Simon reports on treatment news and HIV research. He edits HIV Treatment Bulletin (HTB) and the i-Base treatment guides and co-ordinates the i-Base treatment information services. He has been an advocate for over 15 years.
On Thursday 2 June, health activists led by ACT UP London held a protest in Soho to demonstrate access to PrEP for people at high risk of HIV infection.
The demonstration was loud and active – forming a line from the 56 Dean Street Clinic. Although this is one of the most effective and modern sexual health clinics in the UK, doctors there are still unable to prescribe PrEP, despite having one of the highest rates of new infections.
Afterwards the ACT-UP banner led protesters along Compton Street to increase awareness about PrEP to gay men in the local bars.
In the UK, around 500 people are diagnosed HIV positive every month – very few of whom are even aware PrEP exists. Although PrEP has been available in the US since 2012 where it is widely recommended as part of a strategy to reduce new infections, it is not currently provided by the NHS.
I have long been a strong advocate for PrEP – a daily pill that prevent infection.
The scientific data supporting how effectively PrEP works has been clear for a long time.
As a strategy, PrEP is probably even more effective than condoms, because someone on treatment has protection 24 hours a day. For men, this level of protection is likely to be higher than 95% from taking a pill every other day – ie roughly four pills a week. For women, adherence is likely to be closer to needing daily PrEP – ie 6-7 doses a week.
The need for new interventions in the UK is most clearly demonstrated by annual rates of new HIV diagnoses. The UK has some of the best data on sexual health, and every year for at least the last decade, there have been around 6000 new diagnosis. Numbers might fluctuate a little, but this is broadly a straight line – and this is despite knowing that HIV positive people on treatment are dramatically less infectious.
That is 6,000 people a year, every year. Or 500 people a month or 16 people a week.
PrEP was approved in the US in July 2012 and the NHS still has yet to make it available on prescription.
The UK response was to run a pilot study in just over 500 gay men who remain the highest risk group. This study was not expected to show whether PrEP worked – it was to see whether people would want to take a pill and also whether having this protection might increase their risk by changing their behaviour.
Instead, the PROUD study was able to prove how dramatically PrEP worked. Based on the rates of other STIs, there was no indication than people changed behaviour to taking greater risks.
Most people were actually very concerned and worried about becoming HIV positive.
For many reasons, PrEP is not for everyone. Key to access is that it should be a choice. Equally important, this is an intervention for people who otherwise, this time next year, are at highest risk of testing positive.
However, many people are accessing PrEP though other routes (online, as PEP, from friends) and this i-Base Q&A highlights some of the issues this raises:
Last November, I gave about PrEP to the Glasgow Conference that included showing evidence for PrEP efficacy as early at 1994 – seven years before the main drug in PrEP was even approved as treatment.
I was also involved in the PROUD study as a community advocate, including on the safety monitoring group (DSMB).
All pictures © mikekear.com thanks to ACT-UP London photograher Mike Kear.
- START study reports 18 months early: impact will change guidelines globally
- Methmephangee – ChemSex vs recreational drug use
- NHS PrEP access: ACT-UP demo and community statements
- PrEP talk from Glasgow online as a webcast
- The PROUD study: access to PrEP in the UK to prevent HIV
- HIV and young gay people in London: two short online videos
- UK changes PEP meds: raltegravir replaces PIs
- HIV, gay men and drug use: ASTRA study and comment in The Lancet HIV
- START study open DSMB report (May 2014)
- Generic ARVs in the UK – background paper for drug commissioning
- The importance of evidence for “When to Start”: a response to Dr Myron Cohen
- Pictures from the march in Washington
- Film review: How to survive a plague – the early years of ACT-UP New York
- IAS 2012 webcasts – now online with live streaming
- START study: enrolling well, open DSMB report shows no concerns