Two European studies of pre-exposure prophylaxis (PrEP), PROUD1 and IPERGAY2, 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.

What is PrEP?

PrEP stands for Pre-Exposure Prophylaxis. It involves a person who doesn’t have HIV taking a pill containing anti-HIV drugs to reduce their risk of HIV infection. Several studies show that PrEP works when taken as directed.

PrEP is currently only available in the UK to people enrolled in the PROUD study4. It has been available in the United States since 2012.

Why do we need PrEP?

There are now around 110,000 people living with HIV in the UK. Both gay men and heterosexuals from black African communities are disproportionately affected by HIV.

  • Almost 6% of gay men are living with HIV. Rates of new infections have not decreased in the last ten years.5
  • Over 5% of black African people living in the UK have HIV. Over half of those diagnosed acquired their infection while living in this country.6
  • Overall, a quarter of people living with HIV don’t know they have the virus.7

We need to improve HIV prevention. PrEP can help us tackle these unacceptable health inequalities.

Condom use has prevented tens of thousands of HIV infections.8 But levels of condom use are not high enough to bring HIV under control. Many people do not use condoms each time they have sex and every year there are thousands of new infections. PrEP could 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.

How effective is PrEP?

Research suggests that PrEP is as effective as condoms in preventing HIV transmission, as long as it is taken as prescribed, without missing doses. Results from PROUD in the UK9 and IPERGAY in France10 both showed that PrEP reduced infections among gay men by 86%. In these studies, there have been no instances of someone who was actually taking PrEP acquiring HIV.

PrEP can also be effective for heterosexual men and women. For example, a study in east Africa found that PrEP reduced infections within couples in which one partner is HIV positive by 75%.11 12

PrEP allows someone to protect their own health, even if their partner refuses to use a condom. Because it is taken before sex, it does not rely on decision-making at the time of sex.

As well as preventing HIV infection, PrEP has additional benefits including reducing stress and anxiety about HIV transmission. It can enhance pleasure and intimacy, and limit sexual dysfunction.13 14

PrEP does not prevent other sexually transmitted infections or pregnancy.

Is PrEP for everyone?

Many people, including those who are able to use other HIV prevention options, won’t need PrEP.

But PrEP should be available to all people who are at high risk of acquiring HIV, whatever their gender or sexuality.

The rate of HIV infection is especially high in some sub-groups of gay men. Among those taking part in the PROUD study, 9% who did not receive PrEP acquired HIV in one year. Cost-effectiveness studies show that PrEP will be affordable if it is provided to people with a significant risk of acquiring HIV.15

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. A minority 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?

If people taking PrEP took more sexual risks, this would normally lead to higher rates of sexually transmitted infections. But in the PROUD study, people taking PrEP had similar rates of sexually transmitted infections as people not taking PrEP.

Other studies of PrEP have consistently reported that being on PrEP did not result in people adopting riskier behaviours.16 17 18 Instead it gives people who already find it difficult to consistently use condoms a way to protect their health.

July 2015

We invite other organisations and individuals agreeing with this Statement also to sign up – please use the form below if you wish to do so.

For further information on PrEP and the PROUD study:

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References

  1. http://www.aidsmap.com/Pre-exposure-prophylaxis-PrEP-stops-86-of-HIV-infections-in-PROUD-study/page/2947319/
  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 and http://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.

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