PrEP: the HIV game changer

Local government has played a key role in helping reduce the number of new diagnoses of HIV – and the roll-out of PrEP could help us reduce infection further

Each year, 1.7 million people across the world are newly infected with HIV – and more than 4,484 in the UK alone.

According to Public Health England, an estimated 103,800 people were living with HIV in the UK in 2018, with 7,500 of those unaware of their infection. It costs almost £380,000 to treat one person with HIV across their lifetime.

In January 2019, the Government committed to ending transmission of HIV in England by 2030, and ultimately ending an epidemic that has affected so many in this country, and millions more across the world, since HIV first emerged in the early 1980s.

Over recent years, we have seen a welcome decline in the number of people diagnosed with HIV, although the decline is slowing or starting to plateau. It has been driven by falls in the number of new diagnoses among gay and bisexual men.

This fall was achieved thanks to the hard work and commitment of many across the system, from local government sexual health commissioners to the activists working in and for the communities they represent, supporting a combination of HIV prevention strategies.

These include condom use, information and advice, including through schools, alongside increasing HIV testing that has led to earlier diagnosis. Once people know they have HIV, they can be linked into care and offered treatment. Successful HIV treatment – ‘treatment as prevention’ – means people living with HIV cannot pass on the infection to others. 

While no single approach on its own is a ‘silver bullet’, a key part of HIV prevention is pre-exposure prophylaxis or PrEP, a daily medication to help prevent HIV that is recommended for people at high risk. PrEP has the potential to help us reduce infection still further, getting us closer to zero transmission.

A PrEP impact trial – the largest single study of its type in the world – began in October 2017, and will help inform the potential roll-out of PrEP nationwide later this year. So you need to get ready for PrEP to be made routinely available via your local authority-commissioned health service.

“We have seen a welcome decline in the number of people diagnosed with HIV

PrEP is also important for broader sexual health. It gives an opportunity for individuals at higher risk of HIV and sexually transmitted infection – some of whom will not have been accessing prevention services previously – to regularly engage with sexual health and health promotion services.

PrEP has undoubtedly attracted some moral panic. Yet the principle is not dissimilar to that of malaria-prevention drugs, and comparable with the function of vaccinations and immunisations.

Local authorities have invested hundreds of millions of pounds in offering sexual health services since taking over responsibility for public health six years ago, and we firmly believe that PrEP could significantly reduce levels of HIV in this country.

While we are pleased that the successful trial of PrEP is to be rolled out, there remain real concerns about the extra costs to already overstretched sexual health services provided by councils.

Through the LGA, we are calling on government to ensure that adequate funding is in place, accompanied by a firm guarantee that any unforeseen costs do not fall on already under-pressure councils. 

PrEP is a game-changer in preventing new HIV transmissions and a vital weapon in our prevention armoury, which could bring about an end to new infections within a generation. Is your council ready?

For more information about the LGA’s health work, please visit www.local.gov.uk/topics/social-care-health-and-integration. To find out about the PrEP trial, see www.prepimpacttrial.org.uk/

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