PrEP in Scotland: what next?

Back to news & events

Thursday 27th April 2017

Following the SMC’s decision to make PrEP available on the NHS in Scotland George Valiotis reflects on the work that made this possible and looks forward to the next steps.

The volunteers and staff of HIV Scotland took a few hours to celebrate the announcement to make PrEP available in Scotland. We want to really celebrate this achievement and the fundamental leadership role HIV Scotland played, but we are also conscious that the decision alone is just a box ticked and that the real work now is to make sure the right people can access PrEP.

The next steps for PrEP are continuing our reach out to community members, and the workforces, to help them understand how PrEP works, how to use it, what it means when they’re on it, and what it means if their sexual partners are on it. For this service delivery work to be successful there remain some important policy drivers that HIV Scotland will continue to address.

Human rights are engrained in everything HIV Scotland does, which is why we’re so effective in what we do. We ensured active participation, maintained accountability, challenged discrimination, and encouraged empowerment.

People must be actively involved in the decisions that affect them. This is why we reached out to hundreds of community members, third sector agencies, and other professionals, and incorporated their comments into our policy work that led to PrEP being approved for use in Scotland. We will continue to do this as we influence the roll out.

We will take an active role in the PrEP Monitoring and Assurance group that has been formed so that we can help ensure the right people get access, that this is done fairly, and that lessons are learnt when things go right or wrong. When we administered the Scottish PrEP expert group we called for monitoring and assurance to be an integral part of the roll out, and we are delighted that this ask has been taken up by Health Protection Scotland. This new group will meet for the first time in May 2017 where HIV Scotland has been asked to present our strategy for effective delivery. We will do this by drawing on all the work we've done to date.

PrEP will benefit a diverse range of people of all genders, ages and sexualities. Most of the research has focussed on gay, bisexual and other men who have sex with men who are a group most affected by HIV in Scotland. We will continue to support research and efforts to make PrEP treatment accessible if needed, and information available to people who have ever identified as transgender.

The use of PrEP by heterosexual people is anticipated to be very small in Scotland. To better understand the interest and needs of heterosexual people in relation to PrEP HIV Scotland is working on a project with an MSc masters student from Queen Margaret University. We are holding four focus groups to inform this work and ensure that the right people are getting the right information about PrEP.

We will continue to bring together community members with service providers and decision makers to ensure that everyone is learning from each other and that the best possible information is out there.

We will also be hosting a Third Sector services provider’s forum on PrEP to enable front-line workers to share experience and to influence the decisions being made for implementation.

Another key task will be to hear from and support people who may not meet the prescription criteria for PrEP, or who choose to only access PrEP independently and therefore may need support to link in to NHS for testing and monitoring.

We encourage all feedback. If people have any questions or concerns we want to hear from you. Please get in touch.

And finally, some words of thanks and recognition of the actors and agencies that together made this outcome possible:

The Board of HIV Scotland sets the organisation in a strategic direction that includes addressing the best use of PrEP, and requires that we involve community as part of all decision-making processes. This direction made it easy for volunteers and staff to apply their expertise to that end.

We were especially impressed with the many doctors, researchers, healthcare workers and activists that stepped forward and did far beyond their call of duty: the Scottish third sector HIV and LGBT organisations (Hwupenyu, Waverley Care, Terrence Higgins Trust, LBGT Health and Wellbeing, Equality Network, The Trans Alliance, and Stonewall), also the National AIDS Trust, Prepster, iWantPrEPnow, the University of Edinburgh, and the University of Glasgow, all the local Scottish NHS Boards, and the Scottish Government.

We must thank the MAC AIDS Trust who funded a lot of our work on PrEP, as did the Scottish Government. And pay tribute to world leaders like the European AIDS Treatment Group for their impressive lobbying of the pharmaceutical industry and the European Medicines Agency; the guidance and leadership of the World Health Organisation; the International AIDS Society, and UNAIDS, the PROUD trial, and all the other countries that provided PrEP first from whom we were able to learn so much.

HIV Scotland looks forward to contributing back to the global HIV movement by sharing our learning and outcomes of having PrEP available on Scotland’s fully subsidised health care system.