U.K.'s About Face Puts PrEP in Jeopardy, Shocks LGBT and HIV Activists

After waiting 18 months for the British National Health Service to begin covering PrEP under the publicly funded healthcare system and weeks before it was supposed to be rolled out, activists and clinicians were stunned when NHS England—that country's Department of Public Health—announced instead that it would no longer even consider the proposal. Arguing that England’s healthcare system should not be paying for PrEP, the bugeting and planning oversight board effectively puts the HIV prevention protocol—already available in the U.S, France, and Canada—into limbo in that country.  

“By denying full availability of PrEP we are failing those who are at risk of HIV,” said Ian Green of Terrence Higgins Trust, noting that that HIV rate hasn’t declined in a decade. “Over 2,5000 men are diagnosed with HIV each year in the U.K. It is quite clear that although we have had some huge advances in HIV treatment, HIV prevention is something that we are still struggling with.”

According to AIDSmap, Catherine West, a  Member of Parliament in the U.K., spoke out against the decision saying it “totally fails those at risk of contracting HIV.”

Senior managers at NHS England claimed their reason for the sudden about-face was that they weren’t the correct agency to have been considering PrEP in the first place, because HIV prevention services in the U.K. are the responsibility of local — not national — authorities.

Decrying the “missed opportunity to launch a ground-breaking prevention method," an unnamed representative of the Local Government Association denounced the suggestion that struggling local governments should bear the burden of covering PrEP medications. "NHS England's statement is a selective and untenable reading of the Public Health Regulations 2013 and an attempt to create a new and unfunded burden on local authorities."

“We are perplexed and deeply concerned by NHS England's decision,” added the British HIV Association in a press release. “We will now urgently seek clarification of the process required to reach a commissioning decision. If a decision cannot be reached by NHS England supported by a comprehensive array of stakeholders including local authorities, then we need to know who can make the decision and how it can be made.”

The proposal NHS England was considering planned to make PrEP available for up to 6,000 people a year at a cost up to 25 million pounds annually.  Instead, the agency offered a small concesion, proposing to budget 2 million pounds over the next two years to “run a number of early implementer test sites,” which would "provide protection to an additional 500 men at high risk of HIV infection.”

But scientists point out that such studies would be a waste of time and money, simply rehashing research already conducted. 

“We strongly disagree with the inference that more ‘real-life’ evidence is required to assess the cost-effectiveness and affordability of PrEP as part of an integrated service,” argued Sheena McCormack, a researcher involved in the British PrEP trial, PROUD. “This is exactly what PROUD has already established – and in the most astounding and scientifically robust way due to the very high rate of HIV among those who came forward for PrEP, but did not have access to [the] drug for the first year.”

“The decision is not informed by any due process; the amount of money is arbitrary; the claim that more ‘testing’ of PrEP is needed is disingenuous,” concluded Deborah Gold of the National AIDS Trust in a blog post. 

Activists are calling on the British government to intervene, and urging citizens to conact their MPs.