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The UK Government has now made PrEP available for free across England – but many gay and bi men will still struggle to get it.
Pilot projects have found the drug is highly effective in cutting HIV transmission. But the government refused to fund it for years. And now it has announced the funding just days before the scheme is due to start.
The announcement followed months of delays. Experts expected free PrEP to start on 1 April but it should now start from 1 October.
Those delays in making the funding available have undermined clinics readiness for actually making the drug available.
The National Health Service is funding the tablets. But it is up to local authorities to pay for the essential tests before people can start taking it and run outreach work to encourage people to consider PrEP.
With no guarantee if and when the funding would start, some local councils have been reluctant to make preparations. Indeed, some are so distrustful of the Department of Health as a funder that they didn’t want to rely on promises from Health Secretary Matt Hancock.
As a result, people who ask for PrEP at their local sexual health clinic this week may not be able to get it.
GSN understands some authorities are ready – good examples include Bristol and parts, though not all, of London. However other areas, including those with large LGBT+ communities such as Manchester, are apparently less prepared.
While all areas should eventually provide the essential services, it could be a postcode lottery over the coming weeks.
That could mean a further frustrating wait for gay and bi men. Many have already waited for months to get access to PrEP. Some clinics running the ‘trial’ PrEP schemes found themselves massively oversubscribed, creating long waiting lists.
‘Only the beginning’
The PrEP drug can be taken daily or with a special on-demand regimen. It is highly effective at stopping HIV transmission even when people have sex without condoms.
The government’s funding comes after a long campaign by HIV organizations and PrEP activists.
They argued that a combination of PrEP, prompt HIV testing and putting people on effective HIV treatment fast, is proven to slash HIV rates.
People who are HIV positive and on effective HIV treatment have ‘undetectable’ levels of the virus and can’t pass it on. This is called ‘treatment as prevention’, ‘undetectable equals untransmittable’ or ‘u=u’.
National AIDS Trust was instrumental to the campaign to get PrEP free. They took the government to court to challenge their refusal to move forward.
Kat Smithson, director of policy at National AIDS Trust, said:
‘This announcement finally gives all local authorities in England the certainty they need to progress with providing PrEP, uncapped.
‘We will closely monitor the roll out and hold government to account on ensuring fair and full access to this vital drug.
‘Although it’s been a long road to get to this stage, in many ways it’s only the beginning.
‘The potential contribution of PrEP to the goal of ending HIV transmissions by 2030 is yet to be realised. We must now work on addressing inequalities in access with knowledge and use of PrEP much lower in some affected groups than others.’
Should other NHS services offer PrEP
Indeed the ‘trials’ of PrEP has seen some men getting it for free in England. And the pilot projects have proved particularly popular with gay and bi men who rushed to sign up. Meanwhile, others have been buying PrEP online from private suppliers.
However, unleashing the potential of PrEP will mean moving beyond just gay and bi men.
The vast majority of people in the UK currently taking the drug are cisgender men who have sex with other men. But that’s left out other groups who are also vulnerable to HIV.
For example, people of color are more likely to contract HIV. However they are less likely to be on PrEP.
Richard Angell is head of policy and public affairs at sexual health charity Terrence Higgins Trust.
He told GSN that PrEP should be more widely available, rather than just through GUM (sexual health) clinics.
He argues pharmacies, GP surgeries, gender clinics and maternity services should offer the drug.
This would help roll it out to communities who are less likely to go to GUM clinics – including women. Equally, it would make it more available to rural communities as most sexual health clinics are in cities.
Five year funding demand
Moreover, THT, NAT and others are calling on the government to guarantee funding for future years.
The £11.2million only covers the period until March 2021. They want £16million set aside every year for the next five years to give the chance for PrEP to make a real difference to HIV rates.
Typically the government often announces sexual health funding very late, stopping long term planning.
Meanwhile, Angell hopes to ‘see PrEP made rapidly available right across the country’.
He told GSN: ‘They have got to spend this money by the end of March and so if they are not ready by the end of November they may struggle to use the funds, and that would be a public health travesty.’
However, while he admits there may be delays in accessing the drugs, he points out sexual health clinic staff have been just as frustrated about funding as those waiting to get PrEP:
‘When enquiring, be kind to the sexual health staff because it’s not their fault that there’s been delays.’
PrEP in the rest of the UK
Meanwhile Scotland is ahead of the curve. PrEP has been available there since July 2017.
Likewise, Wales is now ending its pilot project to test offering free PrEP. However, unlike in England, the number of people in the project was uncapped. Moreover, the Welsh government has committed to making PrEP routinely available.
In Northern Ireland, provision has been more patchy. A pilot project to provide PrEP started in 2018 and is due to end soon. However experts hope PrEP will soon become routinely available.
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