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PrEP (pre-exposure prophylaxis)

PrEP means Pre-Exposure Prophylaxis, and it’s the use of anti-HIV medication - taken regularly - to keep HIV negative people from becoming infected. It is not freely available throughout the NHS (as yet), though you can buy it online or get it on private prescription. While the PrEP Impact Trial has increased free access, many say it should be freely available now.

PrEP (Pre-exposure prophylaxis) | National AIDS Trust (NAT)

The evidence

In February 2015, the PROUD study reported that PrEP reduced the risk of HIV infection by 86% for gay men and other men who have sex with men. It measured the effectiveness of daily PrEP for those recruited during the 2-year study. In the UK there is still some concern that widespread use of PrEP could reduce the number of people who are using condoms and therefore increase the number of exposures with people who are not aware of their HIV infection, and who are potentially very infectious.

NHS hope to double capacity of PrEP trial after huge demand for HIV prevention drug | January 2019

NHS England have announced funding to double the size of its PrEP trial, aiming to widen participation by an additional 13,000 patients. The trial expansion will still require approval from a Trial Oversight Board, due to meet later this month. More from the National AIDS Trust here.

First anniversary of the IMPACT Trial  | October 13 2018

October 13 is the first anniversary of the IMPACT Trial – a year down the line and, as we know, many clinics are full and, in spite of an additional 3,000 places, the allocation for gay men and men who have sex with men (MSM) is likely to reach capacity in the spring, well before the trial is due to end. We know that NHS England can now prescribe generic PrEP if there was to be a roll-out of routine commissioning and we know that some people who have been turned away from the trial have acquired HIV very preventably.

PrEP high court ruling | 18 September 2018

The High Court has has overturned Gilead's patent extension on Truvada, the HIV drug also used in PrEP.

Deborah Gold, chief executive of NAT (National AIDS Trust) said: “We welcome this court decision, which overturns the patent extension for Truvada (this is the HIV prevention drug used for PrEP). The decision will mean that unbranded versions of the drug can be legally prescribed. This represents a huge cost saving to buying a drug that would save public money, even at full price. We continue to urge the NHS in England to commission PrEP by April 2019, as the current trial is not reaching everyone at risk, indeed some have acquired HIV after being turned away from clinics whose trial places are full.

“With the generic, unbranded version of the drug available at a fraction of the cost, the pressure increases on NHS England to begin routine commissioning, and make PrEP available to all who need it, urgently.”

PrEP drug patent overturned in UK - NAT respond | 18 Sep 2018

The campaign to get PrEP on the NHS (in a nutshell)

  • Gay men (and many HIV agencies) are campaigning vigorously for PrEP on the NHS
  • The NHS won't pay for it, though you can buy it online (£20-40/ month).
  • The National AIDS Trust launched a judicial review challenging the NHS’ decision
  • On 2 August 2016, the High Court ruled the NHS can fund PrEP
  • The NHS appeals and loses (November 2016)
  • Scotland makes PrEP available on the NHS (April 2017)
  • Wales makes PrEP available on the NHS (April 2017)
  • NHS allocates 10,000 people PrEP in a £10m trial lasting 3 years (August 2017)
  • England PrEP Impact Trial begins (October 2017 for 3 years)
  • Health and Social Care in Northern Ireland have started a PrEP pilot.
  • NHS England have announce funding to double the size of its PrEP trial (Jan 2019)

PrEP Impact Trial

Some clinics in England have agreed to participate in the trial (see link below) which will be updated as sites begin opening to recruitment across the country. Clinics participating in the trial will open to recruitment in a phased approach over a few months. It is not possible to open all sites at the same time and that means that some clinics will open a few months before others. If your local clinic opens slightly later, you will still have the opportunity to join the trial. Different clinics will be ready to start at different times and the rate at which trial sites will open will be dependent on the speed at which clinics can get local approval and put systems in place to train staff and capture trial data.

