England, Scotland and Wales will end up with divergent rules on the use of HIV-preventing drugs, after a recommendation against providing the drugs on the NHS from the Welsh medicines advisory body.
Pre-Exposure Prophylaxis (PrEP) drug Truvada can drastically reduce people’s chances of being infected with HIV, and is available in a number of countries to at-risk groups including sex workers, gay men, and people in serodiscordant relationships.
Health experts say rolling out PrEP in the UK would be cost-effective if it leads to even a small reduction in HIV infections, as the lifetime cost of just one HIV infection can in excess of £300,000.
Due to devolution of healthcare, PrEP provision is being separately assessed in England, Wales and Scotland.
Scotland has become the first part of the UK to approve the use of PrEP as HIV prevention, with the Scottish Medicines Consortium giving the green light last month.
In England, PrEP will be made available to at-risk gay men, but only through a trial set to be rolled out at sexual health centres this summer.
Meanwhile in Wales, the All Wales Medicines Strategy Group today recommended against provision on the drug on the NHS – meaning three drastically decisions on the drugs in the three nations.
In its report, the body expressed concerns about the cost-effectiveness of the drug, and worries that patients would not be protected if they do not consistently adhere to taking the medication.
The body’s recommendation on the issue is not final, however, and activists have appealed to the Welsh government to look at all the evidence.
Deborah Gold, Chief Executive of the National AIDS Trust, said: “[This decision] is a serious disappointment. It flies in the face of the evidence that PrEP approaches 100% effectiveness in preventing HIv and is also cost-effective when provided to those at risk.
“Not providing PrEP will mean there are people in Wales who become HIV positive who would not have done had PrEP made available.
“We urge the AWMSG to think again. Wales is in danger of being left behind in the fight against HIV.”
Sarah Fuhrmann, National Director for Terrence Higgins Trust in Wales, said: “We are disappointed by this short-sighted recommendation to deny PrEP to people at risk of HIV in Wales.
“For every person who receives an HIV diagnosis, the Welsh NHS will pay on average £360,000 in lifetime treatment costs. PrEP can save the NHS this money in the long term, whilst taking us one step closer to ending the HIV epidemic.
“This recommendation could mean a wasted opportunity to tackle the HIV epidemic in Wales, where investment in HIV prevention has been patchy at best, and where late HIV diagnosis rates are the highest in all of the UK.
“This is all the more disappointing so soon after Scotland made history by becoming the first UK country to fund PrEP on the NHS.
“We realise this is not the final decision, but if acted upon, this advice would lead to a postcode lottery within the UK, with major inequalities between borders in terms of who is protected against HIV.”
Nick Baker of gay men’s health charity GMFA said: “GMFA are disappointed by the recommendation today from the All Wales Medicines Strategy Group (AWMSG) not to recommend that PrEP should be made available for the most at risk in Wales.
“We have already gone through a major trial by the PROUD study, and over the past year we have seen statistics that prove PrEP works and is helping in the fight against HIV.
“In some cases, GUM clinics have seen a 40% drop in new HIV infections, and an independent review commissioned by the Welsh Government has also shown PrEP to be highly effective.
“We are calling for the AWMSG to reconsider and that there be a united approach to making PrEP available to all those who need it in the UK. Following Scotland’s decision to approve PrEP on the NHS earlier this month HIV prevention should not become a postcode lottery.”
He added: “Going forward, we need to make sure PrEP becomes free to anyone who feels they are at risk. Too many gay and bisexual men are becoming HIV-positive and we now have a tool that can prevent new infections.
“Every gay and bisexual man living in the entire UK deserves the right to access PrEP for free on the NHS. It’s time this became a reality.
“Too many gay and bisexual men are becoming HIV-positive and we now have an additional tool – along with condoms and regular testing for HIV and other STIs – that can prevent new infections.”