The journey to making the HIV prevention drug, Pre-Exposure Prophylaxis (PrEP) routinely available on the NHS in England has been a fraught one, from blatant homophobia in parts of the media, to being subject to legal proceedings. But this battle is still not over, as capped access to PrEP remains. This cannot continue. Today marks the one-year anniversary since the start of the three-year PrEP Impact Trial in England. Despite the clear need for PrEP to be made fully available to everyone who could benefit from it, the decision was made to cap the trial at 10,000 places in England. From the start, we at Terrence Higgins Trust have been unequivocal in our belief that a capped trial would never ensure that everyone who needed PrEP could access it and the only answer was giving this method of HIV prevention a long-term home on the NHS. Less than 10 months into the three-year trial, our fears were realised, when of the near 9,000 places that had been allocated for gay and bisexual men, several trial sites were having to turn people away due to being completely full. We know PrEP works. In Wales, there have been no new HIV infections among people accessing it as part of the national study. This saw the UK Government include a commitment to extend the trial by 3,000 places as part of the LGBT Action Plan, and NHS England take action to make this a reality. Those additional places have now been distributed, but a number of clinics are either filling up quickly or not providing immediate access to PrEP by placing people on lengthy waiting lists. We now face the crisis situation of the trial being full for gay and bisexual men – likely as soon as January 2019. This means that as things stand, no one in this population – which still accounts for more than 50% of new HIV infections – will be able to access PrEP on the NHS, potentially until the end of the trial in late 2021. While England dithers, the other UK nations have accelerated ahead with rolling out PrEP. Scotland made it available via the NHS in July 2017, and both Wales and Northern Ireland have uncapped access. This means the part of the UK which accounts for the highest rates of HIV infections is withholding a drug that could help to put an end to this epidemic. We know PrEP works. In Wales, there have been no new HIV infections among people accessing it as part of the national study. It’s also been shown that PrEP provides a unique opportunity to engage people, who may have never done so in the past, in sexual health services. This is good for diagnosing and treating potential sexually transmitted infections and also ensures people can make informed choices about their sexual health. We currently have a situation in England whereby our NHS is perpetuating health inequalities by leaving people behind in accessing PrEP. And we currently have a situation where by our NHS is perpetuating geographical inequalities with a postcode lottery in where people can access the drug. This is not acceptable. MORE: HEALTH Girl, 4, pictured critically ill in hospital by mum who hasn’t left her bedside Ketogenic diet may help prevent cognitive decline Cheesy chips pizza is a favourite with customers But it doesn’t have to be like this and the solution is very simple: we need to give PrEP a proper home on the NHS. To get there, two things must happen. The first being an immediate removal of the cap on the trial; there is no reason why this cannot happen and it would remove the artificial scramble that has ensued across clinics. The second must be action by NHS England and local government to agree to provide it on the NHS to all who need it, agree a funding solution and create a system that engages all groups who could benefit from PrEP. The battle to get PrEP into the hands of all people who could benefit from it is not yet won, but Terrence Higgins Trust will continue to keep fighting to end this injustice. Until then, we wish the PrEP trial a very unhappy first birthday. A spokeswoman for NHS England tells ‘While it would be wrong to pre-judge the PrEP Impact trial, it is already expanding with the number of places available increasing this year by 3,000 to 13,000. The NHS will look at evidence from the trial to expand prevention services in the most effective way.’ What is the PrEP Impact trial and how does it work? The PrEP trial drug claims to prevent HIV for people at high risk of catching sexually transmitted diseases. It is a single tablet with two components – tenofovir and emtricitabine. The trial was announced in December 2016, will run over three years and will include 10,000 participants in England. In its latest update from June 2018, the PrEp trial has over 7,000 participants across 139 clinics. PrEP has and will be offered to individuals ‘attending participating genitourinary medicine (GUM) clinics, who meet the trial criteria and consent to participate’. The trial has been initiated to address questions which could determine future implementation of the PrEP drug on a larger scale. The trial will focus on participants at particular high risk of getting HIV, including men who have sex with men, trans men and trans women, HIV-negative partners of individuals diagnosed with HIV (who are not known to be virally suppressed) and…….


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