It has taken me a few days to calm down enough to be able to write something at all coherent about the crass decision that NHS England has taken not to fund access to PrEP in England.
If you haven’t seen the press release here it is: https://www.england.nhs.uk/2016/03/prep/
This is NHS England announcing that they are making £2m (which is loose change) available for those who were on the PROUD study to keep getting PrEP and that there is (essentially) nothing for anyone else. A truly crass decision that flies in the face of worldwide evidence on the efficacy of PrEP.
I do follow the logic that they lay out about them not being responsible for commissioning Sexual Health services. There are three challenges with this though. The first is that there is a need to ‘pump-prime’ the delivery of local commissioning of PrEP services; yes there is a business case and yes it stacks up, but the payback period is some years. Secondly, NHS England commissions Specialised Services (https://www.england.nhs.uk/commissioning/spec-services/) and HIV treatment is commissioned by NHS England. Thirdly, read this and see where there is an inconsistency in approach being demonstrated: https://www.engage.england.nhs.uk/consultation/specialised-services-consultation/user_uploads/tasp-policy.pdf
There are a ton of really good resources about PrEP out there, I’m not going to try and list them all, but these are a few to get you started:
http://prepster.info — great source of information on PrEP
http://www.iwantprepnow.co.uk/ — where and how to self-import and what you need to think about if you go down this route
http://www.tht.org.uk/sexual-health/About-HIV/Pre-exposure-Prophylaxis — THT position on PrEP
http://www.bhiva.org/BHIVA-statement-on-the-NHSE-update-on-PreP.aspx — BHIVA position on NHS England’s update
https://getprep.uk/ — 52 Dean Street Clinic PrEP services (unfortunately only really useful for those with access to Central London)
http://www.proud.mrc.ac.uk/ — is PrEP safe and effective? This major UK trial indicates that it is
So what to do about this? Lobby. Contact your MP. Contact the Health Secretary. Contact the Shadow Health Secretary’s of the Opposition Parties. Contact the All Party Parliamentary Group on HIV and AIDS — http://www.appghivaids.org.uk/
I’m old. I remember the fights to get AZT and anti-retrovirals funded. I remember how exactly the same tactics were used by government to not fund as they were scared about how it would be presented in the press. This was overcome and can be again.
I also remember how exactly the same messaging and framing was used. Clean normal people don’t need PrEP. Its only for those chemsex loving freaks. Well, its not. Its there to protect all sexually active people of all types of backgrounds from a life-changing (and preventable) event. This is about empowering people to make a positive choice to protect the health of themselves and their partners.
Update: 25.04.16
Buzzfeed have run this story about NHS England being responsible for commissioning ART. I knew this document existed somewhere but couldn’t find it! http://www.buzzfeed.com/patrickstrudwick/heres-the-nhs-file-that-contradicts-its-reason-for-not-rolli#.dlA08Wv7j is the story and http://www.bashh.org/documents/SSC1516%20Position%20regarding%20PrEP%20April%202015.pdf is the Specialised Services Circular
NHS England really do want their cake and to eat it at the moment. The illogicality of the position they have taken is just too absurd to maintain.
UPDATE 19th April, 2016
Excellent work by Buzzfeed in keep this story live and in the news. The update that the DH will reconsider the funding decision is excellent. And make no mistake, this is the DH behind this move.
Also worth knowing if you are in London. Chelsea and Westminster have extended the number of clinics that they offer monitoring for those self-importing PrEP to include 10 Hammersmith Broadway and the John Hunter Clinic. Details found here: http://www.chelwest.nhs.uk/services/hiv-sexual-health/clinics
