Pre-Exposure Prophylaxis

NHS England’s – and as a consequence, the Government’s – refusal to commission Pre-Exposure Prophylaxis (PrEP) is as short-sighted as it is stupid. Around seventeen people in the UK are newly diagnosed with HIV every single day, and we have available to us a drug, Truvada, which has been shown to reduce the risk of contracting HIV by between 90 and 99 per cent. In a large international study, those gay men that took at least four doses a week saw 96 per cent fewer infections. A UK study saw a figure of around 86 per cent. Whichever figure you accept, it’s a significant impact in ending the transmission of HIV, and the closest thing we currently have to a cure.

Now I accept Truvada is not cheap – I hate talking about healthcare in purely economic costs (it’s people’s lives we are really talking about here) but even in crude economics, the lifetime costs of treating somebody with HIV could reach around £380,000. By limiting PrEP prescription to those most at risk of contracting HIV, we could drastically reduce the number of infections and the associated lifetime costs.

Now the Government claims that the cost may have to be absorbed by existing local authority public health budgets – which have been slashed repeatedly by the very same Government. And that causes an additional issue: assuming councils did this, ALL of the costs of prescribing PrEP would fall to local authorities, whereas the NHS would be the beneficiary of ALL of the financial savings in hospital treatment, care and lifetime treatment no-longer being necessary. The Local Government Association has rightly called the decision an “attempt to create a new and unfunded burden on local authorities.” And some local authorities would clearly have to devote far more resources than others – authorities such as Manchester and Brighton & Hove, and other similar areas with large LGBT, MSM or African BAME communities, would almost certainly have to spend more than other councils.

The Labour Party has consistently called on the Government to reconsider this counterintuitive position. In my Urgent Question to the Public Health Minister, I made the point that the Health Secretary could delegate the power to commission PrEP to NHS England via Section 7a of the NHS Act 2006, but that this would need to be accompanied by appropriate funding. This, in our view, proves that the Government has made nothing more than a political decision, and is hiding behind legal advice.

The UK was once a world leader in the fight against the HIV epidemic, and yet now it’s lagging behind other countries in Europe. Offering PrEP to people at risk of infection would help us to significantly turn the tide in this fight. It is time for the Government to use its section 7a powers and put this situation right.