Access to PrEP under NHS England: My trip to London

Pre-exposure prophylaxis (PrEP) is a way to prevent HIV infection for people who do not have HIV but who are at high risk of getting it by taking the pill everyday. When someone is exposed to HIV through sex or injection drug use, PrEP can work to keep the virus from establishing a permanent infection. Individuals who take 7 PrEP pills per week, have an estimated level of protection of 99%. It is a powerful prevention tool combined with condoms.

In the United States, PrEP became available in 2012 by the FDA and can be accessed in most clinics and hospitals and is free under most insurance plans. As of 2017, there are an estimated 136,000 people currently on the drug for HIV prevention. This is not the case in the United Kingdom. As a part of a research project for my MPH degree I traveled to London, England to meet with members from the LGBT community, advocates and public health professionals and to learn more about access to PrEP under the National Healthcare System (NHS) England. Currently, PrEP is not available under NHS England even though HIV continues to be a prevalent problem in England, namely among men who have sex with men (MSM) where approximately 54% of the total of MSM population were diagnosed in 2015. England is however enrolling 10,000 people over 3 years through the PrEP IMPACT trial.

Wales, Scotland, and Northern Ireland are also a component of the NHS. Wales has commenced their PrEPared Wales project, which provided information on where to access PrEP in the country. Scotland is currently the only country in the UK that offers a full PrEP provision through their NHS. Northern Ireland currently has no provision of PrEP.

The NHS is widely regarded as a remarkable system, allowing UK citizens to access certain free healthcare services. England has had some shortcomings however when it comes to preventing HIV and I was interested in learning more. I visited the Terrance Higgins Trust (THT), a British charity that campaigns on and provides services relating to HIV and sexual health. In particular, they aim to end the transmission of HIV in the UK, to support people living with HIV (PLWH), and decrease stigma around HIV. I met Greg Owen, the founder of iWantPrEPNow, a website that explains why it is important for HIV protection, who might consider PrEP, what you need to do before you start, where to buy it online, and how to take it. I also met with Will Nutland, who works alongside Greg and is the founder of Prepster, a guide and movement to safely buying PrEP. Both websites have experienced a lot of traffic since the IMPACT Trial began in October 2017. The trial seems like a step in the right direction when it comes to accessing PrEP, this is not the attitude for many and there continues to be a debate.  While there is significant evidence from other trials that demonstrates PrEP is an effective HIV prevention tool, many people believe that NHS will not endorse PrEP after the trial is complete.

I asked Liam Beattie, also a member of the THT team, why he believes NHS England did not endorse PrEP under its guidelines. He believed that it was because of 1. homophobia among the NHS and 2. the media. Liam was recently interviewed on BBC News. During the interview, PrEP was categorized as a “controversial drug,” which paints a negative light on the topic from the get-go.  While England is well-developed and progressive in so many ways, HIV is still known as the “middle-aged gay male virus.” THT and other organizations continue to develop new marketing tools and programs in order to target women, transgender persons, and people of color to visit a sexual health clinic and get tested. Taking PrEP is an advantage for not only the individuals health but the overall cost of healthcare. Many are hopeful that in the future, the NHS will work with organizations like THT to promote PrEP and other educational resources to prevent HIV.


Did you know condoms are considered immoral in some countries?

Condoms have been around since 1855. Crazy, right? Not so long ago, one of the main purposes of condoms was to protect soldiers in World War II against STI’s. Not a lot of things have changed since then. There’s actually more and more reasons now why condoms are useful- it is accessible, it does not have side effects, it lowers risk of STI’s and HIV, and does not change the menstrual cycle like birth control does. That being said, there are several countries in the world that believe condoms and contraceptives are immoral. The below countries and its leaders blast condom use as dangerous. Their anti-condom rhetoric is bringing down youth and many others and could ultimately hurt the world. Continue reading “Did you know condoms are considered immoral in some countries?”

Australia, you’ve done us proud…

Between September 12th and November 7th this year, Australia distributed the Australian Marriage Law Postal Survey, a national survey that gauged support for legalizing same-sex marriage. Unlike electoral voting, which is compulsory in Australia, responding to the survey was voluntary. The survey was returned with 61.6% “Yes” responses and 38.4% “No” responses. Even though the measure was expected to be approved, the size of the win and the unusually large participation of 12.7 million Australians out of the 16 million eligible voters added political legitimacy to it. It’s funny to think three letter strung together in the right order can mean so much to millions of proud Aussies. Several hours after the results of the survey were released, theMarriage Amendment Bill 2017 was introduced into the Australian Senate. The amendment  is a Bill for an Act to legalize same-sex marriage in Australia, by amending the definition to allow marriage between two people. This is not only a time to celebrate a historic moment for the country, but to understand the vast positive impact for the LGBT community especially when it comes to health. Continue reading “Australia, you’ve done us proud…”

NHS England New Guidelines Ask For Sexual Orientation

In the United States, doctors are not required to ask patients their sexual orientation. This information is beneficial not only for health professionals but for the country; the importance of knowing this information is multifaceted. Understanding one’s sexual health is significant because it can affect your physical and emotional well-being. One’s sexual orientation may put you at higher risk for certain health conditions. Lastly it can help provide accurate health and behavior counseling. For instance, several research reports conclude that anal cancer is prominent in gay men or that depression is common among the community, therefore it is extremely valuable for health care providers to meet these needs regardless of sexual orientation.

In the United States the Census Bureau is planning to maximize response and participation by the year 2020, specifically to better understand the LGBT population. Coinciding with this, under Healthy People 2020 some of the main objectives fall under the category of increasing the number of population-based data systems used to monitor Healthy People objectives which collect data for LGBT populations. These objectives involve increasing the number of states that include questions on sexual orientation and gender identity in the Behavioral Risk Factor Surveillance System (BRFSS). Don’t get me wrong, this is great progress, although all of these facets seem to be ingredients from different recipes. England has taken it to a new level. Continue reading “NHS England New Guidelines Ask For Sexual Orientation”

Setting an Example for LGBT Rights

Around the world, gay, lesbian, bisexual, and transgender (LGBT) individuals face worse health outcomes than the general population. As a result, a large portion of the LGBT community faces mental health issues, injury, violence, suicide, substance abuse and more. We know the problem is in part due to the barriers they face to accessing health care and health professionals being educated in LGBT-related health issues. But because there is relatively little health research on this population globally, the true scope of the global burden is difficult to calculate. These barriers range from denial in care, to inadequate or substandard care, to unwillingness to go to a doctor because of discrimination. Sometimes serious penalties are involved. The most recent news involved the LGBT community in Chechnya (North Caucasus region of Russia), also known as Chechens.  

Canada, a country where leaders of many-if not all- levels of government march alongside the LGBT community in Pride parades, it’s easy to forget that much of the world is still a scary place for LGBT individuals to openly live as such. Don’t get me wrong- not everything is ideal for sexual minorities in Canada either, as many people are victims of bullying or risk of violence and suicide. But these issues are recognized and the Canadian government, in the past few decades, has shown a will to address them. For example, with newly created protections geared towards the transgender community. In the last year a policy was approved that men who have sex with men are allowed to donate blood.

Since last March, Chechnya has been making headlines for its cruel treatment of homosexuals. It was reported that Chechnya’s authorities were detaining over 100 gay men. Eventually more information on this issue surfaced and the details are extremely bone-chilling. Most were arrested and detained from anywhere to a day and up to several weeks, beaten, verbally abused, starved tortured, and forced to reveal the names of others. Continue reading “Setting an Example for LGBT Rights”