On 2 August the High Court ruled that NHS England had acted unlawfully in removing PrEP, the HIV prevention drug, from its commissioning process in March. There has been a lot of coverage of this ruling, and a lot of misrepresentation of the facts. Behind all the furore are some important points that must not be forgotten:
- Current HIV prevention isn’t working.
- HIV is a major health inequality disproportionately affecting groups in society which face wider prejudice and disadvantage.
- The court ruled that the NHS does have the power to commission PrEP, now it should do just that.
Everyday around 17 people are diagnosed with HIV in the UK. Condom use has been effective at curbing the epidemic, but infection rates are stable and have been for several years.
PrEP is the game-changer. When used properly, PrEP is pretty much 100% effective. When given to those at the highest risk of HIV, it is cost effective and even cost saving.
One in 18 gay and bisexual men is living with HIV in the UK today. For many gay men, HIV has been the cause of anxiety, fear and stigma. PrEP removes much of this and provides, along with condoms, an additional tool in the management of sexual health. The risk of HIV is very real in this community. One man told us ’PrEP gives me choice, it turns worry and trust on its head and gives me the ultimate responsibility.' There are so many people willing to take responsibility for their own health and that of others. This is admirable.
Gay men are not the only group who could benefit from PrEP. While most women in the UK would not think of PrEP as relevant to them, for some the risk of HIV transmission is very real and negotiating condom use is not simple or at all times possible. To have the option to take PrEP would give them back control over this aspect of their health.
In March the NHS scrapped plans to commission PrEP. It did so before public consultation on a policy for it, and before it had gone to the independent committee (CPAG) which decides on how drugs should be prioritised based on effectiveness and cost effectiveness.
The NHS has always stated that it did this because they didn’t have the legal power to commission a prevention intervention. The recent court judgment confirms that they can, but their decision to appeal shows that they still don’t want to commission PrEP. Those who would benefit from it have been further marginalised in the interim. It shouldn’t have taken a Judicial Review for PrEP to get the fair hearing it deserves. Now for the sake of those people who need it, we hope it will.
Kat Smithson is a spokesperson for the National Aids Trust