When you look at the effects of HIV over the last 35 years, the numbers are staggering. The virus has killed over 35 million people across the world to date, according to the World Health Organisation. It has largely affected gay men, since a man who has unprotected anal intercourse is at an especially high risk, as well as communities in certain parts of Africa, where healthcare infrastructures have failed to control the spread of the virus. For women of reproductive age (ages 15–49), HIV/AIDS is the leading cause of death. But really, anyone can be susceptible to HIV/AIDS.
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That is, until now. In the last few years, scientists have a developed a "miracle" HIV prevention drug. Known as PrEP – short for “Pre-exposure prophylaxis” – it can be given to people who are at high risk of contracting HIV before it ever happens, meaning that, even if they have unprotected sex with a partner who is HIV positive, or put themselves in another high risk situation, doctors say there’s a 99% guarantee rate that they won’t contract the virus.
Great, right? Only, the bad news is... PrEP is not available to people everywhere. Far from it. It is currently only available through healthcare systems in the U.S., Canada, France, Israel and Kenya. Now consider that AIDS organisation UNAIDS is warning of a dramatic resurgence of the virus. According to their statistics, 37 million people have AIDS today, but only 17 million are getting antiretroviral drugs – the treatment which 1. Keeps them alive and 2. Stops the virus from being infectious. We are once again at crisis point.
The International AIDS Conference in Durban, South Africa, last month, threw up a few reasons for why the AIDS epidemic is slipping out of our control. According to the Guardian, these were; increasing levels of resistance to antiretroviral drugs, a lack of proficient funding into new HIV research, the high cost of treatment, the stigmatisation of the virus, and “the lack of power many women have in sexual relationships.” All of these issues apply to people living with AIDS in the UK, of which there are over 100,000.
So, could PrEP be the answer, reducing the number of diagnoses in the UK and beyond? Below, six passionate women working in the field of HIV shed some light on the problem...
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How PrEP works
Terri L. Wilder is an HIV/AIDS Education Director in the U.S., where PrEP is more accessible than the UK. She explains how it works over there: “People who are interested in PrEP find a medical provider who is willing to write a prescription for it. The medical provider and the patient have a discussion and determine if the patient is a good candidate for PrEP. If the person is a good candidate, the medical provider tests the person for HIV. If the HIV test comes back negative, the person can start on PrEP.” Once you’ve got your PrEP prescription written, you’ll take a daily dose of it and visit your doctor regularly for check ups. Side effects are thought to be minimal. The whole thing might sound time consuming, but according to AIDS organisation the Terrence Higgins Trust, “People living with HIV need to take lifelong treatment. PrEP consists of fewer drugs and people only need to take it during periods when they are at risk of HIV.”PrEP’s Potential
“PrEP has the potential to turn the tide on the HIV epidemic,” explains Deborah Gold, Chief Executive of the National AIDS Trust. “Despite the incredible work of three decades in HIV prevention, the numbers who acquire HIV in the UK continue to rise. Condoms remain a crucial mainstay of intravenous prevention, but the evidence shows that condoms alone will not end HIV.” Deborah says that we “need to try something else”, and believes PrEP could be that change. Likewise, Laura, who is 38, works in social care, and is HIV Positive, desperately wants to see PrEP come to market in the UK. “I am a Person Living with HIV and if I had the option of taking PrEP before I was diagnosed, I would have. The increase in cases of HIV diagnosis shows that current prevention methods are not enough.” For Laura, a young African woman living in London, PrEP would mean “increased control and sexual health choices for young women of child bearing age who intend to have children, and for who there may be episodes where we choose not to use a condom because we would like to conceive.” Just one example of a scenario in which PrEP could change people's lives.AdvertisementADVERTISEMENT
Why PrEP is unavailable on the NHS
If PrEP is so promising, then why can’t we get it? The crux of this issue comes down to pricing. The drug company that has developed PrEP, Gilead, have placed the cost of it so high (in order, they say, to recoup the costs of development) that the NHS claim they can't justify paying for it. This has led to an ongoing fight between HIV activists and charities, the NHS, and the drug company. As of June, reports the BBC, an NHS watchdog has even been asked to evaluate the NHS’s decision not to onboard PrEP. As it stands, Gilead want to charge around £355 per person per month in the UK for a course of PrEP. In the mean time, unsurprisingly, the disparity between cost and need is aggravating people. Donna Riddington, 43, is an artist and HIV activist living in London. She says: “As someone who watched friends die one after the other through the early 90s from AIDS-related illnesses, to see pharmaceutical company’s greed again standing in the way of essential medicine to prevent HIV infection is a disgrace.” Dr Sarah Fidler, Consultant in HIV medicine and Senior Clinical academic at Imperial College London agrees with Donna. "PrEP is an essential part of all HIV prevention approaches and must be made available now for those in need,” she states. “The immediate barriers to widespread PrEP implementation are unacceptable drug pricing and artificial division of the NHS funding pathways.” In other words, the NHS are saying they can’t afford it, but Dr Fidler, for one, believes there is a way. What pisses a lot of people off in the PrEP conversation is the widespread belief that, if this HIV prevention drug were properly rolled out on the NHS, it would not only reduce the number of HIV diagnoses, but cost the tax payer less money in the long run. In the words of HIV drug pharmacist Collette Brydon, “PrEP should be funded as a vital public health initiative especially as we all know the costs of prevention are tiny compared to HIV treatment – think of the thousands of pounds which could be saved.” To make matters worse, as long as PrEP is not available via the NHS, people will find other ways to get hold of it. That could mean buying dodgy stand-ins on the web. “Without PrEP on the NHS,” explains Deborah Gold, “we won’t be able to ensure fair and equal access, and we risk an unregulated market buying PrEP from abroad, which carries risk of buying the wrong drug, drug resistance and wrong dosing. The moral imperative for PrEP is overwhelming.”AdvertisementADVERTISEMENT