PrEP Impact Trial | Public Health England/ NHS England
Where you can get PrEP | Map | Forum Link
PrEP trial updates | NHS England

Further information

PrEP (Pre-exposure prophylaxis) | Prepster
PrEP (Pre-exposure prophylaxis) | I Want PrEP Now
PrEP (Pre-exposure prophylaxis) | iBase
PrEP (Pre-exposure prophylaxis) | Gay Men Fighting AIDS (GMFA)
PrEP (Pre-exposure prophylaxis) | Terrence Higgins Trust (THT)
PrEP (Pre-exposure prophylaxis) | National AIDS Trust (NAT)
PrEP (Pre-exposure prophylaxis) | Wikipedia

Some gay and bisexual men see PrEP as a 'social problem'

"Gay and bisexual men have differing attitudes towards men who are using pre-exposure prophylaxis (PrEP), according to US research published in Sociology of Health & Illness. A series of focus groups conducted in New York City showed that some men regarded PrEP users as immoral, irresponsible, naïve and vectors of disease. In contrast, other men saw PrEP as a beneficial new option for preventing the spread of HIV. They had a nuanced view about the effectiveness of condom-based prevention campaigns and the epidemiology of sexually transmitted infections (STIs) among gay and bisexual men."

Some gay and bisexual men see PrEP as a 'social problem' | nam aidsmap | 5 Oct 2018

So, what is the problem with PrEP? Why is there stigma around a pill that, ultimately, prevents HIV infection and can save lives?

"Ultimately, we are a community living in the shadow of a devastating and traumatic chapter in our history (AIDS). With PrEP and undetectable, we are asking people to unlearn everything they ever learned in a climate of fear, infection and death. We are asking people to learn the new science and the new facts, and oftentimes, change or something new can stir deep emotions and reactions. It requires us all to use the basic components of constructive debate, which are respect, compassion and kindness. It will require us to listen and be open to learn. It will be uncomfortable but it needs to happen.”

PrEP: The battle against stigma | GMFA | 2018 FS 168

Do-it-yourself HIV prevention: who do men buying PrEP online get support from?

"Gay men in London who source their own supply of generic pre-exposure prophylaxis (PrEP) drugs, usually from overseas internet pharmacies, most often learnt about this possibility from people in their social network and would like more support from other PrEP users to be available. Nonetheless, clinicians’ endorsement of purchasing PrEP online was important in convincing men of the legitimacy of the practice and men would have much preferred the NHS to actually provide PrEP, according to a study in PLOS ONE."

Do-it-yourself HIV prevention: who do men buying PrEP online get support from? | aids map | 18 Sep 2018


Taking HIV drug PrEP 'doesn't mean you're promiscuous' | BBC | 26 Apr 2019
London Councils to add 4,000 new places to PrEP trial | Pink News | 12 Apr 2019
First year of PrEP in Scotland: more users than expected, few dropouts, few HIV infections | NAM aidsmap | 2 Apr 2019
Sadiq Khan: Cash row is denying Londoners access to HIV ‘wonder drug’ | Evening Standard | 12 Mar 2019
Scotland's introduction of HIV drug PrEP 'puts England to shame' | The Guardian | 27 Feb 2019
PrEP drug uptake 'exceeds predictions' | BBC News | 26 Feb 2019
 Truvada and the truth: is HIV prevention propelling the STI epidemic? | The Guardian | 21 Oct 2018
The HIV-positive man who stopped thousands getting the virus | BBC News | 28 June 2018
PrEP: HIV 'game-changer' to reach NHS in England from September | BBC | 3 Aug 2017
Fall in HIV among gay men could spell end for Britain's epidemic, say experts | The Guardian | 22 Jun 2017
Sex without fear – my experiment with... PrEP | The Guardian | 22 Jun 2017
Buying PrEP online: safer use and NHS monitoring | i-Base and others | June 2016
New (US) research explores the reasons men stop taking PrEP | Avert 28 Mar 2018
Massive drop in London HIV rates may be due to internet drugs | New Scientist | 9 Jan 2017
NHS England has power to fund Prep HIV drug, court decides | BBC 10 Nov 2016
NHS loses court appeal over 'game-changing' HIV drugs | The Guardian | 10 Nov 2016

More about PrEP

PrEP, condoms, STIs and antibiotics

Studies show a significant rise in bacterial STIs in men who are using PrEP that appears to be related to their sexual networks and the level of condom use. Even if PrEP is the game-changer many are hoping it to be, PrEP offers zero protection against other STIs which are on the rise at a time when antibiotics are failing.

Rapid rise in anti-HIV PrEP pills linked to drop in condom use | The Guardian | 6 June 2018
Antibiotics 'may be lost' through overuse, says chief medical officer | BBC | 13 Oct 2017 | 59s

R.I.P. Condoms | Michael Henry | 2 Jan 2019 | 3m 23s

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