Q and A

Question

Can I access PrEP in the UK?

Hi, I’m HIV negative but my partner is positive. I am worried about getting infected, but I don’t want to use condoms.

What is the drug that stops you getting infected with HIV and how can I get this? What are the risks and disadvantages?

Answer

The drug you have heard of is called Truvada. This is a pill that contains two HIV drugs – tenofovir and FTC. Both these drugs are widely used as HIV treatment.

Several studies showed that Truvada dramatically reduces the risk of sexual transmission when taken every day by people who are HIV negative.

On the basis of these studies Truvada was approved in July 2012 for use as PrEP in the US. Truvada was approved in Europe for use as PrEP in 2016. However, because it is already licensed as a medicine, it can be prescribed under certain circumstances. PrEP stands for pre-exposure prophylaxis.

Most of the results about effectiveness and safety in gay men come from a large study called iPrEX. The study focused mostly on young gay men who were at high risk of catching HIV. They were generally young, having many partners, rarely discussing HIV or using condoms and who drank a lot of alcohol. They were also given condoms with support on the importance of using them.

In the study overall, the risk of catching HIV was reduced by 40% in people using PrEP compared to the inactive dummy pill that half the participants were given. But many people didn’t take either. When people who actually took PrEP were looked at (compared to those who just said they were taking it) protection increased to over 90%.

So these results looked good, but you also asked about the risks and disadvantages. One is that PrEP is that PrEP is only effective if you take it, so adherence is important. However, so far in all PrEP studies no new transmissions have been reported in people who are actually taking PrEP.

Sid effects are a second issue, but these were not common and mostly were mild. The risk of developing drug resistance in people who still become positive while taking PrEP, is a concern, but again this was not seen in the studies.

Using PrEP also involves routine HIV testing every three months, but this can be a good thing too as you can have tests for other STIs.

PrEP is an important new option. Anyone wanting to use PrEP, should discuss advantages and disadvantages in more detail with a doctor. Although UK surveys show that about 50% of gay men are interested in PrEP, at least 25% are actively against the idea, so it will not be for everyone.

Another concern – certainly in terms of getting PrEP free on the NHS – is cost. For example, the NHS wanted a UK study before approving PrEP.  This study (called PROUD) has already been completed and reported clear benefits of PrEP in October 2014.

The NHS has since been going through a slow review process which ended with the announcement of a new study. During this time there has been increasing use buying generic PrEP online.

See other recent PrEP Q&As for how and where to do this.

If you feel that you are at high risk of getting HIV and for whatever reasons this is likely to continue, this would be a reason to see a doctor at a clinic that has both GUM and HIV services. If you have already used PEP (Post Exposure Prophylaxis) several times and continue to be at risk, this would be important to discuss.

If a doctor in the UK believes there is a medical benefit PrEP can be prescribed based on individual circumstances.

Please follow this link for more information about both PrEP and PEP, including to reports from the studies that led approval in the US.

This answer was updated in December 2016 and January 2016 from a question first posted on 20 August 2012.

7 comments

  1. Simon Collins

    Hi Robert

    Broadly, the asnwer is yes.

    Testing for both HIV and hepatitis B is essential before you take PrEP. The NHS already provide this free.

    A general screening for other STIs is also a good idea – and again this is free.

    The test for kidney function is very very cheap, so most sexual health centres should be able to do this for you if you explain you want to take PrEP.

    However, given PrEP us new and NHS financial pressure are lmiting many services, the respone you get from your csexaul health clinic may be different depending on where you live.

    Simply by asking fro these tests you will be showing the importance for the clinic to offere support to people on PrEP.

    Clinics that have service that are specific to gay men are more likely to give you a positive response.

    Depending on where you life, you might want to try one of these clinics first (ie in London or Brighton).

  2. Robert

    If I were to buy generic Truvada, can I get support services via the NHS?

  3. Robin Jakob

    Hi,

    Unfortunately PrEP is not yet available on the NHS. You may be able to get a private prescription.

    You can find information here:
    http://i-base.info/qa-on-prep-in-the-uk-and-changes-to-the-hiv-proud-study/

  4. Nick

    I’m a gay and prefer to have sex without condom. how can I get prep to take every day?

  5. Jordan

    No. The NHS will not pay for PrEP for anyone at the moment outside of an ongoing trail (for which they are no longer recruiting participants). The trail will confirm efficacy of PrEP and, unfortunately more important to the NHS, determine cost-benefit analysis of offering PrEP to certain population groups (commonly, men who have sex with men, sex workers, HIV negative people in serodiscordant partnerships, IDUs.

  6. Robin Jakob

    The answer to you question depends on what your girlfriend’s viral load is. If it is undetectable, and has been for several months, the risk of HIV being transmitted is dramatically reduced. If she does not have an undetectable viral load the risk increases as her viral load does.

  7. lulu

    My Girlfriend is HIV positive and I am negative. she is on treatment and her is doing very well. we want to have unprotected sex but I am worried, can I catch the virus???

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