PrEP Finally to Be Fully Available for Free in the UK

After years of wrangling in the courts and in the newspapers in the UK, the Department of Health will soon announce that pre-exposure prophylaxis (PrEP,) the drug that prevents the transmission of HIV with a high degree of efficacy, even during condomless sex, will be made available to everyone who needs/wants it before the end of the year.

Flag series : Full frame image of England flag. Horizontal composition. Photo courtesy iStock

Although PrEP was made available to nearly 20,000 people across the UK at risk of HIV transmission as part of the Impact trial, that trial was hindered by the relatively low number of participants and the lack of facilities for those on the trial to get appointments. The number of distribution sites was increased by 3,000, and then doubled to over 20,000 sites. The effect of this trial has been a reduction of new infections every year since it was implemented. The latest available figures show that new HIV diagnoses dropped 28% to their lowest level in twenty years. The UK has already met the gold standard of HIV management, the “90-90-90” goal, meaning that over 90% of people with the virus have been diagnosed, over 90% are treated with medication and of those, over 90% are fully virally suppressed, or “undetectable”, meaning they cannot pass HIV on. Even before the Impact trial, HIV infection rates in the UK had been reduced by over 30%, thanks in part to supplies of PrEP shipped in from generic providers abroad and sold on a website called run by PrEP activist Greg Owen [A&U, December 2018].

Making PrEP available in the UK has been a huge struggle. Before the start of the Impact trial, NHS England, the national healthcare system announced they would not make PrEP available because HIV prevention was under the purview of local authorities. The National AIDS Trust (NAT) took NHS England to the High Court, arguing that it is NHS England’s responsibility as it is effectively a treatment. The High Court ruled in NAT’s favor. NHS England appealed to the Court of Appeal and lost, allowing the Impact trial to proceed. Meanwhile, British newspapers attacked the idea that NHS would provide medicine to prevent HIV transmission. Under the headline “What a Skewed Sense of Values,” The Daily Mail referred to PrEP as a “lifestyle” drug.

PrEP advocates in the UK welcomed the pending news. Will Nutland, co-founder of PrEPster, told BuzzFeed UK, “We applaud that a decision has finally been made about funding PrEP in England. It is right that cash-strapped local authorities that are struggling to maintain levels of services in many areas, including public health, should be finally receiving additional funding to provide their component of a PrEP service.” Marc Thompson, co-founder of PrEPster, added, “In addition, we support calls for robust and proper investment in our creaking sexual health services, including proper investment in clinical services, peer services, and health promotion programmes.”

The Terrence Higgins Trust, the UK’s largest private sector HIV and sexual health services provider, have been fighting for this change. They welcomed it as “a massive moment in the fight against HIV.” They caution on their Instagram account, however, that “roll-out must now happen rapidly so no one is left behind. Like everything that’s been achieved since the start of the HIV epidemic this commitment on uncapped PrEP access has been hard fought for.”

—Reporting by Hank Trout

Hank Trout, Senior Editor, edited Drummer, Malebox, and Folsom magazines in the early 1980s. A long-term survivor of HIV/AIDS (diagnosed in 1989), he is a forty-year resident of San Francisco, where he lives with his husband Rick. Follow him on Twitter @HankTroutWriter.