How PrEP helps prevent HIV

New report shows a fall in diagnoses across London in 2017

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Regular HIV testing and early treatment of the infection were central to the 21 per cent drop in new HIV diagnoses last year – surpassing reductions seen in other parts of the country – data from Public Health England (PHE) released earlier this month concluded. Behind those headlines, the story of how new prevention technologies are playing their part is still being understood.

PrEP, or Pre-Exposure Prophylaxis, is a pill that prevents HIV. While it only became available on the NHS to a limited number of people last autumn, Do It London has been promoting PrEP as part of its large, award-winning public health campaign since summer 2017, with a big advertising drive this year, too.

A relatively new way for people to reduce their risk of acquiring HIV, PrEP is specifically for someone who is HIV negative, confirmed by a blood test. The single pill – which combines two anti-HIV drugs – is usually taken daily, although it is equally effective when taken before and after condomless sex, according to careful dosing instructions.

PrEP is proven to be effective for both men and women, although women must take the pill every day rather than “on demand”. The medication is now regarded by HIV experts as central to the public health response to prevent HIV, especially in London where – for many years – rates of HIV had been rising relentlessly.

The findings from PHE are promising. They confirm a sustained reduction in HIV in London since 2014, as a result of major increases in regular testing and the prompt provision of treatment following diagnosis. While the report did not cite PrEP as causing this reduction, the scientific community is unanimous in regarding the drug as one of the key elements of HIV prevention: alongside early diagnosis, effective treatment, ongoing condom use, and also quick, easy, confidential and regular testing.

PrEP has been available to purchase privately for a few years, but it is not routinely available in England on the NHS (unlike in Scotland and Wales). In October 2017 NHS England launched a PrEP Impact trial to recruit 10,000 participants at a high risk of HIV to be provided with the drug for up to three years via sexual health clinics, at no cost to the patient. Following high levels of uptake within months of launching the trial, this month NHS England added an additional 3,000 places.

It is important to remember that PrEP is neither an HIV vaccine, nor a cure. It can only provide protection from HIV as long as it is taken as prescribed, supported by HIV testing every three months. It also only protects against HIV – not other sexually transmitted infections – which is why regular STI screening is also essential. Nevertheless, PrEP is now a central way to prevent HIV, especially when used in combination with the other methods highlighted in Do It London’s award-winning campaign.

After a decade of rising HIV rates in London, we are finally seeing a significant drop in new infections – at the same time as London officially became a “Fast Track City” for HIV. A worldwide initiative, signed in January by the Mayor of London, Sadiq Khan, London’s councils, PHE and the NHS, this pledges to achieve zero new infections by 2030. Making sure that Londoners are aware of HIV prevention is central to Do It London’s mission – as is contributing to that ambitious goal.

For more information on the campaign, visit doitlondon.org