PrEP ruling welcomed

Last week, the Court of Appeal in London upheld the High Court’s judgement that there is no legal impediment to NHS England funding PrEP as a means of HIV prevention. Here, our Chief Executive, Grant Sugden, comments on the outcome:

Last week’s Court of Appeal ruling on PrEP could prove to be a significant moment in the fight against HIV.

For a second time, judges found in favour of the National AIDS Trust to confirm that NHS England can legally fund the HIV prevention method. While the decision doesn’t directly affect Scotland, it undoubtedly influences the debate north of the border.

PrEP (or Pre-Exposure Prophylaxis to give it its full name) involves the use of HIV drugs by those without the virus as a means of preventing infection. In recent years, a number of high profile studies (referenced here) have demonstrated the effectiveness of PrEP, not only for gay men but for heterosexual couples too.

Put simply, last week’s ruling means that PrEP can be considered for funding by NHS England, in the same way it does for any other drug.  Not that you’d think that from the reaction in some quarters of the media. ‘Sick children to miss out after ruling on HIV drugs’ shouted the Times. 56 Dean Street, the London-based NHS Sexual Health clinic, rightly described the reporting as shameful, questioning whether the paper would run an article under the headline ‘Pensioner flu vaccine robs funding from sick children’. Here and elsewhere, the reporting has demonstrated that the homophobia more readily associated with the 1980s is alive and well, and that HIV stigma remains a significant challenge.

I do not envy the decision makers in the NHS who have to weigh up the merits of funding some medications over others. Behind every drug are individual stories of lives potentially improved beyond measure, and some will always miss out. The decision is not about pitting one set of patients against another, it’s about considering each drug on its merits and deciding how to allocate finite funding to where it will have the greatest impact. All we ask is that PrEP is afforded the same scrutiny as any other drug. Unsurprisingly, as the Chief Executive of an HIV charity, I believe it makes a compelling case.

For the past 30 years, HIV prevention has revolved around promoting condom use. This has stopped thousands of infections but, in recent years, progress on bringing down the number of new infections has stalled. There are lots of reasons why some people don’t use condoms. The communities who are most at-risk of HIV are not in that position through recklessness. It is through a complex web of inequalities that lead people to make choices that can negatively impact on their health. PrEP has the potential to add to the range of responses to HIV prevention, an alternative that can overcome some of the barriers people face and begin to move us towards a time when new HIV infections are a thing of the past. There is, of course, a cost associated with this, but it compares favourably to the lifelong cost of HIV treatment.

Waverley Care, along with our gay and bisexual men’s project, SX,  is working closely with partners to make a strong, community-focused and evidence based case for funding PrEP in Scotland for those most at risk of HIV. If you’re interested in finding our more , you can join SX, HIV Scotland and Terrence Higgins Trust Scotland for a community discussion in Edinburgh on 8 December. Events are also taking place in Glasgow, Dundee, Aberdeen and online.

The term ‘game changer’ is often overused but, in the case of PrEP, it is wholly appropriate. We know that PrEP works and, by working with communities who are most affected, we now have an opportunity to make a lasting difference in the fight against HIV in Scotland.