What is PrEP?

In 2015, the result from the UK’s Proud study demonstrated that pre-exposure prophylaxis is effective at significantly reducing new cases of HIV. PrEP has been available in the United States since May 2012. Since then, France became the first country with a nationally subsidized healthcare system to approve PrEP. Canada, Australia, Kenya, Peru, and South Africa have also all approved PrEP.

As PrEP has been proven effective, is being discussed more and more as a way to prevent the transmission of HIV, it's worth setting out some basic information about what PrEP is, and what the current situation is in Scotland and the UK regarding the use of PrEP.

What is PrEP?

Pre-Exposure Prophylaxis (PrEP) is anti-HIV medication taken by people who are HIV negative to lower their risk of acquiring HIV infection. It usually involves an HIV negative person taking drugs on a daily basis. It most commonly entails the ARV drug Truvada, which is already licensed for use in Scotland for treatment. Recent research suggests that PrEP is as effective as condoms at preventing HIV. PrEP does not protect against any STIs other than HIV and it only protects the person taking PrEP.

What's the situation with PrEP in Scotland?

Despite not being available on the NHS, there is a growing demand for PrEP in Scotland with people already accessing it through various channels. It is available at private clinics, and individuals are also able to purchase the generic version of PrEP online through international websites. Both these methods of access present their own challenges – to purchase PrEP privately is expensive and only available to those who can afford it. Individuals currently purchasing generic drugs to use as PrEP may have little or no guidance on drug regimens or potential side effects, and encounter conflicting or inaccurate information online.
Others at high-risk of HIV infection are asking their healthcare providers for PrEP, yet due to licensing restrictions, they are denied access to it.

People are currently using PrEP in Scotland and accessing it in a range of ways. For example, PrEP is available through private clinics. Individuals are also purchasing generic forms of PrEP from international websites as a more affordable alternative to private prescriptions of PrEP. This presents a significant issue around equality of health care when individuals have to source PrEP themselves. There could be individuals who would stand to benefit from PrEP but do not have the financial resources to access it.

  • The British HIV Association (BHIVA) and British Association for Sexual Health and HIV (BASHH) published a position statement on the use of PrEP in 2016, which stated that: “The evidence gathered in our own epidemic setting for the benefits of PrEP for the individual, for clinical services and for the wider public health, is compelling. Further, it offers an opportunity to engage with those most at risk of HIV, buying time for a sustainable change in behaviour and averting a condition that requires life-long therapy. The HIV incidence observed in PROUD and IPERGAY is unacceptably high, and existing prevention strategies are clearly insufficient. “

Additional resources:

  • You can read our report on PrEP here.
  • You can read a summary of our Public Roundtable discussion on PrEP, here.
  • National AIDS trust won an important legal case with NHS England over the responsibility of PrEP in England. Information about that can be found here.