LGBT Foundation responds to the Government Roadmap for Imporiving PrEP access

Published: February 16, 2024 by mbelfield

PrEP is one of the greatest tools we have in the fight to end new HIV transmissions by 2030, alongside HIV testing, treatment, and U=U. PrEP can work for everybody, regardless of gender identity, sexual orientation, and ethnic background. However, the need for PrEP outweighs availability in the UK.

Currently, prescribing guidelines mean that PrEP is only able to be provided by specialist sexual health clinics. This requirement is an unnecessary barrier for people trying to access PrEP, meaning it is harder to get a prescription. In many areas across the country, strained and underfunded sexual health services are struggling to meet patient demand, including for PrEP provision. In 2022, the Not PrEPared report described long waiting lists for PrEP, and in some cases, people being diagnosed with HIV before getting a PrEP appointment. We also know that in many underserved communities, including trans communities and minoritised ethnic groups, systemic inequalities and barriers to accessing healthcare mean that the requirement to access a specialist sexual health clinic reduces PrEP uptake. 

It is also key that PrEP access is increased for men who have sex with men. While the majority of NHS PrEP prescriptions have been to this group, demand still far outstrips availability. In 2022, 98,565 MSM who needed PrEP attended a sexual health clinic in England, and only 74% received it, leaving 26,108 MSM who could have benefited from PrEP without it. 

It is heartening to see that in the PrEP Roadmap, the Government acknowledge the importance of PrEP and sets out their vision of enhanced PrEP access and uptake in key population groups. LGBT Foundation would like to echo and emphasise the messages within the roadmap, including the need for appropriate funding of sexual health services and PrEP, tackling inequalities in PrEP access, and improving access pathways in specialist and other settings. In particular, we must draw attention to the need for community-based PrEP offers which will mean PrEP is accessible for those who really need it. Manchester’s community-based PrEP initiation sessions at G-A-Y delivered by The Northern Sexual Health and LGBT Foundation are an incredible example of how PrEP can be delivered outside of clinical settings for people who really need it, in an accessible and culturally competent way. Community-based services must become the norm, available in more geographical areas and targeted to key populations. Voluntary sector organisations have a wealth of expertise and understanding of the needs of groups with lower uptake, including cis women, trans people, and minoritised ethnic groups, and they must be part of the future PrEP access landscape, alongside other community healthcare partners including pharmacists and primary care providers. 

LGBT Foundation also believes that new and innovative ways of taking and accessing PrEP are vital if currently underserved groups are to receive equitable access to PrEP in the future. This might include new ways of taking PrEP such as injectable PrEP, or enhanced digital access including app-based and online prescription routes.

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