Scotland has become the first part of the UK to approve the use of HIV-preventing drugs.
Pre-Exposure Prophylaxis (PrEP) drug Truvada can drastically reduce people’s chances of being infected with HIV, and is available in a number of countries to at-risk groups including sex workers, gay men, and people in serodiscordant relationships.
Health experts say rolling out PrEP would be cost-effective if it leads to even a small reduction in HIV infections, as the lifetime cost of just one HIV infection can be up to £380,000.
Currently, PrEP is not available on the NHS anywhere in the UK despite growing demand, with people accessing it through private channels.
The Scottish Medicines Consortium today announced that it would approve the provision of PrEP (Pre Exposure Prophylaxis) by the NHS to prevent HIV.
The PrEP4Scotland Coalition (HIV Scotland, Terrence Higgins Trust Scotland, Waverley Care, and NAT (National AIDS Trust) welcomed the announcement by the SMC, which paves the way for PrEP to be made available on the NHS for at-risk groups.
In a statement to PinkNews the coalition said: “We applaud the SMC for taking this bold step to tackling HIV in Scotland. PrEP provides opportunities to reinvigorate how people at higher risk of HIV exposure engage with testing and prevention opportunities, and it is a vital opportunity to make a real reduction in the number of new HIV transmissions.
“All NHS Boards in Scotland need to now follow the SMC’s advice and ensure they’re making PrEP available to those who need it, so that no-one at risk is left behind.”
To get to this stage hundreds of community members across Scotland have contacted coalition members, attended information events, contributed to consultations, appealed to clinics, and spread the word on PrEP. This outcome was only made possible by these collaborations and shows what progress can be made when professionals and the community join together to learn from each other and find solutions.
George Valiotis, CEO of HIV Scotland said: “HIV Scotland welcomes this great decision that we have spent years campaigning for as an essential addition to Scotland’s HIV prevention approach.
“In 2016 HIV Scotland published a PrEP good practice guide, and administered Scotland’s expert group which produced prescribing criteria, cost assessments, and mapped information and training needs of workers and the community.”
Deborah Gold, Chief Executive at NAT, said: “NAT is delighted at the announcement that PrEP will be made available throughout Scotland within a matter of weeks.
“This game-changing prevention tool has the potential to massively reduce HIV rates and turn Scotland into a model internationally of how to do HIV prevention well. The speed and decisiveness of the Scottish process contrasts starkly with delays in the other three UK nations.”
Grant Sugden, Chief Executive of Waverley Care, said: “This is a ground-breaking decision that has the potential to reduce new HIV infections and also improve the quality of life of at-risk communities in Scotland.
“HIV still looms large over the lives of many gay and bisexual men, with damaging consequences for their relationships, and their physical and emotional health. PrEP can play a role in addressing this, helping to rebuild confidence and self-esteem, and allowing men to lead healthier, happier lives.”
Robert McKay, National Director for Terrence Higgins Trust Scotland, said: “Today, Scotland has made history in the fight against the HIV epidemic, becoming the first country in the UK to routinely commission PrEP on the NHS. People at risk of HIV in Scotland will finally have access to this groundbreaking pill that will protect them from HIV.
“It can now be used as a vital tool in our HIV prevention armoury – alongside condom use, regular testing and early treatment – to help bring an end to HIV transmission in Scotland. Not only will this make a life-changing difference to each of these individuals by protecting them from a lifelong and stigmatised condition, but for every person who would have become HIV positive without PrEP, NHS Scotland will save £360,000 in lifetime treatment costs.
“We applaud the Scottish Medicines Consortium for acting on the overwhelming evidence for the clinical effectiveness of PrEP, and taking this trailblazing step to tackling HIV in Scotland.
“It is brilliant to see Scotland leading the way in stopping HIV transmission – but there’s a long way to go before everyone at risk in the UK has access to PrEP.
“NHS Boards in Scotland now need to make sure they heed the expert advice from SMC and make PrEP available to their patients who are identified as at risk of HIV as a matter of urgency.
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“NHS Wales makes its decision on PrEP later this month, and we hope they will follow Scotland’s leadership in preventing HIV.
“Meanwhile a long awaited PrEP trial from NHS England and Public Health England is still yet to materialise. We urgently need answers on when exactly the trial will begin and who will have access to it, and ultimately, assurance that the NHS will retain responsibility for PrEP in England when the trial comes to an end.
“We must not let PrEP become a postcode lottery – it should be available to all those at risk, regardless of where they live.”
Dr Elizabeth Carlin, President of The British Association for Sexual Health and HIV, SAID: “BASHH are delighted at the decision reached today by the SMC to make PrEP available within the NHS in Scotland.
“PrEP has rightly been described as a ‘game changer’ and has been shown to reduce the risk of acquiring HIV infection by 86%. It is cost-effective for those at the highest risk and is one of the best evidence-based tools for reducing onward HIV transmission.
“As a next step we urge that treatment is made available to the people that need it as quickly as possible, both in Scotland and ultimately across the whole United Kingdom.”
The decision comes after a lengthy dispute on the issue in England, where the issue ended up in court.
NHS England had claimed that it was not responsible for commissioning PrEP, pointing to elements of devolved healthcare laws to place the issue on the already-strained budgets of local councils.
However, after a legal challenge from the National AIDS Trust, the High Court ruled that the NHS does have responsibility. The NHS is set to begin a PrEP trial in England over the summer.