Two European studies of pre-exposure prophylaxis (PrEP), PROUD1 and IPERGAY2, reported results in February 2015. The two studies of PrEP in gay men and trans women have demonstrated that the availability of PrEP reduced the rate of infection by 86%. This amounts to the highest effectiveness yet seen for PrEP and is superior to most other HIV prevention interventions. Extraordinarily, two separate studies which provided PrEP in very different ways found exactly the same level of effectiveness.
In light of this news, together with data on continued high rates of new infections3, the NHS urgently needs to make PrEP available.
Although an NHS England process to evaluate PrEP is underway, any decision to provide PrEP will probably not be implemented until early 2017, which is too long to wait. We are calling for earlier access to PrEP - sign the statement at www.prepaccess.org.uk.
The NHS must speed up its evaluation process and make PrEP available as soon as possible. Furthermore, we call for interim arrangements to be agreed now for provision of PrEP to those at the highest risk of acquiring HIV.
What is PrEP?
PrEP stands for Pre-Exposure Prophylaxis. It involves a person who doesn’t have HIV taking pills regularly to reduce their risk of HIV infection. Several studies show that PrEP works.
PrEP is currently only available in the UK to people enrolled in the PROUD study4, but has been available in the US since 2012.
Why do we need PrEP?
There are now over 100,000 people living with HIV in the UK.5 We need to improve HIV prevention.
Tens of thousands of HIV transmissions have been prevented by condom use.6 However many people do not use condoms all of the time and each year there are thousands of new infections. PrEP has the potential to prevent new infections among some of those at greatest risk of acquiring HIV.
Condom use will remain a core strategy in HIV prevention. PrEP gives people who already find it difficult to consistently use condoms an additional way to protect their health.
Due to the high rate of HIV infections, there is a particular need for the NHS to make PrEP available to gay and bisexual men. However it should be available to all people who are at high risk of acquiring HIV.
How effective is PrEP?
Research suggests that PrEP is as effective as condoms in preventing HIV transmission, as long as the pills are taken regularly, as directed. Evidence from a large international study suggests that gay men who maintained at least four doses a week had 96% fewer infections.7 8 Results from separate studies of PrEP in the UK and France both show that PrEP substantially reduces infections among gay men by 86%9. PrEP has also proven effective for heterosexual couples in which one partner is HIV positive and not on HIV treatment.10
PrEP does not prevent other sexually transmitted infections or pregnancy. It allows someone to protect their own health, irrespective of whether their partner uses a condom. Because it is taken several hours before sex, it does not rely on decision-making at the time of sex.
Why take HIV treatment to avoid taking HIV treatment?
People living with HIV need to take lifelong treatment. PrEP consists of fewer drugs and people only need to take it during periods when they are at risk of HIV. Many people find that their sexual behaviour changes over time, for example when they begin or end a relationship.
Does PrEP have side-effects?
Any medicine can have side-effects, so taking PrEP is a serious decision. The drugs in PrEP have been used as part of HIV treatment for many years. This has shown that they have a low risk of serious side-effects. Most people taking PrEP don’t report side-effects. Some people have stomach problems, headaches and tiredness during the first month but these usually go away. People taking PrEP have regular check-ups at a clinic.
Does PrEP mean people take more risks?
In the PROUD and IPERGAY studies, participants incorporated PrEP into existing risk reduction strategies, which included condom use. It was found that there was no difference in the number of men diagnosed with other STIs between those on PrEP and those not on PrEP. Other studies of PrEP have consistently reported that being on PrEP did not result in people adopting riskier behaviours.11 12 13 Instead it gives people who already find it difficult to consistently use condoms a way to protect their health.