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.


Happy #InternationalWomensDay!

A message from our section chair, Laura Altobelli

In 1909 and 1917, women organized to demand better wages, equal working conditions, and the right to vote.

In 1975, the United Nations established March 8 for the annual recognition of these struggles.

On this International Women’s Day, the tendency is to think that today celebrates women just for BEING WOMEN — instead of its true meaning….THE GLOBAL STRUGGLE FOR EQUAL RIGHTS OF WOMEN.

Today is to commemorate the hard work that has not yet ended, and to celebrate those women (and some men), past, present, and future, who push the boundaries toward empowerment of women and girls and gender equality in all aspects of life.

Today is an annual call to continue the struggle.

In international health and global development work, this is arguably the most important of our callings — to reach the 5th Sustainable Development Goal: to ‘achieve gender equality and empower all women and girls,’ after which all other SDGs will be easier to reach.

Have a good day and keep up the struggle!

Achieving health equity in global health through workforce diversity

This International Women’s Day we honor the achievements of women leaders working to advance the health and well-being of people all over the world. Their path to success was certainly not easy. It was fraught with numerous challenges; challenges that are not only experienced by those of us working in global health but by women across all industries.

We are considered either too soft and feminine or too bossy and pushy to be seen as competent leaders. Our work culture lacks family-oriented, work-life balance policies which enable us to contribute to our field in significant ways. We lack female mentors to encourage us to grow and push us to overcome any obstacles we encounter in our career. We work for organizations where the people who make the big decisions on what policies and programmatic areas to focus on are men. The struggles we face trying to advance in our careers are reflected in the lack of gender equality in the global health workforce. While women make up 70% of the global health workforce, only 25% of leadership positions in global health are held by women.

We have known for a long time that when women are given equal opportunities for leadership at all levels of decision-making in economic, political, and public life, everyone in society does better. Female leaders in health “promote access to contraceptives, empowerment programs for girls, women’s rights to family planning and maternity care, safe abortions, and protecting environmental assaults on children’s health.” In addition, women leaders at all levels of governance have shown to be the primary driver toward financing public goods such as health, education, hospitals, clean water, and sanitation. Women’s participation and leadership in economic, political, and public life is so critical to advancing societies that it is even written into one of the sustainable development goals. When women have a voice at all levels of decision-making, we are closer to eliminating the inequities that lead to disparities in health.

More global health organizations are recognizing the need for women leaders and organizations such as Women in Global Health are working toward achieving gender equality in global health leadership. Last year the World Health Organization’s newest Director-General, Dr Tedros Adhanom, appointed eight women to senior leadership, effectively outnumbering the men. In doing so, he took one big leap toward achieving gender equity at the WHO – a goal that was first set in 1997 and that took two decades to realize.

Gender equality is not the only type of diversity we need to strive toward in our global health leadership however. Diversity in global health leadership must also focus on inclusion of people from different ages, race and ethnicity, sexual orientation, social class, geography, religion, and other characteristics of personal identity.  As a woman and a first-generation Filipino-American working in global health in the United States, I often find myself at global health and public health conferences and meetings wondering why there are very few leaders that encompass the diversity that I represent on stage (and occasionally even in the audience). The people who make the decisions with the biggest impact in global health must reflect the diversity of the people we serve.  

Learning from, understanding, and seeing the world through another person’s point of view is at the heart of working in global health and a driving reason for why I chose to work in this field. In order to truly reflect the diversity of this field though, the definition of diversity itself needs to go far and beyond the characteristics of one’s personal identity. To fully be inclusive, we must also be open to learning from, understanding, and seeing the world through the perspectives of individuals in the global health workforce with diverse backgrounds, life experiences, and competencies. Our field could benefit from the ideas of diverse individuals in solving some of the world’s most pressing global health problems. These ideas cannot always come out of our own echo chambers. 

Achieving diversity in the global health workforce is everyone’s job. It requires each one of us to recognize and overcome the personal biases (whether they are subconscious or not) which prevent us from hiring and working with more diverse talent. For those of us responsible for making decisions, we must work to create policies at all levels which not only promote but require inclusion. It’s only then that we can achieve true diversity in our workforce and our leadership. It’s only then that we can progress further in achieving health equity.

Stay tuned for part two of my series on Achieving health equity in global health through workforce diversity in which I will discuss different ideas for how we can achieve diversity in the global health workforce.

Global News Round Up

Politics & Policies

In a world with no dearth of global challenges or domestic health issues to address, why should countries, in particular bilateral donor countries, care about preventing epidemic threats in other countries?  The moral argument is clear-cut: Epidemics cost lives—in some countries, much more than others.

The Environmental Protection Agency (EPA) announced on Thursday it will scrap Obama-era rules governing coal ash disposal. The changes would provide companies with annual compliance cost savings of up to $100 million, but environmentalists warn that doing away with the regulations risks poisoning clean drinking water for millions of Americans and pollute already-endangered ecosystems.

Programs, Grants & Awards

Malawi is the first country in Africa to use the newly approved typhoid vaccine. About 24,000 children are set to take part in the clinical trials to test efficacy and cost-effectiveness of the vaccine.

The 5th Global Symposium on Health Systems Research will be held in Liverpool, UK from October 8-12.

The Dartmouth Institute’s accelerated on-campus Master of Public Health program is designed to help you develop or advance your career while gaining a rigorous understanding of: Epidemiology and biostatistics, decision analysis, improvement and innovation in health systems, healthcare finance and payment systems and shared decision-making.


