PrEP Down

Following last week’s announcement from the National Health Service that they will not be commissioning the highly-effective HIV pre-exposure prophylaxis medication PrEP, we spoke to three experts on what this decision will mean for the community going forward and what you can do to challenge it.

 


Matthew Hodson

GMFA

I’m shocked, disappointed and saddened that NHS England is ducking any responsibility to provide PrEP. The UK should be leading the way in HIV prevention, but now we are falling behind.

At the recent LGBT reception in Downing Street, the Prime Minister made a commitment to do all that is within his power to speed access to PrEP. Adding PrEP to our HIV prevention armoury could have the power to turn the tide on new HIV infections.

This would have been a great legacy for any Government. But once again, that opportunity has been dismissed. Every year thousands of gay and bisexual men in the UK are diagnosed with HIV.

In many of these cases, if PrEP had been available, infection could have been avoided and the overall bill for HIV treatment and care could be reduced. Currently the UK spends about fifty times more on treatment and care for people living with HIV than it spends on preventing new infections.

Limiting our prevention options, leading to more people becoming infected with HIV, only leads to greater costs down the line. PrEP is not a magic bullet. It isn’t going to prevent all future HIV infections, not least because there are many who won’t want to use it.

However, if we are able to utilise all of the weapons in our prevention armory, which includes PrEP, condom use and work to ensure people with HIV are diagnosed promptly and able to access treatment, we could bring about an end to new infections within a generation.

We’ve seen early indicators of significant success in cities such as San Francisco which have allocated substantial resources towards cutting new HIV infections.

This work combines early initiation of treatment, community-based prevention messages highlighting the ongoing role of condoms in improving sexual health and PrEP. PrEP isn’t for everybody. There are a number of gay men who, by their behaviour, are likely to become HIV-positive in the next year. They are not hard to identify.

They are showing up at GUM clinics on a regular basis with a range of STIs. For these men, PrEP could make the difference between sero-converting, or remaining HIV-negative. That’s the difference between a lifetime of treatment and care costs and a much smaller bill for providing an intervention when they most need it.

HIV and health charities, professional medical associations and gay activists have come together to demand PrEP.  Now is not the time to condemn the choices of others. We should be wary about any divisions within our community being used to delay access to PrEP.

Our fight must be to ensure that those who will clearly benefit from PrEP have access to it, not be against them for needing it.  HIV infection has been a burden on the gay, bisexual and trans communities since the 1980s.

Young gay men have never known a time before HIV. We now have all the tools that we need to bring an end to new infections. We must not waste this opportunity.

 


Yusef Azad

National AIDS Trust

Many readers of QX will know about PrEP, that it is almost 100% effective when used correctly in preventing HIV transmission. Gay men have been waiting and longing for an additional prevention option to add to condom use for years. And now it has arrived. But we can’t have it.

In March this year NHS England suddenly announced their decision to pull PrEP from the decision-making process for the funding and provision of new health policies, only a couple of months before an expected decision in June.

NHS England claimed they had, at the last minute, come to the view they could not lawfully commission PrEP in this way. At NAT we disagreed (they already commission PEP that way ..) and began legal proceedings.

This made NHS England promise to reconsider and we suspended our legal action.  But on 31 March NHS England reconsidered … and came to the same negative conclusion.

No alternative process to commission PrEP has been identified by the Government or the NHS. We are in limbo – the only thing on the table is £2 million over two years for an additional 500 gay men to access PrEP.

This is only a fraction of the gay men at high risk of HIV acquisition who need PrEP. It also ignores the needs of heterosexuals at high risk. We still believe that NHS England have got the law wrong and we are therefore planning legal action.

At the same time we are calling on the Government to bring together all stakeholders round a table to work out how to make PrEP available as soon as possible to all who need it. At the moment we have chaos and confusion, whilst every day a further eight gay men in the UK become HIV positive.

This cannot continue. The Government and the NHS need to prove that they care about gay men’s health and act now to provide PrEP comprehensively and fairly to those at high risk of HIV

NAT is crowdfunding to support the costs of our legal action on PrEP.  To contribute to the fight go to: uk.virginmoneygiving.com/fund/prep

 


Alex Craddock

Co-founder of I Want PrEP Now

The NHS’s decision last week to once again deny their responsibility to provide healthcare to those at risk of HIV is a huge blow to the LGBT, African and HIV communities.

So far PrEP has been delayed from being made available by 2 years, in that time 12,000 people in the UK have acquired HIV whilst transmission rates continue to rise.

PrEP, condoms and anti-retroviral treatment as prevention are all the tools we need to end the HIV pandemic within a generation, but because of government failure around the world, HIV is still devastating millions of people’s lives with no end in sight, our NHS is now a world leader in these failings.

In the USA, PrEP has been available for 4 years now and has shown staggering reductions in transmission rates. The NHS spends less than 2% on HIV prevention compared to what it spends on HIV treatment. If they did the maths and invested more in things like PrEP and HIV education, the bill for treatment would plummet.

Now PrEP looks unlikely to be made available within the next 12-18 months, adding another 6000 – 9000 infections. This is completely unacceptable and the time to fight against this is now.

If you want to do your bit and call on the NHS to make PrEP available, visit www.prepster.info to find out easy ways that you can get involved. If you or someone you know thinks that PrEP might help you, visit www.iwantPrEPnow.co.uk the only place in the UK where you can find out how to get PrEP affordably, without a prescription and before it’s available on the NHS.

 

• What do you think of the NHS decision on PrEP? Let us know on Twitter at @qxmagazine

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