Our Day Of Reckoning In The Fight Against HIV

18/05/2016 16:50

There is a pill that can prevent HIV. I'm not referring to something that could potentially change the lives of future generations, one day, after decades of further research. This 'miracle drug' is real, it's ready now, and it is called Pre Exposure Prophylaxis, or PrEP.

When taken correctly, PrEP has proven to be 100% effective in stopping HIV negative people from contracting the virus.

As a gay man living with HIV, and the new chief executive of the UK's leading HIV and sexual health charity, it is stunning to see this breakthrough in my lifetime.

When antiretroviral drugs became available in the 1990s it was a game-changer for people living with HIV. PrEP has the potential to be this generation's defining moment in the fight against the HIV epidemic. Together we now have a powerful arsenal with which to end HIV: condom use, regular testing, treatment leading to the virus being undetectable, and PrEP.

We've been well educated about condom use for decades, but the HIV epidemic isn't going away. PrEP could be the last vital piece of the jigsaw puzzle. But right now, its remarkable potential is yet to be realised in this country.

The response to PrEP from NHS England has been frustratingly underwhelming - the journey to make PrEP available on the NHS has been dogged by delays, false starts, red tape and apathy. People will needlessly be infected with HIV because no-one can quite decide whose budget it should come out of.

This is a country that used to lead the way in tackling the HIV epidemic. A country that now has the worst HIV epidemic of any large country in western Europe, having overtaken Spain, France and Portugal. So why is PrEP not available in the UK, when it being accessed by men who have sex with men in countries such as the US, Canada and France?

In the 18 months up until March, NHS England had been following a process to decide whether PrEP should be available to people at high risk of HIV on the NHS.

But on 21 March - just weeks after I took up my position at Terrence Higgins Trust - there was universal outrage when NHS England suddenly, unfathomably, abandoned its own process, claiming HIV prevention was not its responsibility after all.

With the National AIDS Trust (NAT), we wrote to and met NHS England to express our concerns and in April, NAT mounted a legal challenge.

NHS England have since said they will 'carefully consider' their position. This apparent u-turn was a promising step but we remained sceptical and, as I write this today, we are still awaiting answers as to when access to PrEP will be available to those who need it.

In these frustrating times, one glimmer of hope has shone through. What I've witnessed is the incredible campaigning spirit that we saw in the 1980s being reignited in the sector, as we have fought hard to see PrEP made available to people at high risk.

As was the case 30 years ago, out of adversity has come strength. We have been united in our fight, working closely with the community, activists, clinicians and other HIV organisations to make the case for PrEP. We will not let this lie.

Thanks to these efforts, momentum is building. In April, I met the Minister of Public Health who is keen to find a solution. Last week, we worked with Mike Freer MP who asked the Prime Minister a question on PrEP, so it is now firmly on the radar of David Cameron. In response, the Prime Minister acknowledged the growing rate of HIV in this country, and promised an answer from NHS England in the next month.

So, at last, a decision appears to be looming. On 31 May, NHS England's specialised commissioning committee will meet to decide whether the previously agreed approval process for PrEP should continue. When that meeting happens, that group will effectively help decide on the future of the HIV epidemic in the UK.

But we know more hurdles await - we still need answers on whether PrEP will make it through for discussion at the next meeting of the Clinical Priorities Advisory Group (CPAG) in June, which is now just weeks away.

The whole process has been frustrating, cumbersome and far from ideal, but at the end of the day the money has to be found somewhere. We have a mess, created by NHS England, and we are looking to them to find a solution for where that money comes from.

Every day this is delayed, seven more men who have sex with men in the UK are infected with HIV. Meanwhile, the drug supply for the 500 people accessing PrEP as part of the PROUD trial is running out. As long as they remain in that high-risk category, we are calling for their supply drug to be continued so they remain protected from HIV.

We are finally approaching our day of reckoning in the fight to end the HIV epidemic. Let's hope NHS England seize the moment.