MPs warn of ‘cliff-edge’ in access to HIV prevention pill PrEP in open letter to Public Health Minister calling for ‘urgent action’
Today (19 December), MPs and peers from across Parliament have published an open letter calling on public health minister Steve Brine MP to urgently expand access to HIV prevention pill pre-exposure prophylaxis (PrEP) in England.
PrEP is currently available in England via a capped 13,000 place trial – but it looks highly likely that all places for gay and bisexual men will be full by early 2019. Despite this group making up more than half (53%) of the 4,363 new HIV diagnoses in 2017.
PrEP is almost 100% effective when taken as prescribed, but some gay and bi men have already been turned away in parts of the country where trial places are full with individuals going on to be diagnosed with HIV.
The 14 MPs and peers include lead signatory Lloyd Russell-Moyle MP, who last month revealed he’s living with HIV in a speech to the Commons, and Brighton Pavilion MP Caroline Lucas, whose constituency has one of the highest prevalences of HIV in the country.
Lord Michael Cashman, a Terrence Higgins Trust patron and Stonewall founder, is a signatory. Lord Guy Black, the first openly gay Conservative peer and patron of Terrence Higgins Trust, has also given his support.
In the letter, the MPs and peers state “We are writing to you to seek urgent action regarding the national PrEP Impact Trial” where “demand for the trial has far outstripped availability of places”. It continues, “This cliff-edge scenario is simply not an option.”
Infection with HIV after PrEP refusal already reported
On the need for urgent and decisive action, the letter says, “There has already been one report in the media concerning an adult becoming infected with HIV after being refused access to PrEP via the Impact Trial due to there being no places available at their local clinic. This is unacceptable and we risk failing other gay and bisexual men if the current situation continues.”
The MPs and peers also criticise the number of trial sites yet to open, despite being 14 months into the trial. It says, “This is perpetuating regional health inequalities, in particular among those living in the north of England.”
The move by MPs and peers has been welcomed by leading HIV and sexual health charity Terrence Higgins Trust, which is urgently calling for an expansion to the trial and then for PrEP to be made routinely available on the NHS in England.
Uncapped in Wales, freely available in Scotland
PrEP is already available on the NHS in Scotland and via an uncapped study in Wales. In the letter, MPs and peers said “England must not lag behind” and “PrEP must be given a long-term home as part of existing HIV prevention services”.
The letter is signed by Lloyd Russell-Moyle MP, William Wragg MP, Dame Caroline Spelman MP, Caroline Lucas MP, Peter Kyle MP, Ben Bradshaw MP, Helen Hayes MP, Paul Williams MP, Catherine West MP, Norman Lamb MP, Sarah Champion MP, Lord Michael Cashman, Baroness Liz Barker and Lord Guy Black.
Ian Green, Chief Executive at Terrence Higgins Trust, said, “We welcome cross-party support from MPs and peers on this hugely important issue. It’s unacceptable that people who have been denied access to PrEP in England have gone on to be diagnosed with HIV. PrEP is highly effective at preventing HIV and we must fully utilise it in England in order to achieve our ambitious aim of ending new HIV transmissions.”
Lloyd Russell-Moyle, Labour MP for Brighton Kemptown, said, “During my speech in Parliament last month, I called on the Government to take immediate action to avoid this cliff-edge scenario. We know of people who have become infected with HIV because they cannot access this HIV game-changer. I want to see PrEP have a long-term home as part of sexual health services, but in the meantime, NHS England and local authorities must act now and agree to increased places on the trial.”
Caroline Lucas, Green Party MP for Brighton Pavilion, said, “It is dangerous and short-sighted of the Government to withhold PrEP from those most at risk of HIV. When taken as prescribed, PrEP is almost 100 per cent effective at stopping HIV – so Steve Brine should urgently ensure NHS England and local authorities add new places to the trial.”
William Wragg, Conservative MP for Hazel Grove, said, “Increasing places on the PrEP Impact Trial immediately is an important and urgent step the Government can take to prevent HIV transmissions. It will bring immediate benefits to those in need of PrEP and who are at risk today, as well as longer-term benefits to both public health and the public purse, by preventing HIV transmissions and the consequential costs of life-time treatment.”
The letter in full:
We are writing to you to seek urgent action regarding the national Pre-Exposure Prophylaxis (PrEP) Impact Trial. As you will be aware, demand for the trial has far outstripped availability of places. Since the start of the trial in October 2017, nearly 10,000 places have been filled, and despite an increase of 3,000 places for gay and bisexual men, it’s forecast that all those places will be full by early 2019. This cliff-edge scenario is simply not an option.
Last month the UK met the UNAIDS 90-90-90 targets which positions us as a leading nation in the response to HIV. Access to PrEP has ultimately played a crucial role in reducing new infections but artificially restricting this access undermines efforts to reach zero new HIV infections.
There has already been one report in the media concerning an adult becoming infected with HIV after being refused access to PrEP via the Impact Trial due to there being no places available at their local clinic. This is unacceptable and we risk failing other gay and bisexual men if the current situation continues.
There are also a number of trial sites that have yet to open, despite being 14 months since the trial commenced. This is perpetuating regional health inequalities, in particular among those living in the north of England.
When taken correctly, PrEP is 100% effective at stopping HIV. Other UK home nations have taken steps to give PrEP a home on their respective NHS; England must not lag behind.
We are therefore calling for an immediate increase in places on the Trial so no one is turned away from accessing PrEP, and a timetable for getting to routine commissioning of PrEP to be agreed between NHS England and local authorities. PrEP must be given a long-term home as part of existing HIV prevention services.
Over the past few weeks, both you and the Secretary of State for Health & Social Care have made references about the need to reach zero new HIV infections here in the UK, which is welcome. However, PrEP remains a key missing piece of our response to HIV and continues to fundamentally undermine our ability to reach zero new HIV infections.
You said in a recent Adjournment Debate on HIV that you were in listening mode regarding PrEP. We therefore urge you to listen to our concerns with urgency and prevent this impending cliff-edge scenario and ensure there is access to PrEP for all those groups who could benefit from it, including women and BAME communities.
Lloyd Russell-Moyle MP (lead signatory)