More than half of gun owners do not safely store all their guns, according to a new survey of 1,444 U.S. gun owners conducted by researchers at the Johns Hopkins Bloomberg School of Public Health.

In the present study we described the protein level of C1q production and its gene expression in the peripheral blood and skin biopsies in patients with ENL reaction and lepromatous leprosy (LL) patient controls before and after treatment.

Cholera remains a persistent health problem in sub-Saharan Africa and worldwide. Cholera can be controlled through appropriate water and sanitation, or by oral cholera vaccination, which provides transient (∼3 years) protection, although vaccine supplies remain scarce. We aimed to map cholera burden in sub-Saharan Africa and assess how geographical targeting could lead to more efficient interventions.

Crifasi, 34, is part of what she calls “the large moderate swath that is invisible”: those who believe the Second Amendment protects citizens’ right to have a firearm in their home, but also believe that right should be regulated by effective, evidence-based gun policy.

Diseases & Disasters

For a long time, researchers have found it difficult to explain exactly what the Obesity Paradox is, dumbfounded by the notion that putting on excess weight somehow adds extra years to one’s life. The answer? Easy. It’s simply not true.

Diabetes – or uncontrolled blood sugar levels – is normally split into type 1 and type 2.
But researchers in Sweden and Finland think the more complicated picture they have uncovered will usher in an era of personalized medicine for diabetes.

Brazil is suffering its worst outbreak of yellow fever in decades.  The virus, which kills 3 to 8 percent of those who are infected, is now circling the megacities of Rio de Janeiro and São Paulo, threatening to become this country’s first-blown urban epidemic since 1942.


Not very far away, in Malawi, a drone must have taken off with a cargo of a blood sample for testing HIV infestation of an infant. Usually, it takes 23 days to get the diagnosis done and treatment rendered.  But the drone would make this possible in a few days.

Sub-Saharan Africa is leveraging emerging technologies to improve access to basic provisions to reduce maternal and neonatal mortality.

Environmental Health

Penguins preserve records of Antarctic environmental change.  The bird’s feathers and eggshells contain the chemical fingerprints of variations in diet, food web structure and even climate, researchers reported February 12 at the American Geophysical Union’s 2018 Ocean Sciences Meeting.

Children as young as 4 years in the Democratic Republic of Congo work at cobalt mines, a critical component of lithium-ion batteries. Chronic exposure to cobalt  dust or fumes poses a serious threat to health and wellbeing.

Equity & Disparities

While both income inequality and prevalence of cardiovascular (CVD) risk factors rose in South Africa, the changes in district level GINI coefficients were not significantly associated with changes in CVD risk factors, a new study shows.

Guatemala has the world’s third highest rate of femicide due to domestic violence and health professionals in the country are taking a stand against domestic abuse.

Maternal, Neonatal & Children’s Health

Highly detailed maps show that while there have been improvements in childhood malnutrition, many African nations are set to miss the 2030 SDG targets on malnutrition.

Taking a daily fish oil capsule during pregnancy and the first few months of breastfeeding may reduce a baby’s risk of food allergy, research suggests.

A lack of iodine in pregnancy and early childhood puts nearly 19 million babies around the world at risk of permanent but preventable brain damage every year, a new report has warned.

Ten years ago, a South Asian girl’s risk of getting married as a child was about 50%, but now that has fallen to about 30%.  A UNICEF release Tuesday attributed the progress in India to increasing rates of girls’ education, government investments and public messaging around the illegality of child marriage.

Action Alert: Call your senators today and urge them to lift the ban on CDC research on gun violence

Sent on behalf of Paul Freeman, IH Section, Action Board

In 2016, the scientific community labeled gun violence a public health crisis and called for a greater public health response including federal research. We desperately need action on gun violence and prevention, but evidence-based decisions can’t be made because of an anti-science ban on research at the Centers for Disease Control and Prevention (CDC)

Call your senators today and urge them to lift the ban on CDC research on gun violence.

Congress is working right now to put the finishing touches on its spending bill, which means that now is the perfect time to ask your senators to lift the ban on gun violence research at the CDC.
Call 855-589-5698 to reach the Capital switchboard and Press 1 to connect to your Senators. Dial in again and Press 2 to connect to your Representative.
Example Script

Hi, my name is ______, and I’m calling from [town/city]. 

I’m calling to express my strong opposition to the budget rider that bans the Centers for Disease Control and Prevention from researching gun violence. 

With deaths and injuries mounting from gun violence in our schools and communities, we need the federal government to study this problem and offer effective, evidence-based solutions to this crisis.

Putting our public dollars behind this problem is critical – we cannot continue to offer only thoughts and prayers, we must act. 

I urge [Senator X] to remove the anti-science rider that prevents the CDC from conducting research on gun violence from the spending bill. 

Thank you for your time.

IF LEAVING A VOICEMAIL: please leave your full street address to ensure your call is tallied

Gun violence is a leading cause of premature death in the U.S. Guns kill almost 30,000 people and cause 60,000 injuries each year. As a longtime advocate for violence prevention policies, APHA recognizes a comprehensive public health approach to addressing this growing crisis is necessary.

The issue of gun violence is complex and deeply rooted in our culture, which is why we must take a public health approach to ensuring our families and communities are safe. We must place a renewed emphasis on improving gun injury and violence research. Ongoing work is needed to ensure firearms do not fall into the wrong hands and to expand access to mental health services to those who need it most.

If you are interested in a sample op-ed, letter to the editor or technical support to help reach your local media, please contact APHA Media Relations.

Visit APHA’s website to learn more about this issue and how you can take action.