By Debbie Laycock, Head of Policy at Terrence Higgins Trust
The potential of PrEP
HIV prevention drug pre-exposure prophylaxis (PrEP) is a pill taken by people at risk of getting HIV and is almost 100% effective when taken as directed. Alongside other HIV prevention tools, such as condoms and HIV treatment as prevention, PrEP has been a factor in the incredible reductions in HIV cases seen in England – particularly in gay, bisexual men and other men who have sex with men (GBSM). But uptake of PrEP is predominately by GBSM and other at-risk populations such as heterosexuals and people in Black African communities are being left behind. That’s why access to PrEP is so important – and community pharmacy could be one route by which access is expanded.
Government commitment to increasing access to PrEP
In the 2021 HIV Action Plan for England, the government committed to ensuring equitable access and uptake of HIV prevention programmes. This included plans to drive innovation in PrEP delivery to improve access for at risk populations including settings outside of sexual and reproductive health services (SRHS), including prisons and pharmacies. The HIV Action Plan’s Implementation task and finish group on PrEP chaired by the Association of Directors of Public Health and Terrence Higgins Trust was set up to gather evidence to understand why some key groups who would benefit from PrEP are underrepresented and to identify potential barriers and facilitators to access.
Equitable access to PrEP now
Key pieces of evidence have been published in the past two years.
- The Not PrEPared report published last autumn highlighted inequalities in PrEP. It revealed not a single local authority in England reported more than five women using PrEP in any of their services. Only a third of those who were trying to access PrEP via SRHS were able to access it and the majority of requests were for first time use.
- The first UKHSA data on PrEP estimates that only about half of the 3,119 heterosexual men and a third of the 3,009 heterosexual and bisexual women using sexual health services in England who could benefit from PrEP are accessing it.
- The English HIV and Sexual Health Commissioners Group’s PrEP Insight Project report, which explored the barriers and facilitators among Black African women, trans communities, and sex workers to access PrEP found low PrEP awareness among these groups. It recommended increasing awareness in settings already accessible to these populations, such as pharmacies, to increase uptake.
Making PrEP accessible through pharmacies
Community pharmacies are ideally situated to support the expansion of access to PrEP. Pharmacies already provide sexual and reproductive health services as part of Advanced Services provision, including pharmacy contraception services and locally commissioned services such as chlamydia screening and treatment. Despite the potential of community pharmacies, there has been little progress on the commitments in the HIV Action Plan since its launch and the Government’s annual report on progress against the HIV Action Plan does not mention the issue of expanding access to PrEP.
The way ahead…
The UK government has committed to ending new HIV cases by 2030. Here are the three key things they can do to ensure we achieve this:
- Raise awareness of PrEP by advertising it more widely, highlighting efficacy, who it’s for, risk perception, relevancy, how to access it, and potential side effects.
- Pilot providing PrEP via settings outside of sexual health services, for example in community pharmacies, online and in prisons in order to improve equity in access.
- Include disaggregated data for trans communities in the annual PrEP data from UKHSA.
Read about one patient’s experience of their struggle to get PrEP.
Read more RPS blogs.