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Illustration Callum Abbott

New research highlights the inaccessibility of PrEP

PrEP became available on the NHS in England in 2020, but this worrying new report finds that accessing the preventative HIV drug is an uphill battle

New research has spotlighted the difficulties people are facing when trying to access PrEP in England. This comes as the latest data from the UK Health Security Agency shows that seven people are diagnosed with HIV every day in England.

PrEP – aka pre-exposure prophylaxis – reduces the risk of getting HIV from sex by about 99 per cent when taken as prescribed. Campaigners rejoiced when PrEP became available on the NHS in England two years ago as part of the government’s plan to end new HIV infections by 2030. Still, this worrying new research finds that accessing PrEP is far from straightforward.

The research was conducted by National AIDS Trust, Terrence Higgins Trust, PrEPster, Sophia Forum and One Voice Network. The report spotlights some troubling findings: namely, that 65 per cent of people who want to access PrEP are unable to do so.

The most common challenge in accessing PrEP services reported was trying to book an appointment online (40 per cent), followed by difficulties getting through to clinics by phone (30 per cent). Meanwhile, nearly a quarter of respondents said they were turned away due to a lack of available appointments. Additionally, more than half of those seeking PrEP appointments at sexual health clinics wait more than 12 weeks to be seen.

The most challenging experiences for potential PrEP users across all regions were faced by those trying to access first-time PrEP (68 per cent), followed by those trying to get repeat prescriptions for NHS PrEP (24 per cent), and those trying to restart PrEP after taking a break from it (8 per cent). 

Location is one factor which impacts how accessible PrEP services are. The regions where people were most commonly turned away from PrEP services were the north-west (21 per cent), London (18 per cent), and the south-east (11 per cent). Worryingly, the research flagged that these are the three areas of England with the highest levels of identified PrEP need.

Disturbingly, gender and race also appear to be barriers when it comes to accessing PrEP. Less than one per cent of the respondents captured by our survey were heterosexual, and only 2 per cent were Black. According to the report, this suggests “that many groups at-risk for HIV are not accessing PrEP, including women and ethnic minorities”. Not a single local authority reported that they had more than five women that were PrEP users, despite women being an at-risk group

This is impacting potential PrEP users massively – 48 per cent reported mental health-related issues whilst trying to access PrEP, including stress and anxiety. Additionally, from 555 survey respondents who provided further free text responses, 21 per cent reported impacts on their dating or sex lives while waiting to access PrEP services, with around 10 per cent indicating that they abstained from sex while waiting. “Forced abstinence is not a solution to these issues,” the report reads. “Instead of requiring people to change their sexual behaviour as a result of having been unable to access PrEP, provision needs to be upscaled across the UK to ensure that people are able to have the sex they want safely, with access to the most effective HIV prevention tools available.”

“PrEP should be easy to give to anyone who needs it,” says Deborah Gold, Chief Executive of National AIDS Trust. “Clinics are under immense strain due to COVID-19 and are now having to deal with the country’s monkeypox response without additional funding and support. That means services face massive backlogs.”

“It’s the government’s responsibility to fix this,” she continues. “And without action, we cannot meet the national objective of ending HIV transmissions by 2030.”

The coalition of organisations who compiled the research are now calling on the government to improve access to PrEP and cut waiting times, as well as calling for a dedicated PrEP Action plan as promised in the government’s HIV Action Plan which was published on World AIDS Day in 2021. “Sexual health clinics must be resourced to meet the existing high demand for PrEP but they also shouldn’t be left to go it alone,” Gold adds. “Access and reach could be dramatically improved if it were available through other health services, such as community pharmacies.”