What is it?
PrEP, or pre-exposure prophylaxis, is HIV medication that is taken by people at-risk of exposure to HIV. In the US it is already available and is marketed as ’Truvada’ ( emtricitabine and tenofovir disoproxil fumarate).
Is it available in the UK?
In the UK it is not currently available, but this is likely to change in the near future. PrEP is currently being trialled here in the UK under the PROUD study, where it has been shown to be highly effective. There is currently an NHS England process underway to evaluate PrEP, although this is unlikely to be implemented until 2017. Given the effectiveness of PrEP in previous and current studies we would suggest that procedures should be brought into force as soon as possible that would allow those most at risk to start taking PrEP while the evaluation is ongoing.
Does it work?
Overall, studies show that PrEP is effective at reducing HIV transmission. Indeed, the UK PROUD study and European IPERGAY studies were so effective that everyone in these studies has been offered PrEP. It was viewed unethical to give placebo as a comparison because of this. While research generally shows high efficacy, this varies between study. A study published in 2012 (as part of the iPrEx trial) showed efficacy rates of 99% when PrEP was taken daily, although this fell to 76% when taken twice per week. This study is one example which demonstrates the importance of adherence to treatment for PrEP to be effective. Although figures for the PROUD study have not yet been published they are also likely to also show a high level of efficacy
Who would take PrEP?
When PrEP is approved in the UK it will be taken by those who are at high risk of seroconverting (becoming HIV positive). This would include three main groups: 1) serodiscordant couples 2) people who are unable to insist on condom use, and 3) other high risk populations such as injecting drug users.
Do we really need PrEP?
PrEP is a vital addition to the toolbox of HIV prevention strategies. It can allow those unable to consistently engage in protected sex to reduce the risk of HIV transmission. It can also be used when needed to match changing sexual behaviour. However, for PrEP to be effective (and especially to encourage adherence) it must be part of a wider HIV prevention strategy focused on behavioural approaches (e.g. counselling and one-to-one work).
In November 2014 a joint statement on PrEP was issued by community organisations working on HIV prevention, including the GMI Partnership organisations (Metro Centre, Positive East and West London Gay Men’s Project). The statement outlines the need for PrEP, gives information on its efficacy and, speaks to commonly highlighted barriers to the introduction of PrEP. Importantly, the statement also demonstrates that there is an emerging consensus amongst sexual health and HIV charities that PrEP is supported across the field. It also represents an attempt to collectively lobby for action, including for the immediate provision of PrEP for most at risk populations.
For more information on PrEP please see the Aidsmap website
To arrange a drop-in, rapid HIV test at a time that is convenient for you please call GMI Partnership on 020 7160 0941.