree to giving PrEP a long-term home on the NHS.
This year will mark the 30th World AIDS Day.It will provide a moment to reflect on those lives who have been lost to the epidemic, but also to step up efforts to end the epidemic once and for all. Without access to PrEP, this challenge risks simply being unachievable.
Until PrEP is given a home on our NHS, Terrence Higgins Trust, alongside other organisations will continue the fight to end this injustice. And that’s exactly why we won’t be celebrating with any cake or balloons on this anniversary but instead wishing the PrEP trial a very unhappy 1st birthday.