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Saturday 08 April 2017

The PrEP Underground, UK-style

Posted in: Health & HIV
By Commentary by Craig Young - 4th February 2017

Given the unholy row about England's National Health Service previously maintaining barriers to PrEP access, British gay men nevertheless seem to be obtaining access to the HIV prevention drug - amidst a steep apparent decline in new HIV infection notifications in London.


[Editor's note: PrEP stands for PRe-Exposure Prophylaxis and is an HIV prevention technique whereby people at heightened risk of contracting HIV are put onto a monitored programme of HIV medications to minimise the chances of the virus taking hold in their bodies.

It's being used with now-proven success in a number of countries or areas with similar, ie. predominantly gay and bi male, epidemics as New Zealand's but is, despite the urging of everyone from Body Positive, the NZ AIDS Foundation and even the World Health Organisation, still unavailable here except in the most extreme situations.]

According to a recent New Scientist article (09.01.2017), there is now a 'massive decline' in London HIV rates, which may be attributable to gay men being able to access PrEP through other means. This conclusion is based on statistics from four London sexual health clinics, which reportedly saw significant declines in new HIV infection notifications for the year after 2015, on average forty percent lower.

This may be attributable to people being able to access PrEP through means other than regulated access through the National Health Service, argued one figure associated with the diversionary tactic, Will Nutland of the London School of Hygiene and Tropical Medicine.

Nutland established PrEPster, a website that provides British gay men and others with information about how to sidestep the cumbersome bureaucratic regulatory process and access PrEP when they need it. As for guilt-tripping about condom use, some HIV activists note that straight people never get asked these questions about their exposure to STIs, HIV and unwanted pregnancies, so why single out gay men?

Given that NHS England still isn't funding Truvada, one of the core PrEP medications yet, the sidestep involves sourcing the drug from India and Swaziland through another website, I want PrEP now. Of course, there are some objections to this process- isn't it possible that there may be source or en route substitutions of placebos or unsafe substitute medication?

However, the PrEP underground railroad networks cited in the New Scientist article have assistance from amenable UK medical practitioners, who provide blood and urine tests to insure that hasn't happened, and so far it hasn't. Moreover, the UK General Medical Council has provided support for such doctors, arguing that their first duty is to safeguard patient safety in this context.

The United Kingdom isn't alone - San Francisco has also seen a steep decline in new HIV diagnoses, given expedited access to PrEP there. In addition to facilitated access as outlined above, new prevention, diagnosis and treatment methods have also assisted the apparent decline.

Ironically, NHS England may be responsible for its own marginalisation in this context, given that its stonewalling may have contributed to the increased visibility and practical need for such websites as PrEPster and I want PrEP now. In some cases, PrEP can be urgently accessed through the NHS through provision of a free month's supply, and then 'clinic hopping' through false names to get additional free supplies from successive NHS outlets.

How significant is the apparent aforementioned decline? According to UK government health statistics, it is the case that over half of new HIV notifications tend to be amongst gay men, so this apparent decline may herald slowing of the UK HIV/AIDS epidemic.

Greater condom use, more testing and treatment options could also be playing secondary roles in this encouraging turn of events, according to the National AIDS Manual, 56 Dean Street and Public Health England. Meanwhile, NHS England is providing a 10,000 place clinical trial within England, which will take care of more access needs amongst gay men and others at risk. However, the question remains what NHS England will do when those places are full.

Meanwhile, here in New Zealand, are we over-reliant on the AIDS Foundation to 'rescue' us? Isn't it time that we explored similar options to circumvent our own government's inaction and sclerosis on new HIV prevention options?


Clare Wilson: "Massive drop in London HIV rates may be due to Internet drugs" New Scientist: 09.01.2017:


National AIDS Manual UK:

Commentary by Craig Young - 4th February 2017

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