You may have heard about PrEP, the drug which can protect people against HIV.
PrEP stand for Pre-Exposure Prophylaxis. It is used as an anti-HIV medication that keeps HIV negative people from becoming infected. The drug is called Truvada and is more commonly used as part of HIV antiretroviral therapy for HIV positive men and women, but in recent years has proved to work as a preventative pill as well.
There have been concerns raised recently over the cost and whether or not it should be available on the NHS. To get a better insight into PrEP, I spoke to Will Nutland. He has worked with many HIV charities over the years and has recently set up PrEPster – a volunteer group of London-based HIV prevention activists. Their aim is to educate and agitate for PrEP access in England and beyond.
Tell me about PrEPster. Prepster.info was launched this week by four of us including myself and Marc Thompson. Marc and I have been feeling for a while that there wasn’t enough accessible information out there about PrEP.
At the beginning of the year, Nicholas Feustel released a documentary about the Proud Study. It’s a great film which helps people understand what PrEP is and what the results of the study were. I worked with Reshape to help get the film its first showing in London and from there, other places around the country. Many of the people who came to see the film already knew something about PrEP and the main thing we heard from them was ‘I don’t know where to go to get basic, non-biased information that will help me make a decision about PrEP.’
There is some great information currently available but it’s quite technical and not always easy to understand, so Marc and I decided to build a website and PrEPster was born.
A lot of people are calling for PrEP to be freely available on the NHS like the morning after pill. The difference being, PrEP is a drug called Truvada which currently costs around £8,000 per person, per year. Is it viable to for this expensive drug to be so freely available? PrEP will only be available under clear prescribing guidelines. The current discussion is looking at whether PrEP with be cost effective or cost saving. In order to answer those questions, you have to set parameters by which PrEP would be available. I don’t think anyone would expect to walk into their sexual health clinic and walk out with PrEP unless they meet prescribing criteria.
Research from the UK and the USA has asked gay men whether they would use PrEP and around a third to a half of them said ‘this isn’t for me, I wouldn’t want it’. So I don’t think we should work on the assumption that suddenly everyone is going to want it. Even the people who do want it are still going to have to be evaluated by the medical practitioner.
Going back to the Proud study where 554 gay men and trans-women were on the trial, only around 400 of them are still using PrEP. There are people who started the trial when they were single and now they’re in a monogamous relationship and have decided they no longer need it.
The other thing regarding the cost of Truvada, it is about to go off-patent in the next couple of years which will dramatically bring down the price.
There is also a need for proper PrEP provision and wrap-around services. When I did my interviews with men and particularly older men, they talked about the potential of what PrEP could offer them. Even men that didn’t think from a purely HIV preventative perspective, they could understand the other benefits it could offer. Some men said they found it difficult to get an erection with condoms; Truvada would help obtain this without the risk of not using a condom.
If PrEP became available on the NHS, those people who ask for it should be given a consultation and a chance to talk about why they want it. It could be that after the consultation the person actually didn’t want PrEP but needed help with their drug use, or help finding a relationship, help with loneliness, erectile dysfunction or even help sourcing condoms that are the right size or type. It could be any of these things and this for me is the biggest opportunity that PrEP offers us: it has the potential to bring people in to a range of services.
We need to convince local authorities that these are services we should be paying for as well as all the other wrap-around services that will come from taking PrEP.
There is a worry that the people who use PrEP will be less concerned with other STIs as they already have protection against HIV. There are already cases of drug-resistant gonorrhea and an increase in syphilis diagnoses. Do you think more people taking PrEP could lead to an increase in other STIs? Maybe, and you’re right in saying that STIs are increasing across the whole population. STI figures are partially increasing because there has been a massive expansion in clinics testing people – which of course is a good thing as these are now being diagnosed and treated. Despite that, STIs are on the increase in almost every group of people and particularly amongst men who have sex with men who already have HIV. What needs to happen in that group in particular is that when they go for their HIV check-up, they should also be offered a full STI screen to test for anything they may or may not have.
PrEP is a fantastic drug and for the first time since HIV was discovered; there is now protection against it. But it is not an Invincibility drug. It can’t stop the spread of any other STI. If you are already or decide to start taking PrEP, you need to take care of yourself just as much as before.
You shouldn’t take PrEP until you’ve had a recent and reliable HIV test. PrEP can’t help you if you already have HIV and can in fact cause a lot more problems as Truvada is used as part of a combination HIV treatment. The use of it on its own could cause drug resistance.
If you do decide to take PrEP, as well as having a recent HIV test, you should also keep having your regular three month HIV check-ups and kidney tests done. Also be aware of interactions with other drugs you are taking.
As well as PrEPster, there is another new website called I Want Prep Now. This site has information and a review section of PrEP bought from other countries. So far they have verified three places from where you can safely buy PrEP. The drugs have been tested and they are the real thing. If you do decide to buy from abroad, please do your research first. This is a great source with a lot of good and researched information which will help you if you decide to go down this path.
Whether you believe PrEP is a good thing for people to use or not is your personal choice. PrEP exists and it works and I believe it should be made available to anyone who needs it.