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?

Why should I pay for that? Your risk, your insurance.

I think in England (since 2013) that Local suthorities are responsible for commissioning local sexual health services, so Prep is a problem as it is yet another thing that has to be funded by already cash strapped councils from their public health budget. Many sexual health services are being cut and clinics closed so the roll out for Prep isn't happening as quickly as had been hoped.

Is the drug effective for everyone? Just wondering, because if not could it not lead to complacency and undo all the brilliant awareness raising work done by the THT and similar organisations?

Just wondering, because if not could it not lead to complacency

I think the research overwhelmingly supports the conclusion that availability of PrEP doesn’t significantly impact numbers of people engaging in unsafe sex and that people who do will do so regardless - hence the justification for providing PrEP on the NHS.

I think the view of “if you want to take the risk I shouldn’t have to pay for it” is a slippery slope to reducing access to contraceptives, abortions and all kinds of medical care which we provide to treat or prevent the outcomes of so-called “self inflicted health issues.”

Thanks Comtesse. I think the drug should be available, but just wondered if that was why it wasn't everywhere. I agree with you, the slippery slope argument is bullshitt and dangerous.

There was a really interesting documentary about this last year - I think on BBC. May be available on iplayer?

The logical part of me says it should be available as it is much cheaper than treatment. But there is concern that it being available will just increase the prevalence of other extrenely harmful STDs like syphilis.

The BBC documentary seems to no longer be available, but there are a few clips from it here which give a good potted version:

www.bbc.co.uk/programmes/p06bttt6

The costs quoted per year for PrEP in these clips have reduced massively since the generic version of Truvada was approved.

As far as how effective it is - it’s thought to be more effective against HIV than condoms. THT have been very instrumental in pushing for PrEP and facilitating its use as seen in the links above

Lauren, then why does the NHS supply the pill? Surely you can use a condom instead?
Because some people don’t use the pill simply to prevent pregnancies?
Because the pill prevents an actual life being made which is much more costly?

I'd understand the comparison if the pill prevent STD's. You can't compare this with access to contraception and abortion.

Friends of ours, a couple, are in the unfortunate position where one of them has HIV. The other is prescribed PrEP on the NHS and rightly so. I work in an environment where I could suffer a needle prick and have been threatened with used needles. I wouldn't want to constantly take medication just in case, if that happens there are emergency treatments that can be provided within 72 hours.

This is my field. We don't give it to everyone because its not 100% effective, its more like 85/86%. The majority of people living in Britain are at pretty low risk of HIV so the risk:benefit ratio and the cost effectiveness just aren't favourable for a mass role out.

It is worth it though for high risk people, as at the moment it seems like the cost of lifelong HIV treatment is quite a lot more than the intermittent use of PrEP at high risk times in a person's life.

IDontLikeZombies, how does the cost of a full blood transfusion, as has been done, compare with antiretroviral treatment? Just out of interest.

OP, you'd have to state what changes you would like. I can't comment because we have good availability were I am, in Liverpool.

"as at the moment it seems like the cost of lifelong HIV treatment is quite a lot more than the intermittent use of PrEP at high risk times in a person's life."

What are the high risk times? Is that for Partners whose HIV partner carries the virus in their genitals?

The figure I saw was £185,000 for a lifetime of treatment for a man who caught HIV in his 30s (I think, I don't have the figures with me).
I don't have any idea how much the chemo/blood tranfusion was. I am watching that with interest.
What complicates the whole matter if we're only counting cost effectiveness as a marker of success is that people on HIV treatment who conform to a couple of fairly easily hit criteria can't pass the virus to anyone else so the £185,000 acts as prevention as well as treatment. However, can you imagine how amazing it would be to be able to cure someone, to free them from a lifetime of stigma and worry? From a human perspective, worth way more than £185,000. I'm actually very glad I'm just a pleb and don't have to make any of these choices.

Birds - high risk times in people's lives would be the times, when for whatever reason, they are having sex that would put them at higher risk of HIV. It tends to fluctuate, people who are happy, in good relationships, have good self esteem, etc tend to be a bit less risky while the opposite can be said for folk who are having a more difficult time.

It is available on the NHS and we do supply it to those who meet the criteria

@Birdsgottafly I’m not sure of the connection between a full blood transfusion vs ART. If you mean the Berlin patient who was effectively cured of HIV, this was done via a stem cell transplanyt (the donor having a gene resistant to HIV infection) to try to cure him of leukaemia and effectively wiped out his immune system which also had the knock on effect of ridding him of HIV too. It is a very risky procedure with potentially fatal consequences so not for “wholesale use”. Very recently there have been 2 others (also with cancer) who have possibly also been cured. So great to hear and will hopefully help in cure research.

Re high risk people and genitals - HIV does not confine itself to one area. It is carried all over the body, in blood, lymph nodes, organs etc. However when on ART and taking it every day, the viral load is supressed and so low, that the person is unable to pass it on to anyone. In this situation even PrEP is not needed, even without condoms. There are many couples, one HIV+ and the other not, who have sex without condoms with no risk.

As for the cost - the increased used of generics is bringing the price down a lot. If anyone can buy PrEP via the THT link for £19 pm, ie £228 pa, then allow for the NHS buying power to be able to get it cheaper. Also, while women need to take it daily, men do not and can take it “on demand” so possibly even cheaper.

You do realise that NHS is so strapped for cash that children cannot access immediate MH professional support unless they are on their umpteenth suicide attempt or in a state of absolute psychosis?

Now tell me why prep should
take priority?

There seems to be a bit of confusion on what/who is termed as high risk. These are:

Men who have sex with men (MSM);
Trans men and trans women;
HIV-negative partners of individuals diagnosed with HIV who are not known to be virally suppressed;
Heterosexual people who are considered to be at high risk of HIV acquisition.

The last could be, for example, sex workers, those from somewhere with High HIV prevalence like sub Saharan Africa, those in abusive relationships etc.

There is more to it, such as MSM in monogamous relationships would have no need of it, but this is a tough idea of people considered eligible.

I’m in no way saying that it should take priority. It is for the NHS to decide that. I’m just explaining how it works.

Plus my DD also used MH services when younger and had to wait

My brother is on PrEP in Australia, I think it's under our pharmaceutical benefits scheme so the price is capped.
However he is a gay sex worker who uses intravenous drugs, so he is definitely high risk.

On one hand, I wish he'd get his act together, get out of the sex industry, get a job that he can be proud of, as there's only so long he can be a sex worker before he will be too old.
On the other hand, I'd hate to see him die young from HIV.
But he is an idiot for living the lifestyle he does, he puts himself at risk every time he sees a client.
He's an idiot, but he's my idiot and something that buys him more time is good.

I do think PrEP should be given to couples where one of the partners is HIV+. Perhaps also to health workers/emergency service personnel as there is a risk (tiny I know but still a risk) of getting HIV through their work e.g. accidental stick injury, being bitten etc.
What sits uncomfortably with me is giving it to those people who constantly engage in very risky behaviour like chem sex groups & won't wear protection, because they feel they have the right not to.
However in *

Posted before I finished:
However I know I would feel exactly the same as PRoseLegend if her brother was my sibling. (I do hope your brother will be okay, drug addiction makes you do crazy things & is a horrible thing to have to live with.)
It's just hard when the NHS has a finite amount of money & other services such as mental health/oncology plus others are suffering cuts.
Finally free contraception benefits everyone.

HIV/AIDS research and care was effectively ignored in the 80s, the introduction of prep should have our support IMO. There continues to be so much misinformation going around even now.