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UNITED STATES – MAY 08: Pharmacy technician Carolyn Van Syckle, of Feasterville, Pennsylvania, fills a prescription inside a Wal-Mart store in Trevose, Pennsylvania, U.S., on Thursday, May 8, 2008. Wal-Mart Stores Inc., the world’s largest retailer, posted first-quarter profit that rose more than analysts estimated after it cut prices on groceries and pharmacy items to lure consumers strained by higher food expenses and $3.70-a-gallon gasoline. (Photo by Mike Mergen/Bloomberg via Getty Images)
We can end new HIV cases in the UK by 2030. Here’s how

We can end new HIV cases in the UK by 2030. Here’s how

UNITED STATES – MAY 08: Pharmacy technician Carolyn Van Syckle, of Feasterville, Pennsylvania, fills a prescription inside a Wal-Mart store in Trevose, Pennsylvania, U.S., on Thursday, May 8, 2008. Wal-Mart Stores Inc., the world’s largest retailer, posted first-quarter profit that rose more than analysts estimated after it cut prices on groceries and pharmacy items to lure consumers strained by higher food expenses and $3.70-a-gallon gasoline. (Photo by Mike Mergen/Bloomberg via Getty Images)

The life changing drug PrEP must be rolled out in community pharmacies, as well as sexual health clinics, to reach all those who need it

Ending new HIV cases by 2030 is no longer a dream – it is a very real possibility. We have the knowledge and we have the tools to do it – the problem is only that access to them is unequal. If we fail to fix that inequality and to reach the life-changing 2030 goal, it will be a dereliction of responsibility.

If HIV cases are diagnosed and treated early, you are now no more likely to die than people of the same age in the general population. But diagnosis is not equal. Rates of late diagnosis are sky-high among heterosexual Black men. In 2019, 35 per cent of gay and bisexual men diagnosed were diagnosed late. The same figure for heterosexual men was 52 per cent. 

Why is this the case? One of the key tools in preventing HIV is PrEP (pre-exposure prophylaxis). It is a prevention pill, which is not a silver bullet, but when taken by HIV-negative people before and after sex it effectively reduces the risk of getting HIV. But while its use among gay and bisexual men (particularly in big towns and cities) is becoming ever more common, many other groups who could benefit still don’t know it exists, or don’t have fair access to it. I’m talking about women, Black African people, and other minorities.

That’s because PrEP is still, in practice, restricted. After years of campaigning by activists and organisations like us at t Terrence Higgins Trust, and a PrEP trial from NHS England (initially for 10,000 people, later expanded to 23,000) PrEP finally became uncapped in England in October 2020. That means it can now be distributed as a standard part of NHS care, bringing the country in line with Scotland, Wales and Northern Ireland. But that hard-won victory was just the start of PrEP’s potential. Yes, the cap on how many people can access the drug has been removed – but it is still only available via sexual health clinics. 

Many people will never set foot in a sexual health clinic. While we know that many gay and bisexual men use these services and have a solid awareness of PrEP, other groups (including Black African heterosexual men and women, as well as women more broadly) don’t. For example, gay and bisexual men accounted for 96 per cent of participants in the NHS England PrEP trial – just four per cent came from other groups.

We can see the impact of that unequal access to PrEP in the case rates. In the UK, new cases of HIV are declining much faster among gay and bisexual men than among women and Black African heterosexual men. In 2019, overall new HIV diagnoses fell ten per cent compared to 2018 – driven largely by the 18 per cent fall among cases in gay and bisexual men. Improvements in the new HIV cases contracted from heterosexual contact lagged behind – with just a six per cent drop.

That’s why Terrence Higgins Trust has teamed up with the National Pharmacy Association, as well as National AIDS Trust and PrEPster, to call on the government to pilot PrEP in primary care – including pharmacies. 

Many people who never visit sexual health clinics will routinely visit their local pharmacy or doctors’ surgery – usually conveniently located alongside other shops. Pharmacies in particular are an important part of the puzzle in towns and rural areas, where people are less likely to have access to other sexual health services. And they are an excellent source of education for communities like women and ethnic minorities for whom PrEP could be a highly effective way to stop HIV.

Piloting PrEP in primary care, including GPs and community pharmacies will mean more people who can benefit from PrEP will be able to access it. And it will enable pharmacists like me – who are already on the frontline of healthcare – to expand the help we already provide through sexual health prevention and treatment services, and advice. 

With the right resources in place to support the expansion on PrEP provision, we absolutely can play a vital role in accelerating the efforts to end new HIV cases by 2030. But this change needs to happen soon. The UK government has promised to end new HIV cases by 2030, but it has also missed many opportunities to root out the racial inequalities that exist in the national HIV epidemic. That’s why the government must now address inequalities in PrEP access within its HIV Action Plan, due to be released this World AIDS Day, on 1 December. 

So let’s get the tools of HIV prevention into community pharmacies – and let’s do it quickly. That clock to 2030 is already ticking. PrEP can no longer be the gay community’s best kept secret.

Photograph Getty Images

Ngozi Kalu is a researcher at Terrence Higgins Trust and a trained pharmacist.

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