We are wasting our most precious resource in the fight against HIV

PrEP is one of the best tools we have for stopping HIV transmission. Studies have shown that, when taken as prescribed, it reduces the risk of contracting HIV by 99%.

As gay and bisexual men increasingly use PrEP, we have also seen a steep decline in new diagnoses among this population. The effectiveness of PrEP is indisputable. Yet despite its limitless potential, navigating the path to getting this pioneering drug to all who need it has been fraught with challenges.

Last week, the National Aids Trust – along with One Voice Network, Prepster, the Sophia Forum and Terrence Higgins Trust – reported new data showing the significant barriers people face in accessing PrEP. Of more than 1,100 people who had tried to access treatment over a 10-month period in 2021-2022, two-thirds had been unable to do so.

It was in 2016 when we won a case against NHS England which cemented their ability to provide this intervention. We share the deep frustration of those without access to PrEP, that six years later people are resorting to sharing pills with friends or paying privately to access something that should be freely and simply accessible. .

Survey respondents generally reported wait times of 12 weeks for PrEP, while many people were forced to wait even longer, or were turned away due to a lack of appointments. One person we spoke to contracted HIV after trying to access PrEP at their local clinic and being denied. This is totally unacceptable, and I’m afraid this is not an isolated case.

Not only do these barriers put people at additional and unnecessary risk of contracting HIV, but the process of trying and failing to access PrEP can itself be so stressful that almost half (48%) of respondents experienced an impact on their mental health. Many reported changing their sexual behavior, including abstaining from sex – although we know for sure from our 40-year history of fighting HIV that forced abstinence is not a sustainable, effective or humane way to address sexual health issues.

These are just the problems faced by people actively trying to get PrEP. But that’s only part of the story. There are still huge racial and gender disparities in terms of who takes it (the vast majority being white gay and bisexual men) and many are unaware of its benefits or are led to believe they are ineligible.

Not a single local authority we interviewed told us that more than five women were taking PrEP. At a time when heterosexual women represent a growing number of new cases, this represents a major public health failure. While most of the services that participated told us they were trying to reach underserved communities and demographics, it’s clear that more needs to be done.

To keep up to date with all the latest opinions and comments, sign up for our free weekly Voices Dispatches newsletter. click here

None of these problems exist in isolation: they are all the result of an overstretched and underfunded NHS and public health system that will only get worse if further cuts come. Still reeling from the impacts of Covid-19, since research for last week’s report was conducted, the monkeypox outbreak has also hit our sexual health system with already over-capacity services leading the response.

System leadership investment and support could change the trajectory. Currently, PrEP can only be prescribed in sexual health clinics, but it could be safely and effectively administered by general practitioners and community pharmacies if political barriers were removed. This would not only provide sexual health relief to bear the brunt of childbirth, but it could also allow us to reach some of the many people we are currently not reaching because they are not attending sexual health clinics.

This is a small step in making PrEP services visible and acceptable to more people who qualify.

PrEP is currently not delivering the results it could and which we need if we are to meet the government’s goal of ending new transmission by 2030 – for reasons that have nothing to do with pharmacology. We cannot continue to waste such a precious resource.

Deborah Gold is Chief Executive of the National Aids Trust

Leave a Reply

Your email address will not be published. Required fields are marked *