What is 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.
Is PrEP effective?
Yes, when used as prescribed, PrEP has proven, in clinical trials, to be highly effective at stopping HIV transmission. Two recent trails – IPERGAY in France and Canada, and PROUD in England - examined the potential of PrEP to prevent HIV transmission, with each study focusing on a different type of PrEP regime. Both studies reported an 86% reduction in HIV transmission amongst people using PrEP when compared to those who were not. The PROUD study noted that there were no new cases of HIV diagnosed in individuals taking PrEP (as directed).
Read more about the PROUD study
Read more about the IPERGAY trial
What is the current situation 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.
What are the opportunities and concerns?
In Scotland, PrEP brings new opportunities for HIV prevention for at risk individuals. The World Health Organisation has now recommended offering PrEP as an additional HIV prevention choice for all people at risk of HIV. However, there have been some important debates regarding accessing and using PrEP.
There are questions about who might stand to benefit most from PrEP and how access should be determined. There is uncertainty about how to ensure that PrEP is safely used e.g. ensuring that people take the right dosage and adhere to the regimen
Additionally, there’s concerns that PrEP would be used as a replacement for condoms, changing sexual practices and increase risk taking behaviour. There have also been discussions concerning the human rights implications regarding accessibility. PrEP will present the opportunity for Scotland to ensure that people are better able to enjoy the right to the highest attainable standard of health.
What do we need in Scotland?
PrEP presents Scotland with a major opportunity to reduce rates of new HIV transmissions. Over the last five years, there has been no significant reduction in the transmission of HIV. PrEP provides the opportunity for expanding our existing prevention methods, and creating a comprehensive prevention package that will better be able to meet the needs of the most at risk populations. People are already using PrEP and it is becoming more and more apparent that something must be done now to ensure safe use and equal access to PrEP.
What we need in Scotland:
- PrEP should be made available to high risk MSM and transgender women in areas of high prevalence as a matter of priority, in accordance with existing evidence on cost and clinical effectiveness.
- There is an urgent need for agreement on when ‘off-label’ prescribing might be considered appropriate, and guidance for prescribers and other related health practitioners to support them in this regard.
- The development of consistent public messaging and information about PrEP is a key priority. People must have access to the facts about PrEP so that they can be empowered to make informed choices about their own sexual health and HIV risk reduction strategies.
- It is critical that PrEP is integrated into existing prevention methods to form part of a comprehensive package of HIV prevention methods. PrEP implementation strategies will need to engage with these wider, socially embedded risk reduction practices.