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?
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.
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.