NHS England’s Decision on PrEP


prep-1The NHS this week announced it had abandoned any plans to offer Pre-Exposure Prophylaxis, or PrEP. In a statement, NHS England said:

As set out in the Local Authorities (Public Health Functions and Entry to Premises by Local Healthwatch Representatives) Regulations 2013, local authorities are the responsible commissioner for HIV prevention services.
Including PrEP for consideration in competition with specialised commissioning treatments as part of the annual CPAG prioritisation process could present risk of legal challenge from proponents of other ‘candidate’ treatments and interventions that could be displaced by PrEP if NHS England were to commission it.

In other words, NHS England has decided that PrEP represents a preventative measure, and is therefore the responsibility of local authorities to provide – not NHS England’s.

In the same statement, they offer £2 million to fund the treatment of around 500 people across the country. These funds will be allocated to local authorities which bid for a portion, and the two-year treatment programmes will be used to measure further the feasibility and cost-effectiveness of offering PrEP.

This news has been greeted with consternation by the HIV community. In Beyond Positive, editor Tom Hayes says:

This news comes as a blow to both HIV negative and HIV positive people alike. The fact that there is cost effective, and provenly effective single pill out there that can stop HIV infection, but the most at risk communities are being denied access to it, is nothing less than a disgrace.

The decision by NHS England can be seen as nothing else short-term and short-sighted commissioning, they’re saving a pound now, but spending fifty later. This will only contribute to the increasing number of HIV infections in the most at risk communities, as well as alienation and disenfranchisement of men who have sex with men. We should be empowering people to make responsible and healthy decisions about their sex life. With this announcement NHS England have essentially said that they don’t care whether gay, bisexual or other men who have sex with men contract HIV.

Dr Michael Brady of the Terrence Higgins Trust said to the BBC: “For the last 18 months charities, academics and patients have been lulled into a false sense of security. Because NHS England has been involved in all the discussions, we had expected the drug to go to a public consultation and then be commissioned and rolled-out – with guidance – towards the end of the year. Pulling the plug on this process at the eleventh hour is leaving people at risk who would otherwise have been protected.”

The National AIDS Trust has published an excellent paper entitled, ‘Why is PrEP needed?’. You can read it here [PDF]. The paper’s conclusion? “Given to gay men at high risk of HIV, PrEP will be cost-effective or could even start saving money now, especially if it is as effective as it was in PROUD and if at least a proportion of users take it intermittently.”

So, what do you think ?