Challenges Accessing PrEP for HIV Prevention in England

The successful integration of HIV prevention programs that increase testing and offer early treatment for infected individuals is contributing to reductions in new HIV infections. By 2016, the 5,164 HIV diagnoses in gay and bisexual men living in England represented an 18% decline compared to the 6,286 diagnosis in 2015.  Secure integration of pre-exposure prophylaxis (PrEP) will continue to reduce infections. HIV prevention programs need to address persistent barriers and doubts however, including limited access of PrEP in England. Continue reading “Challenges Accessing PrEP for HIV Prevention in England”

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Kenya Just Banned a Homosexuality Test

Suspicion of having gay sex or relationships is illegal in Kenya and punishable by 14 years in jail. As a result, a group of activists and human rights lawyers in Kenya have been challenging this criminal code and fighting laws that punish LGBT people for being in a relationship or having sex.

One of the most prominent organization leading the issue is the National Gay and Lesbian Human Rights Commission in Nairobi, an organization arguing that LGBT communities are being unfairly targeted. In 2016, the commission received 193 reports of violations, mostly cyber-bullying, blackmail, verbal assault, and physical assault. Other forms of violence and discrimination include eviction, employer termination, or “corrective” rape. Most recently, forced anal exams were still carried out in Kenya despite being considered a degrading form of torture and having no medical merit; while straight people who have anal sex are not considered criminals. Forced anal examinations are usually performed by a healthcare provider at the request of law enforcement officials. These examinations are intended to cause emotional and physical pain and offer no potential benefits to the individual. This could also result in serious mental health concerns such as depression or suicide. This forced homosexuality test is not only a violation of medical ethics but a violation of health equity.

It originated when two men were found and arrested by police because they were thought to be gay. During this time, the court ruled against them and had them get the tests. Little is known about the true prevalence of this practice but the fact that it was codified in legal systems is astonishing. This ruling was reversed in Kenya in March 2018. Many are trying to determine if the ruling on forced anal testing could be an indicator for a turning point for LGBT cases. Promoting equality through health is extremely valuable, especially in this instance, and addressing any barriers could improve the overall health around the LGBT community.

To this day at least nine countries, several of which are in Africa, force anal examinations to investigate or punish alleged same-sex behaviors between consenting men or transgender women. A study from 2016 found that Kenya and several other countries use anal examinations as a means of determining a man’s sexuality. Tunisia, Egypt, Turkmenistan, Cameroon, Lebanon, Uganda, and Zambia, and Tanzania and possibly some others that have reported some instances, such as Syria, are included.  Law enforcement officials should never order the examinations since they lack evidentiary value. Doctors should not conduct them and courts should not admit them into evidence.

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…”