Less than 0.25% of people contracted HIV out of nearly 2,000 people who were at the highest risk of becoming infected with the virus after taking preventative drugs made available for the first time by NHS Scotland.
Campaigners who want to see HIV PrEP (HIV Pre-Exposure Prophylaxis) made similarly available elsewhere in the UK say that Scotland’s initial success “puts England’s sluggish delivery to shame”.
In July 2017, Scotland became the first country in the UK to make PrEP available free to those at the very highest risk of acquiring HIV sexually and who meet specific eligibility criteria, for example having a partner who has HIV. In clinical trials PrEP has been shown to reduce the risk of sexually transmitted HIV by 75-86%.
A report by NHS National Services Scotland into the first year of PrEP provision also revealed that more than 90% of those considered eligible for the drug came forward for prescriptions, and that one-fifth of those had never visited a sexual health clinic before.
NHS England has resisted rolling out PrEP because of the cost, although campaigners argue it is far cheaper than a lifetime of HIV treatment, which can cost £360,000. After losing to campaigners in the courts, NHS England has enrolled thousands of people in a major trial to answer “significant outstanding implementation questions”. PrEP is also available from sexual health clinics in Wales.
Prof David Goldberg, chair of Scotland’s HIV PrEP coordinating group, described the drug as a “game-changer” that was “very likely to reduce substantially the sexual transmission of HIV”.
He added that it was too early to draw any conclusions about the impact of PrEP on the transmission of other sexually transmitted infections such as gonorrhoea. Some health professionals have raised concerns that PrEP use may discourage people from using condoms.
Deborah Gold, chief executive of the National Aids Trust, which funded the court battle in England, said: “Scotland’s progress on PrEP … puts England’s sluggish delivery to shame.”
She added: “A fifth of people accessing PrEP attended sexual health clinics for the first time, which shows PrEP increases people’s engagement with sexual healthcare. This means that as well as bringing down HIV infection rates for the first time, PrEP may help us diagnose, treat and contain other STIs”.
Gold said there was still work to be done to make sure women and other groups could access PrEP: of the 1,872 individuals who were prescribed PrEP in Scotland during the first 12 months, 99% were men who have sex with men.
