In short, both, but the potential impact on HIV transmission in many people’s opinions far out ways the possible rise in other STIs. To understand this, however, more context is required on how PrEP works, who it can help, the current perceptions of it, and the current landscape of its availability.
What is PrEP?
PrEP or pre-exposure prophylaxis is a treatment which can be taken to radically reduce the chances of an individual contracting HIV. There are many ways it can be taken but the most common form is daily which when done consistently has been shown to have an effectiveness of 99% meaning the individual has a near-zero chance of contracting HIV.
This works by inhibiting HIV when it enters the bloodstream, and as a result preventing the infection from taking hold. The medication usually used here is the same as is usually used to treat individuals who have themselves contracted HIV, common examples of PrEP are Truvada and Descovy.
The availability of PrEP?
In the last few days there have been significant developments in the widespread availability of PrEP across the UK, with NHS England finally giving the green light to allow for unrestricted access to those at risk of contracting HIV from the 1st of October this year. However prior to this there was variable availability of PrEP depending on where in the country you reside. For example, in Scotland and Wales, it has been freely available for individuals deemed to be at risk of contracting HIV and who have recently tested negative since 2017. Access in England, and therefore to the majority of potential beneficiaries in the UK, lagged significantly.
Up to this point PrEP in England was primarily distributed through the impact trial, a large-scale trial of the treatment conducted across England providing access to 26,000 individuals. This was intended to determine the viability and cost-effectiveness of a full-scale rollout and was mainly focused on those most at risk of contracting HIV, gay and bisexual men.
While the trial served as a significant testbed for the wider roll-out of PrEP it has been far from controversy-free. On one side it left numerous people without treatment, and as a result, led to a significant number of individuals unnecessarily contracting HIV, with the MP Lloyd Russell-Moyle addressing the House of Commons to state that, “we now know of cases of young men who have tried to gain access to PrEP, who have been turned away and who have subsequently contracted HIV”.
On the other side of the debate, there have been objections about the necessity of PrEP through the NHS, as it can be purchased privately and would potentially come at the cost of other possible medications. However, the facts show that the cost of PrEP is far lower than the lifetime cost of treating an individual diagnosed with HIV.
Is PrEP viable for me?
If you are or you believe you may be at risk of contracting HIV then you should discuss this with your doctor or your local STI clinic as they will be able to provide you with more specific details relevant to your situation. However, in most cases, those who are the most likely to be able to benefit from the use of PrEP are MSM (men who have sex with men), particularly those who are less likely to use condoms.
Though an important factor to consider is that PrEP only reduces the chance of contracting HIV and provides no protection for other STIs, so using a condom is still recommended, especially when having sex with multiple partners.
Another element to take into account are the potential side effects of PrEP, though these are rarely severe, they have been reported. if you are on boarded on to PrEP Kidney function tests will be conducted through a clinic and should be requested if you purchase your PrEP privately.
How can I access it?
Now that PrEP is available in England you should be able to receive PrEP from your local STI clinic, however it is possible there will be a backlog due to significant upticks in demand. If you experience this and would like faster access you can look at resources like iwantprepnow, a site developed by PrEP users to facilitate access to affordable treatment in confidence.
Behavioural and Social Impacts
While wide-scale usage of PrEP is recent occurance there have been some signs that users may be more likely to partake in unprotected sex, and as a result, some studies have shown a rise in the number of other STIs in PrEP users. More evidence is still required to show a significant link between these occurrences but it seems very likely that the factors are related.
On the positive side, however, it has also been seen that individuals using PrEP have experienced a fall in anxiety related to contracting HIV. But again, further studies are required to extract more reliable insight regarding these findings.
Living with HIV today
To round this off I would just like to add some context around the state of HIV today. In nearly all cases HIV is entirely treatable and will not impact the life expectancy of the individual. Additionally, an individual living with HIV, when effectively taking treatment, can become undetectable, which means they have a low viral load and cannot pass on the infection to their sexual partners.
PrEP is a valuable tool to minimise the spread of HIV but it should not reinforce a stigma within our community. If the content in this article was new to you there is significantly more to learn on HIV and PrEP and I would be more than happy to point you in the right direction so please get in touch and have a look at the work we’re doing at troglo.io.