A study by Public Health England has discovered that nearly a quarter of gay men seeking preventative anti-HIV drug PrEP (Pre-Exposure Prophylaxis) cannot access it and that the situation for men outside London is significantly worse.
PrEP drug Truvada has been available on the NHS in England since last year as part of the IMPACT trial. However, a study conducted with PrEP access groups PrEPster and IWantPrEPNow found that of 1,711 gay men in England who wanted to access the drug, just under 25 percent found they were unable to.
Of the men surveyed, 393 attempted to access PrEP since January 2016 but had been unable to.
PrEP is available to privately buy online or through the NHS IMPACT trial, which has broadened usage since its introduction in 2017, after an extended battle to get the NHS to approve PrEP provision.
Of the men who had failed to access PrEP, 72 percent lived outside London – with only half of overall survey respondents living outside the capital, this means that men outside London are 40 percent less likely to be able to access PrEP, especially anyone living in the north of England.
Places on the IMPACT trial are limited and it seems provision in some NHS trusts is insufficient, with one survey respondent reporting: “I wanted to get PrEP to try and protect myself and not be…anxious about having gay sex anymore. I rang the only place that is/was doing the PrEP trial but was told there were no more places on the trial…”
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This continues the ‘postcode lottery’ approach to PrEP provision where the drug is available directly on the NHS in Scotland, on trial in England and at a limited number of sexual health clinics in Wales, while Northern Ireland has no NHS provision for PrEP.
That the chances of accessing PrEP on the NHS even in England are so unbalanced is extremely disappointing but unsurprising, according to PrEPster’s Marc Thompson.
“It’s unsurprising that PrEP access is so geographically unequal. We need more targeted health promotion activity and advocacy in parts of the country where it’s hardest to access PrEP,” said Thompson.
The PrEP IMPACT trial is recruiting 10,000 participants, via 151 currently-enrolled clinics across England.
Of those, 14 are currently listed as ‘closed to recruitment’ for gay or bisexual men, the vast majority of which (11) are in London. However, provision in general across the UK wildly varies with 26 participating clinics in London and only 13 across the North East.
Alongside HIV prevention, PrEP usage was shown by the study to improve men’s satisfaction with their sex life.
Under 10 percent of respondents who had not been able to access the drug were happy with their sex lives, whereas 28 percent of those who were able to access it are.
Will Nutland of PrEPster said that this showed the broader impact of PrEP access, beyond immediate HIV risk reduction.
“This data confirms what we’ve been hearing directly from PrEP users: PrEP has a bigger benefit than just preventing HIV. PrEP facilitates better sex, and is reducing fear, anxiety and stress,” he said.