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.

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”