The documentary and the issues it raises has begun to spark a public debate in Scotland’s LGBTI communities.
KaleidoScot interviewed several key policy, and health charities as well as hearing the opinion of an HIV+ Scottish gay man.
Speaking with KaleidoScot, George Valiotis, CEO of HIV Scotland highlighted the importance of documentary raising awareness regarding PrEP: “The PROUD study documentary clearly demonstrates the compelling evidence that PrEP is effective as a HIV prevention tool and is also cost effective. Therefore public sector leaders can no longer delay taking decisive action to make PrEP available across Scotland.
KaleidoScot: What is HIV Scotland, as a policy charity, doing about it?
“HIV Scotland have been urging the Scottish Government and Lead Clinicians for a national roll out in prescribing PrEP to particularly at risk communities. In August, HIV Scotland will be hosting a round table to discuss the challenges and opportunities of making PrEP available and to develop a position statement on the next steps for prescribing PrEP in Scotland.
“HIV Scotland supports the statements in the PROUD study documentary that consistent and correct condom use remains the most effective way that someone who doesn’t have HIV can reduce their risk of acquiring HIV when they have sex but that there is extensive social and clinical research that shows this strategy alone hasn’t worked for everyone and for those people PrEP can offer an effective extra layer of protection that that they can use.
KaleidoScot: Can you explain briefly about PrEP and its potential use in Scotland?
“PrEP’s key ingredient is Truvada: a drug that is already licensed for use in Scotland for people who have HIV to help suppress the virus in their body. Truvada is also already used in a different way, technically ‘off label’, as a treatment of an HIV negative person who had immediate exposure to HIV – blocking the HIV from settling into the cells and enables it to be cleared out of the system.
“As Truvada is already routinely used ‘off label’ in Scotland, there should be no additional approval needed to use it as PrEP. What needs to change then is commissioners need to ensure funding is made available to pay for this treatment to be made available, especially to those who can most use it.
KaleidoScot: What is next regarding PrEP in Scotland?
“HIV Scotland would like to encourage more community dialogue on PrEP and HIV prevention, the Proud study documentary highlights the need for community education to ensure that gay men and other people at risk are fully aware of the benefits of PrEP and how they can use it as an addition HIV prevention tool. At Pride Edinburgh HIV Scotland surveyed people if they knew anyone taking PreP and 13% told us they did.
“People are already using it in England if they’re on the PROUD study, American tourists may be on PrEP, and other people in Scotland may have accessed it from unlicensed channels. This supports the idea that PrEP is already changing and will continue to change how people negotiate safer sex with their partners.”
We also spoke to David, a longterm HIV+ gay man living in Scotland, asking him for his views on PrEP.
KaleidoScot: What are the implications of PrEP to HIV+ and negative people?
“As a longterm HIV+ gay man I, like the vast majority of others, have fully accepted my own responsibility to ensure I don’t pass on the virus to any of my sexual partners. However, this has often added to the other demands of living with HIV and perpetuated a sense of stigma and alienation, not least within the community from which I need to find support.
“Now that the Proud study has decisively proven the efficacy of PrEP amongst gay men it offers everyone, regardless of HIV status, the chance to more effectively take responsibility for the part we all play in preventing the transmission of HIV.
“In the USA, where PrEP has been available for some time, this has enabled a more engaged dialogue between HIV+ and HIV- people, and has begun to destigmatise HIV in a powerfully inclusive way.
“What stands out for me is the recognition that if PrEP had been available at the time I contracted the virus it is highly likely that I would not have become infected.
“Understanding the immeasurable impact living with the virus has had on my life over the last 23 years enables me to appreciate just how important something that would have prevented this, in a simple and effective way, really is: the results of the Proud study firmly demonstrate that PrEP has the potential to offer us this.
KaleidoScot: What do you think this documentary highlights in terms of prevention?
“Truvada, the medication used in PrEP, is already available and being routinely used for HIV treatment as well as for PEP (post-exposure prophylaxis). The hurdle now appears primarily to be one of licensing and this is what stands in the way of enabling us here in Scotland to implement arguably the most powerfully positive change in HIV prevention in the last 30 years.”
“Although the cost of PrEP isn’t necessarily cheap, I recognise that it is far more cost-effective than the lifelong economic price of the treatment and support HIV+ people need.
“This, however, needs to be accompanied by a confident and clear education campaign, directly and effectively targeted at those HIV- negative people in the communities most likely to benefit. Inaccurate or misleading misinformation surrounding PrEP, circulated by word of mouth or through unreliable sources online, may be counterproductive.
“The arguments for the urgent licensing of Truvada, as PrEP, in Scotland seem to be clear. So perhaps the important question we must now ask is why something so demonstrably effective, readily available and economically viable is not being fast-tracked as a vital tool at the heart of our HIV prevention strategy?”
Alastair Rose, Head of Operations for the Scottish charity, Gay Men’s Health, praised the documentary: “The film is powerful and extremely educational piece of work, highlighting the proud study.”
KaleidoScot: In a sense you see this documentary as empowerment?
“GMH welcomes the documentary and we wish to empower the community to participate in the discussion around PrEP. A documentary like this enables the community to develop its voice. Gay men, and the gay community in general, are essential in the continued fight to improve the sexual health of all men who have sex with men. This includes new prevention options – of which PrEP should be part of.
KaleidoScot: So PrEP should be used within a broad prevention strategy?
“There’s so much still to be done to improve the health and wellbeing of gay and bi men, and the community mutually should feel empowered to have a full role in achieving good sexual health for all men who have sex with men. The proud study highlights an exciting stride forward, but we must ensure that men are aware of all prevention opportunities available including condoms and lubricant.”
“The results of the PROUD study demonstrate the important role that PrEP could potentially play in HIV prevention in future.
“Prevention and education are key aspects of Waverley Care’s work supporting at-risk groups and we will be following developments closely.”
Charities across Scotland and the UK have previously called upon the government for access to pre-exposure prophylaxis (PrEP) as an effective means of preventing HIV infection.
When KaleidoScot asked the Scottish government to clarify its position regarding PrEP in may 2015, Scotland’s Health Secretary Shona Robison responded: “I read the recent PROUD study into PrEP treatments with interest.
“I would encourage the manufacturer to apply for a marketing authorisation in Europe and put forward a submission to the Scottish Medicines Consortium so that they can take a decision about whether this drug should be recommended for use for prevention purposes in Scotland.”