Why is PrEP not available widely on the NHS?

[prapest]

The stuff can prevent catching HIV and all the awful side effects.

It is dropping rapidly in price and so should be widely available on the NHS.
Sure money is tight, but if contraception such as the pill, condoms, implants etc are provided on the NHS, why isn’t PrEP?

It is in Wales.

And Scotland

A couple of my friends have been prescribed this too. On the nhs.

What do you mean by "widely available"? It's hardly side effect free, and the chances of the majority of people contracting HIV are vey very slim.

Typical mumsnet responses, women only.

Local sexual health clinic (in England) supplies of here.

I'm sorry but why should PrEP be available to people who can't be bothered to use condoms when they have sex? The NHS is strapped for cash as it is.

Typical mumsnet responses, women only.

Eh?

Lauren, then why does the NHS supply the pill? Surely you can use a condom instead?

Lauren - maybe prevention is cheaper than treatment?

Because the pill prevents another HUMAN from being made. It benefits the majority.

No I don't think it should be available widespread. When we are struggling to fund vital treatments already. There are cut backs left right and centre. Hard decisions are being made at the moment about what we can and can't deliver and I expect more people are going to be in for a shock in the coming years. It's a sad state of affairs but the NHS has become a victim of its own success and now people expect EVERYTHING but it's just not affordable

Quick internet search shows one brand is $2k per month supply

I work in sexual health. I would say it’s several reasons. One I think is financial. NHS England is quite cautious about commissioning any new services (not the same as Wales and Scotland, though the areas and populations they cover are hugely different). One bit of it is trepidation still I think about what would happen if the broader use of antiretrovirals led to viral resistance. This is unlikely but a truly nightmare scenario. The science of HIV prevention has moved so rapidly in recent years that I think for some it’s still quite scary to think what if we’re doing something wrong, with methods only tested in very short term trials.

The rest is probably political. Imagine the stories in the Daily Fail (and there have already been some) about all these irresponsible people having sex....just like all the other irresponsible people who already have sex every day and get chlamydia or have an unwanted pregnancy. Of course, it doesn’t stop us providing free birth control, rightly so.

That said, more PrEP places are opening up. I think my clinic is getting another 700 or so. So it’s there, just not for everyone just yet (of course, I don’t expect it will ever be just for everyone, you will have to demonstrate need, which is good probably to weed out the low risk health anxiety folks). There is also the private market, though accessible only to some. There was a community based pill testing service (in London only) that would test pills bought privately for quality, which was better than nothing, though obviously still points out the glaring issues with an unregulated private market.

I do think we’ll see big changes soon, if politically the NHS gets a bit of a boost with funds. Magic promises Brexit windfall please?

PrEP is already avaioable to high risk individuals on NHS

I'm not quite sure what it is that you want? Different risk parameters? If so what do you want them to be?

(other than to rapidly turn to misogynist slurs)

The NHS would be in a difficult position. The drugs aren’t cheap. Also the drug only prevents HIV so if lots of people started taking it and having unprotected sex, rates of other diseases such as Hep C and syphalis would shoot up.

I want to know what typical mumsnet responses means.

And they are cutting access to sexual health services btw

Our clinic collects details of those interested so we can contact them when more places appear on the IMPACT trial. All the evidence supports the efficacy of PrEP and I expect it will be rolled out with similar rules to Wales / Scotland in a few years. The problem with the cost going down is that the flip side is the cost of treating HIV is also reduced greatly so doesn’t necessarily make it much more cost effective in lower risk groups.

This thread should be interesting.. Very pleased that it is being discussed on MN, especially in light of the fact that given the right conditions we are all at risk.

More places for the PrEP trial have been approved but are as yet not forthcoming in all areas that need it (London)

And yes PrEP is WAY cheaper than HIV treatment (can provide figures if needed) especially in light of the fact that PrEP can now be given in generic form here which is much much cheaper than Truvada.

.

I do agree that there are other much more easily caught STIs than HIV. I guess the proof will be if rates of these go up as PrEP use increases. On the basis that women can contract too, and it has been proven that risks are higher for some than others, here is some further information...

Details re the PrEP Inpact trial in England: www.prepimpacttrial.org.uk/

If you can’t get a place but qualify and would still like to take it, you can access it here. The cost is £19 pm but you must get checked beforehand and then regularly. There is a good “should I take PrEP” tool. www.iwantprepnow.co.uk/about/

And as above but you can’t afford it, see here www.tht.org.uk/our-services/online-services/mags-portman-prep-access-fund

There is a pilot trial in N Ireland and Wales with no numbers cap, and in Scotland it’s available at all GUM clinics. You can get access if deemed in a high risk category.

LaurenOrdering

Or for NGS workers and the police how have needle stick exposure or some other mishap.

*NHS

@ThePlaceToVent there is PEP for that (bit like the morning after pill but taken for 28 days and started within 72 hrs of the incident. Available from clinics and A&E.

Btw HIV has never been contracted by anyone being stuck by a discarded needle, despite what some scaremongering newspaper articles like to tell us.

@HIVpos

I know