PrEP (pre-exposure prophylaxis)
Pre = before
Exposure = coming into contact with HIV
Prophylaxis = treatment to prevent an infection from happening
When someone is exposed to HIV through sex - or injecting drug use - these medicines work to keep the virus from establishing a permanent infection. When taken daily, PrEP is highly effective for preventing HIV. Studies show that PrEP reduces the risk of getting HIV from sex by about 99% when taken daily.
As PrEP only protects against HIV, condoms are important for the protection against other sexually transmitted infections (STIs). Condoms are also an important prevention strategy if PrEP is not taken consistently.
Where to get PrEP
Available to people in England (from September 2017).
PrEP Impact Trial
Available through NHS Scotland (from July 2017).
Three-year pilot though Public Health Wales (July 2017).
PrEPARED in Wales
Two year pilot through sexual health (GUM) services (September 2018).
Sexual Health Northern Ireland
PrEP Access Fund
Fund supports people with no income or in receipt of benefits who do not have access to PrEP on the NHS.
Mags Portman PrEP Access Fund
More about PrEP
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
The evidence for PrEP and more about the PrEP story (which is both long and complicated)
The evidence for PrEP
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.
The campaign to get PrEP on the NHS (in a nutshell)
- Gay men (and many HIV agencies) campaign 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 launches a judicial review challenging the NHS’ decision
- High Court ruled the NHS can fund PrEP Jul 2016)
- 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)
- NHS England recommends uncapped PrEP trial access (Jul 2019)
News, articles and updates
A drug can stop HIV infection – so why isn't it available on the NHS in England? | The Guardian | 16 Feb 2020
Second case of unintended HIV transmission during HIV cure study prompts questions about PrEP provision | 22 Nov 2019 | nam aidsmap
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
NHS England 45 Day PrEP Consultation | 10 Aug 2016
HIV drug row: A very modern dilemma for the NHS | Nick Triggle, BBC | 2 Aug 2016
NHS England: August update on the commissioning and provision of PREP for HIV prevention | 2 Aug 2016
HIV campaigners win NHS drug battle | BBC 2 Aug 2016
Judicial review over HIV Prep drug | BBC News | 13 June 2016
NHS England reconsiders HIV Prep drug decision | BBC | 19 Apr 2016
NHS will now consider putting PrEP back... | NAT | 19 Apr 2016
England’s PrEP policy in disarray after NHS U-turn | NAM Aidsmap | 22 Mar 2016
Row over HIV prevention drug Prep (Funding 500 over 2 years) | BBC | 22 Mar 2016
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
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
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R.I.P. Condoms | Michael Henry | 2 Jan 2019 | 3m 23s