GayNZ Logo & Link
Wednesday 28 June 2017

PrEPping Scotland - And Wales?

Posted in: Health & HIV
By Craig Young - 4th May 2017


While the devolved National Health Service England and Welsh medicine regulators are obstructing the public funding of PrEP (post-exposure prophylaxis) in the context of HIV prevention, NHS Scotland has just authorised its distribution and public funding across the northernmost component of the United Kingdom.

On April 10 2017, the Scottish Medicines Consortium announced that NHS Scotland would fully fund the popular prophylactic combination therapy option, placing it ahead of NHS England, which is still awaiting more clinical trial data before it makes its decision. Dr Alan McDonald, chair of the Scottish Medicines Consortium, said that given that combining PrEP and condoms were the most effective option to curtail HIV infection within gay men and other groups that may potentially undertake risky sexual practices and that the Scottish Government was committed to curtailing the HIV epidemic, they were in full accord with Scottish HIV prevention groups. Previously, THT Scotland, HIV Scotland, the Waverley Centre and National AIDS Trust had gotten together in the PrEP4Scotland Coalition to lobby for such an outcome.

The happy outcome may have been influenced by the Scottish Health Promotion Network's paper PrEP in Scotland, produced by their PrEP Short Life Working Group in October 2016. That report estimated that 1700-1900 men who have sex with men would be able to access the combination therapy, and if there was an estimated 58% uptake of the option, that would mean 1000 men who have sex with men would benefit.

The Terrence Higgins Trust Scotland and HIV Scotland both welomed the decision, noting that it would vastly improve access to the medication and therefore reduce HIV infection amongst Scottish gay, bisexual and men who have sex with men, as well as saving Scotland's National Health Service an estimated three hundred and sixty thousand pounds through its proven protective usefulness in preventing HIV infection.

Scotland's fourteen health boards will now roll out PrEP access over the next three months. London's Gay Men's Fighting AIDS (GMFA) also welcomed the move, although asked why NHS England was still insisting on a three year trial, even if it was funding 10,000 places on that trial, given both abundant clinical data from other large scale PrEP clinical trials and NHS Scotland's commendable initiative on the issue.

NHS England was forced to fund the trial after court action from the UK National AIDS Trust compelled it to do so, after obstructing access beforehand. Consequently, south of Hadrian's Wall, gay men at risk of HIV infection have had to pay for the unsubsidised combination therapy out of their own pockets or sidestepped the glacial NHS approach through ordering PrEP from overseas jurisdictions, with the risk of adulteration or substitution with placebos in that context despite paying thousands of pounds for it.

But while Scotland has decided to fully fund Truvada/PrEP, Wales may not decide to do so. The All Wales Medicines Strategy Group has advised NHS Wales not to prescribe PrEP to patients in the principality. However, this decision is only a recommendation and Wales' devolved government is under no obligation to follow their advice.

Gay Men Fighting AIDS is not happy at this turn of events and Nick Baker, their Outreach and Communication Manager has advised the All Wales Medicines Strategy Group to think again, citing the PROUD clinical trial , an independent Welsh PrEP assessment which yielded positive results. Deborah Gold, director of the UK National AIDS Trust, concurred and urged reassessment of the highly positive available data from large scale clinical trials, as did Sarah Fuhrmann, director of the Terrence Higgins Trust Wales.

However, Wales' devolved government has decided to fund an NHS PrEP clinical trial of its own. The trial will last for three years, which means that its recipients will receive the drug over that period. Terrence Higgins Trust Wales applauded the decision to fund the clinical trial, and Wales' regional government for disregarding the All Wales Medicine Strategy Group opinion that it not fund the HIV prevention and prophylaxis drug in its region.


David Hudson: "Scotland becomes first country in UK to make PrEP available through the NHS" Gay Star News: 10.04.2017:

"Scotland will fund pre-exposure prophylaxis for people at high risk of HIV" Pharmaceutical Journal: 12.04.2017:

PrEP in Scotland (Scottish Health Promotion Network, October 2016):file:///C:/Users/Welcome/Downloads/Scotland%20PrEP%20report%20October%202016.pdf

Gus Cairns: "PrEP is approved in Scotland" AIDSmap: 10.04.2017:

Lewis Corner: "Wales advised not to fund PrEP on the NHS" Gay Times: 26.04.2017:

Nick Duffy: "Postcode lottery for HIV-preventing drugs as England, Scotland and Wales split on the issue" Pinknews: 26.04.2017:

Lewis Corner: "Welsh government announces plans to trial HIV prevention drug PrEP on the NHS" Gay Times: 27.04.2017:

Craig Young - 4th May 2017

   Bookmark and Share