What is PrEP?
PrEP stands for Pre-Exposure Prophylaxis. An HIV-negative person takes pills (developed to treat people with HIV) regularly to reduce their risk of HIV infection. Several studies show that PrEP works. PrEP is currently only available in the UK to people enrolled in the PROUD study,[iv] or by private prescription from some sexual health clinics and GPs.

Why do we need PrEP?

  • There are now over 100,000 people living with HIV in the UK. [v] We need to improve HIV prevention. Tens of thousands of HIV transmissions have been prevented by condom use.[vi]  However, many people do not use condoms all of the time and each year there are thousands of new infections
  • PrEP has the potential to prevent new infections among some of those at greatest risk of acquiring HIV.Condom use will remain a core strategy in HIV prevention. PrEP gives people who already find it difficult to consistently use condoms an additional way to protect their health.

Due to the high rate of HIV infections, there is a particular need for the NHS to make PrEP available to gay men. However it should be available to all people who are at high risk of acquiring HIV.

How effective is PrEP?
The PROUD study, which began in 2012, announced its findings on 24 February 2015. The study found that: 

  • PrEP reduced the risk of HIV infection by 86% for gay and other men who have sex with men when delivered in sexual health clinics in England 
  • The researchers concluded that PrEP offers a major opportunity to curb new HIV infections in men who have sex with men in the UK
  • Research suggests that PrEP is as effective as condoms in preventing HIV transmission, as long as the pills are taken regularly, as directed
  • Evidence from another large international study suggests that gay men who maintained at least four doses a week had 96% fewer infections.[vii] [viii].

In light of this news, together with data on continued high rates of new infections[iii], the NHS urgently needs to make PrEP available. 

PrEP does not prevent other sexually transmitted infections or pregnancy. It allows someone to protect their own health, irrespective of whether their partner uses a condom. Because it is taken several hours before sex, it does not rely on decision-making at the time of sex.

Why take HIV treatment to avoid taking HIV treatment?
People living with HIV need to take lifelong treatment. PrEP consists of fewer drugs and people only need to take it during periods when they are at risk of HIV. Many people find that their sexual behaviour changes over time, for example when they begin or end a relationship.

Does PrEP have side-effects?
Any medicine can have side-effects, so taking PrEP is a serious decision. The drugs in PrEP have been used as part of HIV treatment for many years. This has shown that they have a low risk of serious side-effects. Most people taking PrEP don’t report side-effects. Some people have stomach problems, headaches and tiredness during the first month but these usually go away. People taking PrEP have regular check-ups at a clinic.

Does PrEP mean people take more risks?
The PROUD study did not find significant difference in risk behaviour between the control arm of the study (those not on PrEP) and the immediate arm (those prescribed PrEP at the commencement of the study). Other studies of PrEP have consistently reported that being on PrEP did not result in people adopting riskier behaviours. [xii] [xiii]  [xiv] Instead it gives people who already find it difficult to consistently use condoms a way to protect their health.


PrEP Statement

Two European studies of pre-exposure prophylaxis (PrEP), PROUD (1) and IPERGAY (2), reported their results in February 2015. Both studies showed that PrEP was a highly effective method of HIV prevention, reducing new infections by 86%.

Meanwhile, rates of new HIV infections are far too high. (3) The NHS urgently needs to make PrEP available.

An NHS England process to evaluate PrEP is underway, but any decision to provide PrEP will not be implemented until late 2016 at the earliest. This is too long to wait.

We are calling for earlier access to PrEP. The NHS must speed up its evaluation process and make PrEP available as soon as possible. Interim arrangements should be agreed now to provide PrEP to those at the highest risk of acquiring HIV.

We invite other organisations and individuals agreeing with this Statement also to sign up – please visit the PrEP Access website.

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References

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(2) http://www.aidsmap.com/Pre-exposure-prophylaxis-also-stops-86-of-HIV-infections-in-Ipergay-study/page/2947854/
(3) Public Health England. HIV in the United Kingdom: 2014 Report. London: Public Health England. November 2014.

(4) For more information, http://www.proud.mrc.ac.uk
(5) http://www.thelancet.com/journals/laninf/article/PIIS1473-3099%2812%2970341-9/abstract andhttp://journals.plos.org/plosone/article?id=10.1371/journal.pone.0055312
(6) Delpech V. HIV transmission in the UK within Black African communities: how common is it and how do we prevent it? British HIV Association conference, Brighton, April 2015.

(7) Public Health England. HIV in the United Kingdom: 2014 Report. London: Public Health England. November 2014.
(8) Phillips AN et al. Increased HIV Incidence in Men Who Have Sex with Men Despite High Levels of ART-Induced Viral Suppression: Analysis of an Extensively Documented Epidemic. PLOS ONE 8(2): e55312. doi:10.1371/journal.pone.0055312.
(9) http://www.aidsmap.com/Pre-exposure-prophylaxis-PrEP-stops-86-of-HIV-infections-in-PROUD-study/page/2947319/
(10) http://www.aidsmap.com/Pre-exposure-prophylaxis-also-stops-86-of-HIV-infections-in-Ipergay-study/page/2947854/
(11) Baeten JM et al. Antiretroviral Prophylaxis for HIV Prevention in Heterosexual Men and Women. New England Journal of Medicine 367: 399-410, 2012.

(12) Baeten J et al. Near Elimination of HIV Transmission in a Demonstration Project of PrEP and ART. 2015 Conference on Retroviruses and Opportunistic Infections (CROI), Seattle, USA, abstract 24, 2015.
(13) Gilmore H et al. To Take or Not to Take PrEP: Perspectives from Participants Enrolled in the iPrEx Open Label Extension (OLE) in the United States. 9th International Conference on HIV Treatment and Prevention Adherence, Miami, abstract 440, June 2014.
(14) Koester K et al. Sex on PrEP: qualitative findings from the iPrEx Open Label Extension (iPrEx OLE) in the US. 20th International AIDS Conference, Melbourne. Abstract TUAC0102. 2014.
(15) Cambiano V et al. Is pre-exposure prophylaxis for HIV prevention cost-effective in men who have sex with men who engage in condomless sex in the UK? BASHH Spring conference, Glasgow, abstract 01, 2015.
(16) Marcus JL et al. No Evidence of Sexual Risk Compensation in the iPrEx Trial of Daily Oral HIV Preexposure Prophylaxis. PLOS ONE 8: e81997, 2013.
(17) Mugwanya KK et al. Sexual behaviour of heterosexual men and women receiving antiretroviral pre-exposure prophylaxis for HIV prevention: a longitudinal analysis. The Lancet Infectious Diseases 13: 1021–28, 2013.
(18) Grant RM et al. Uptake of pre-exposure prophylaxis, sexual practices, and HIV incidence in men and transgender women who have sex with men: a cohort study. The Lancet Infectious Diseases 14: 820-829, 2014.




For further information on PrEP and the PROUD study:

http://www.aidsmap.com/PrEP/cat/1623/

http://i-base.info/qa-on-prep-in-the-uk-and-changes-to-the-hiv-proud-study/

http://www.proud.mrc.ac.uk