Letter from Sir Liam Donaldson to all Chief Executives of Primary Care Trusts and Strategic Health Authorities in England

From Sir Liam Donaldson, Chief Medical Officer, Department of Health

6 April 2006

Category: URGENT

Improving the Prevention and Treatment of Sexually Transmitted Infections (STIs), including HIV

Dear Colleague,

I am writing to update you on some of the elements of clinical good practice on sexual health and, in particular, the more serious sexually transmitted infections (STIs) such as HIV. I would be grateful if you could bring this advice to the attention of your relevant management colleagues, clinical and public health teams so they can take any necessary action to safeguard the health of your local population.

Good practice standards in relation to both sexual health and HIV services have been published [1, 2]. In addition, ‘The NHS in England: the operating framework for 2006/07’ [3], prioritises action on sexual health and access to genito-urinary medicine (GUM) services, so that by 2008 everyone should be able to have an appointment within 48 hours. Building on this good practice and improving access to sexual health services has particular benefits for HIV prevention.

As well as general prevention work, it is important also to consider postexposure prophylaxis (PEP) which can prevent HIV transmission taking place after non-occupational exposure to HIV. PEP is an emergency treatment, and to be effective in preventing HIV, it must be prescribed as soon as possible after potential exposure to the virus. After 72 hours it is unlikely to be effective. The British Association for Sexual Health and HIV (BASHH) has recently published new clinical guidelines, including those for risk assessment, on prescribing PEP following non-occupational exposure [4]. ‘Recommended standards’ also includes guidance on the provision of PEP after non-occupational HIV exposure [1, 2].

I would therefore ask you to ensure that PEP is part of the spectrum of sexual health services for your local populations. Provision of PEP for nonoccupational exposure is not a replacement for evidence-based HIV health promotion, but it can have a contribution to make in preventing transmission of HIV.

Sir Liam Donaldson, Chief Medical Officer


  1. Recommended Standards for NHS HIV Services’ (2003) produced by the Medical Foundation for AIDS and Sexual Health
  2. Recommended Sexual Health Standards’ (2005), produced by the Medical Foundation for AIDS and Sexual Health
  3. The NHS in England: The operating framework for 2006/7 PublicationsPolicyAndGuidanceArticle/fs/en?CONTENT_ID=4127117&chk=BgslVK
  4. United Kingdom Guideline for the use of post-exposure prophylaxis for HIV following sexual exposure (BASHH) 2006


Unfortunately, this letter is much more likely to have been prompted by an individual challenging the government in court, for not providing access to PEP, than the recent publication of PEPSE guidelines by British Association for Sexual Health and HIV (BASHH).

Hopefully, the letter (alongside the guidelines) will help to ensure that clinics now provide PEP, that it is publicised more widely, and that it is appropriately funded – without which, nothing will change. This is not clear in the current payment-by-results (PBR) tariffs.

Several presentations at the BHIVA Conference emphasised that PEP can only work if people know about it, and that awareness in both HIV-positive and HIV-negative individuals was not extensive.


BASHH guidelines on use of PEPSE (February 2006):

Letter available as pdf download:

Links to other websites are current at date of posting but not maintained.