The Saving Lives charity reaffirms its support for greater access to PrEP to those most at risk to help prevent HIV infections.
This morning BBC Radio 4’s Today Programme aired a piece on PrEP in England. The broadcast featured our Medical Director, Steve Taylor. You can listen again here. In the following piece Saving Lives would like to reaffirm its support for greater access to PrEP for those who most need it.
The evidence is clear. Pre-Exposure Prophylaxis, or PrEP for short, prevents HIV. Numerous studies the world over have shown reductions in risk of HIV infection by around 90% – including the PROUD study here in the UK.
So whilst countries like Scotland, France; Norway; Peru and this week New Zealand; are offering PrEP for free why is England lagging behind? Two words: Money, and Stigma.
Looking at the money problems first – whilst England is rolling out a PrEP trial, called IMPACT, it is limited to 10,000 places and the London centres are already fully subscribed. Other centres outside London are yet to start enrolling – months later. Based on even the most conservative estimates, however, 10,000 places is nowhere near enough. So what’s holding back a full rollout?
One of the main problems is the pricing of the drugs used for PrEP – tenofovir disoproxil fumarate (TDF) and emtricitabine (FTC) – commercially marketed as Truvada by Gilead Sciences. However, when Truvada comes off patent and is available in generic form it is expected to cost the NHS up to 90% less than what it is currently paying. Indeed a generic formulation, by Mylan, is being used for the IMPACT trial.
‘One of the reasons why there has been so much debate about the introduction of PrEP in this country is almost certainly the unesssasarily high cost of drugs used. If these were cheaper I am sure PrEP would have been rolled out sooner. There surely must be a case for differential pricing for drugs used as prevention rather than treatment’
The financial other concern is the wrap around services for PrEP users. As with any potent medication people taking PrEP need regular monitoring – this means clinic time, this means laboratory tests. At at time when our sexual health services are being defunded to a dangerous level could this be too much for them to bear?
When it comes to social attitudes many of the barriers proponents of PrEP are coming up against are the same that women campaigning for the contraceptive pill heard in the 1960s.
The combination of misinformation about PrEP, the most affected populations, and the slut-shaming that goes with it is counterproductive to good sexual and mental health – both on a personal health and a public health level.
‘It is not our position to moralise on what consenting adults do in their own sex lives, but any civilised society should provide educational information, and the tools to, keep themselves healthy, safe and free from infection.’
The data shows us that for every 11 people prescribed PrEP, often just for a few months at a time during a period of need, we can prevent one HIV infection. The cost of treating that person for life far outweights the cost of those 11 people on PrEP.
That’s before we get to those who fall outside the stereotypical image of a “PrEP user”.
In many parts of the world women and men are find themselves in positions where they maybe unable to negotiate condom use both within, and outside of, relationships. For these individuals the ability to have a method to protect themselves which is within their control, not their sexual partners, is of vital importance.
‘As a charity we fully support evidenced based approaches to prevention, which include condom-use, Treatment as Prevention (TAsP or U=U) and PrEP. The Proud and IPERGAY studies have demonstrated clear benefit in high-risk MSM (men who have sex with men) and other studies, such as Partners in Kenya, have demonstrated benefit in Women.’
The message is clear: PrEP must be a part of our HIV prevention toolkit. Only once we learn to use all the tools at our disposal – condoms; treatment as prevention; and PrEP – will be be able to finally start reducing new HIV infections across all population groups.
But this means commitments.
It means commitments from NHS England to fund and prescribe PrEP on per-person basis, taking into account the individual risks each person faces. It means commitments from our government to properly fund our sexual health services. It means commitments from sexual health professionals to consider all possible options to give each person the best chance at enjoying good sexual health. Working together we can reduce new HIV infections.
Please consider signing our petition calling for greater funding for our sexual health services: you.38degrees.org.uk/petitions/save-our-sexual-health-services-1
For more information on the IMPACT trial: www.prepimpacttrial.org.uk
For more information on PrEP check out: www.iwantprepnow.co.uk
For more information on Saving Lives UK please visit our about us page: www.savinglivesuk.com/about-us