Terrence Higgins Trust, National AIDS Trust, PrEPster and 47 other HIV, health and equality organisations are today jointly calling for urgent action to ensure the benefits of the national roll-out of PrEP – the HIV drug – means “no community is left behind”.

The successful PrEP “IMPACT Trial” benefitted largely gay and bisexual men.  This life-changing drug is now free on the NHS in principle, but concerns exist whether the drug will be accessed by all who can benefit from it. This includes Black African people, women, trans people, younger and Black and minority ethnic gay, bisexual and other men who have sex with men groups. “Inequity in access to PrEP is not acceptable”, the statement says.

This joint statement by so many community organisations shows the level of concern about this issue and “seek[s] to address the structural inequalities that drive inequity in PrEP access … [including] socio-economic and cultural factors.”

The HIV sector and local government has called for the chancellor to provide at least £16m per year to local authorities in England to ensure “enhanced community mobilisation and engagement, especially for Black African men and women, women of other ethnicities, trans people, younger and BME GBMSM groups, and other underserved groups.” There is a real need, the statement says, to increase “awareness of PrEP in young people.”

Black communities risk being left behind on PrEP

Many people from the Black African community could benefit from the PrEP rollout but start from a disadvantaged position, with dire consequences.

“HIV Prevention England has found that Black African men and women are less likely to know about PrEP and may have misconceptions about what it means, who it is for and how to access it. This is despite making up 44% of new heterosexual HIV diagnoses in 2018. This is not equality.

One step towards improving greater and more equitable access would be to expand the NHS services that can provide PrEP such as specialist GP services and pharmacists in areas of high HIV incidence.  As the national PrEP guidance from BASHH and BHIVA states, “limiting provision of PrEP to level 3 sexual health clinics risks widening health inequalities disproportionately among black, Asian, and minority ethnic (BAME) population”’

Call to action

The signatories call for three immediate changes:

First, best practice must be championed in the system: “Between 2018-2019, a PrEP Commissioning Planning Group was established, jointly chaired by NHS England and the Association of Directors of Public Health and reporting to the Impact Trial PrEP Oversight Board. The group drafted a document: “Preparing for the commissioning of Pre-Exposure Prophylaxis (PrEP) in England: Recommendations of the PrEP Commissioning Planning Group”. This document was not published, yet it includes important recommendations around ensuring equitable access to PrEP in England that we believe the Government must address.”

Second: PrEP must be available “outside specialist sexual health services … and be undertaken by community organisations and non-GU clinicians … [including in] primary care (including non-traditional delivery e.g. app-based provision of GP services), maternity, and termination of pregnancy services”.

Third, the signatories are united in calling for “a national PrEP Equity Audit tool should be used to ensure that no communities are being left behind in accessing PrEP”.

The statement was devised by the Terrence Higgins Trust, National AIDS Trust, PrEPster, the Children’s HIV Association (CHIVA), the trans sexual health group cliniQ, the HIV positive women’s group Sophia Forum and One Voice Network for Black communities. 50 organisations in total have added their name to the statement. Individuals are being invited to add their name to the statement at: https://www.tht.org.uk/prep4all.

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