England’s story in providing access to pre-exposure prophylaxis (PrEP) has been battle after battle after battle. Most recently, London councils have not agreed to double places on England’s PrEP trial despite almost half of clinics in the capital being full for gay and bisexual men – and despite London seeing the highest number of new HIV diagnoses in the whole country.
So how did we get here?
Following a high profile court case back in 2016, NHS England conceded it would provide limited access to PrEP via a national trial of 10,000 places. Since the three year trial rolled out in October 2017, uptake among gay and bisexual men has outstripped availability with an additional 3,000 places having to be added within the first 12 months.
This year, following pressure from Terrence Higgins Trust and a coalition of other HIV, sexual health and equalities organisations, we successfully pressured the Health Secretary, Matt Hancock, to commit to doubling places on the trial.
But since this commitment was made at the end of January, a series of meetings have taken place between NHS England and local authorities who are responsible for dispensing PrEP via sexual health services. The latest announcement on PrEP from NHS England has revealed that, while other parts of England would be going ahead and doubling trial places, London councils have currently withheld these additional places, citing financial pressures due to continued public health cuts by central government. We understand the impact of these cuts and are actively campaigning for proper investment in public health.
In our view there is nothing stopping London council’s accepting the full allocation of additional PrEP places now while funding discussions continue. We need to see decisive leadership as failure to act hugely undermines London’s leadership on HIV. This is more than an administrative delay. This is putting the health of gay and bisexual men at risk in London right now. Most of the city’s busiest clinics are turning these men away because they are oversubscribed. These men are not only being unnecessarily put at increased risk of HIV, some of them have contracted HIV.
Like so many of you who have stood with us throughout our years of PrEP activism, I am really frustrated at these continues delays – but I want you to play your part to change this decision.
For context, last year London accounted for 41% of all new HIV diagnoses among gay and bisexual men in the UK, and 36% of all new diagnoses. Every week, 15 gay and bisexual men in London are diagnosed with HIV. London was the first part of the UK to commit to end new HIV diagnoses and is a Fast Track City. Not accepting the doubling of trial places in London not only undermines London’s status as a global leader on HIV prevention, it places gay and bisexual men in the city at a major disadvantage to those elsewhere in England.
Since last week’s news we have written to the leaders of London’s 32 boroughs alongside the National AIDS Trust and Prepster, lobbied London Assembly Members and supported a cross-party letter signed by 15 MPs and Peers to Matt Hancock. We have also written to the four signatories of London’s Fast Track City. The urgency of PrEP in London has long been acknowledged by the UK Government itself. As early as December, Public Health Minister Steve Brine said the Government’s own forecasts suggested the majority of trial places for gay and bisexual men across England would be gone by March 2019 – which is now.
That cliff-edge has now happened and access to PrEP for those men is now quickly drying up. But unlike other parts of England which have made the right decision to double the number of places, London councils have chosen to sit on their hands. We’re told they will make ‘some’ places available – but without specifying a number or timeline for this happening.
We’re quite clear: London needs double the number of places and anything less is unacceptable.
What makes this all worse is how (quite rightly) confused many people are about whether they can or can’t access PrEP. Each day at Terrence Higgins Trust we’ve had many questions, comments and queries from gay and bisexual men across England who are struggling to get access to PrEP.
Local authorities are legally responsible for providing information and services that can help prevent HIV. We are calling on local authorities in London to urgently double the number of places offered to them as part of the trial. Other parts of England have shown decisive leadership on PrEP access, it’s time for London to do the same.
Put simply, every day there is a delay in access to PrEP, more and more gay and bisexual men are put at risk of HIV. This cannot be allowed to continue.
Ian Green is CEO of the Terrence Higgins Trust. For people with no income or on benefits, THT launched the Mags Portman PrEP Access Fund to support those to access PrEP