33 Pre-exposure prophylaxis in the UK: Identity, stigma and activism
33 Pre-exposure prophylaxis in the UK: Identity, stigma and activism
Rusi Jaspal, De Montfort University
Human Immunodeficiency Virus (HIV), which is the cause of Acquired Immune Deficiency Syndrome (AIDS), remains a major public health concern some 35 years after its first clinical observations. According to the Public Health England HIV Situation Report in 2015, approximately 43% of the 103700 individuals living with HIV in the UK are MSM, while 57% of the 5850 new HIV diagnoses (through sexual exposure) were within this demographic group. In London, it is estimated that 1 in 11 MSM is living with HIV. These epidemiological data suggest that existing HIV prevention methods, such as condom use, have not been entirely effective and that novel approaches are needed in the fight against HIV/AIDS.
This has led to discussions about the feasibility of pre-exposure prophylaxis (PrEP), which is a novel bio-medical approach for preventing HIV infection. The drug Truvada® (which consists of two nucleoside reverse transcriptase inhibitors, emtricitabine and tenofovir disoproxil fumarate) is currently used as PrEP in the US and was used in clinical trials in the UK. PrEP works by blocking a key enzyme that enables HIV to replicate once it has entered a human CD4 t-lymphocyte. As HIV is unable to replicate, infection cannot occur. Various clinical trials in several populations suggest that PrEP is highly effective. Data from the UK PROUD study, for instance, indicated an 86% reduction in HIV infection among individuals in the experimental group taking Truvada. Truvada as PrEP can be taken either on a daily basis or “on-demand” (that is, before and after a possible exposure) in order to prevent HIV infection.
While PrEP has been available in the US since 2012, there is only limited access to PrEP in the UK. Following the promising data yielded in the UK PROUD study, NHS England began an economics evaluation in order to explore the cost effectiveness of offering the prevention tool on the National Health Service (NHS). In March 2016, NHS England decided not to commission PrEP, arguing that commissioning HIV prevention services is the responsibility of local authorities. In response to this decision, supporters of PrEP launched a petition calling for PrEP to be made available on the NHS. On the basis of robust scientific data, PrEP activists argue that the provision of PrEP would prevent thousands of new HIV infections among MSM, that is, it would reduce HIV incidence. Furthermore, despite concerns about the cost of funding PrEP, HIV prevention using PrEP is significantly less costly than life-long HIV treatment using ART. In view of these arguments and growing activism in favour of making PrEP available on the NHS, it is possible that NHS England will once again consider offering PrEP on the NHS.
As PrEP is currently unavailable on the NHS, it can only be obtained privately. The only sexual health clinic to provide access to PrEP is 56 Dean St (an NHS sexual