‘Decision to withhold PrEP shows the government and health bodies are contributing to HIV epidemic’

By Chris Godfrey, Assistant Editor

In a judgement as irrational as it is infuriating, NHS England yesterday announced it would be abandoning its decision to make highly effective HIV prevention drugs, otherwise known as ‘PrEP’, available to those most at risk of HIV. In what has become a recurring theme, authorities have once again met the opportunity to tackle rising HIV transmission rates with complacency and disregard.

PrEP, which studies have shown can reduces the user’s chances of HIV infection by 99% when taken daily, has long been deemed by charities, health professionals and activists as one of the most potent weapons for combatting rising HIV rates, particularly within the gay community. Over the last decade the number of gay men newly diagnosed with HIV has risen from 2,423 in 2004 to 3,360 in 2014, with the latter figure representing the highest number since records began. Of the 45,000 gay men living with HIV, 14% are unaware of their infection. The situation shows minimal signs of improvement without intervention from the government and public health bodies.

Over the next two years, 5,000 gay men are expected to be diagnosed with HIV. The NHS response is to provide just 500 gay men with PrEP. Other high risk groups – the trans community and sex workers – have been ignored entirely.

The case for making PrEP available to those most at risk from HIV is overwhelming. There’s extensive clinical evidence and trials proving its efficacy, as well as the fact the drug has shown no safety concerns so far. There’s a compelling financial incentive too, as prescribing PrEP is substantially cheaper than treating HIV (the NHS currently spends 55 times more on treating HIV than preventing it). The drug has also been recommended by the World Health Organisation and has already been approved in the US, Kenya, Israel, Canada and France. In cities like San Francisco it has been widely credited with reducing HIV transmission rates.

Despite the substantial evidence already available, which included an 18-month consultation, NHS England has pulled the plug on any initiative to roll-out PrEP in the near future. It announced its intention to do so in a press release laden with insincerity, one in which it absolved itself of any responsibility for commissioning HIV prevention services, desperately trying to shield itself from blame.

NHS England’s logic-defying decision arrives as a result of it needing to see more “real-world evidence” over the next two years. Rather than accept the wealth of evidence that demonstrates PrEP as the medically sound, cost-effective drug that it is, it has commissioned another trial, offering an arbitrary sum of £2 million of treatment to an arbitrary group of 500 gay men. It would rather passively watch on as it confirms what it already knows than actively address rising HIV transmissions.

Refusing to make PrEP available to those who need it is just the latest short-sighted decision in the ever-growing list of predictable, dangerous decisions made by the current government and its various health bodies. Over the last few years’, key HIV support services have been steadily shut down through cuts to funding, and the budget for HIV prevention has been decimated. Meanwhile, the opportunity to comprehensively educate young people about HIV and other aspects of sexual health has been roundly rejected (again) by the Department of Education’s decision not to introduce statutory sex and relationship education. At best, the government’s attitude towards rising HIV transmission rates is reckless, at worst it’s directly contributing to the problem.

3,360 gay men were diagnosed with HIV in 2014. Over 5,000 gay men are expected to be diagnosed in the next two years. If the situation wasn’t already, it’s fast becoming a public health crisis. Between HIV prevention, HIV treatment, and inclusive sexual health education, the government has the power to drastically reduce this number, to all but halt the epidemic. Instead, it’s failing on all three counts; the government and its health authorities have systematically chosen to address the epidemic with inertia and silence. We’ve been here before.

A petition for the NHS to make PrEP available can be found here.

Words: Chris Godfrey

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