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HIV in the UK: Why we're still facing an epidemic and trials are not enough

One in seven gay and bi men in London lives with HIV. The number of new diagnoses in the UK is nearly double the average of Western Europe. Nearly half of those are diagnosed in London. Make no mistake; we are still in the midst of an HIV epidemic in this country, and the epicentre is London.

Next month NHS England will begin a trial of Pre-exposure phophylaxis (PrEP), a course of drugs taken before sex that can reduce the risk of getting HIV by up to 99 per cent.

Four London clinics trialled it and witnessed a 40 per cent drop in new HIV infections among men who have sex with men (msm), and it’s been credited as a major factor in helping 2015 become the year where, for the first time, there was a decrease in the new rate of infections among this group.

In the upcoming trial, PrEP will be given to 10,000 high-risk individuals for three years. This is fantastic news, no doubt about it.

Obviously, some have their doubts. There have been the usual flurry of articles that suggest PrEP will overwhelm the gay community with excitement and we’ll all just forget what condoms are and die of syphilis/ scabies/ sin. Or something.

You’ll be shocked to know the claims don’t hold water, and NICE even concluded last year that the drug actually encouraged users to seek other types of sexual health services.

So, increased access to PrEP is fantastic. No doubt about it.

However, I’m not convinced this upcoming trial is necessary. Endless studies tell us PrEP works really, really well. Scotland didn’t need a trial when it rolled out full implementation, and the National Aids Trust has said that while some of the trial’s research could be useful, “We would certainly have wanted to see England move immediately to routine commissioning of PrEP.”

I hope this trial isn’t just an exercise in delaying payment.

NHS England fought (and lost) multiple court cases arguing it didn’t have the ‘legal power’ to fund a national PrEP service, and has stated that it would rather use the money for ‘other priorities’.

That statement was framed by certain sections of the press as choice between deviant immigrant homosexuals and elderly puppies with cancer, where only one can get the pot of dough.

This argument is frustrating as it is completely illogical. PrEP is much more likely to save the NHS cash rather than drain it of all resources. Excuse the mini maths lesson but:

A full rollout of PrEP is estimated to cost around £20m a year.

That is much cheaper than treating someone with HIV for life. In fact, the entire PrEP budget equals the cost of treatment for 55 new diagnoses. If PrEP is as successful elsewhere as it has been in London, full implementation would save just under two and a half thousand people annually from being diagnosed with HIV, which would save the NHS £864m.

And, you know, save just under two and a half thousand people from living with HIV.

There may well be useful information that comes from the trial; more information on other high-risk groups including trans men and women, and women of colour would be helpful in filling blanks left by previous studies.

But three years of inaction for everybody not included in the trial seems cruel and unnecessary. There is no reason why you can’t roll out full implementation while conducting research, as France is doing.

Delays will cost lives. We’ve prepped enough.

Africa Advocacy Foudation