Who should take the HIV prevention drug PrEP?

What is PrEP and how does it prevent HIV?

PrEP is a medication that prevents HIV transmission. When taken as prescribed - usually a pill taken daily - it’s almost 100% effective. It works by helping the body to produce antibodies which prevent HIV from replicating inside the body. Essentially, the drug stops the virus from crossing into the healthy cells and reproducing.

While it's possible to take so-called 'events-based PrEP' - when you take it as and when needed - daily dosing is generally considered more reliable.

Different PrEP delivery methods such as injectables and implants are also being researched. In 2021, the World Health Organisation recommended a new option called the vaginal ring for women at substantial risk of HIV acquisition¹.

Who should take PrEP?

Adam Freedman, senior policy and campaigns officer at the National AIDS Trust, says anyone who feels at risk of getting HIV could consider taking PrEP. It may be suitable for you if you are HIV negative or have sex in a variety of situations where condoms are not easily or always used.

"That said, there are higher rates of HIV among certain demographics, including gay and bisexual and other men who have sex with men, migrants, Black Africans, Black Caribbeans, and transgender people," he says. "Uptake of PrEP has been higher among white gay and bisexual men, which has led to a corresponding drop in new diagnoses," Freedman adds.

"However, uptake has been much lower among other groups. That’s why it’s so important to make PrEP more accessible for everyone who needs it."

Evidence from the UK PROUD study reported that PrEP reduced the risk of HIV infection by 86% for men who have sex with men². In 2021, however, NICE recommended promoting PrEP to several higher-risk groups, including HIV negative men who have condomless sex with other men and HIV-negative heterosexual men and women having condomless sex with partners who are HIV positive. It also suggested promoting PrEP among HIV-negative trans women at elevated risk of developing HIV through condomless sex³.

How to access PrEP

PrEP is available for free from sexual health clinics in England, Scotland, Wales and Northern Ireland.

"PrEP is available on the NHS, meaning everyone has the right to access it. If you want to start taking it, your first port of call should be your local sexual health clinic," says Freedman. "Lots of people choose to buy PrEP on the internet, which, while legal and typically safe, can be expensive. As we see it, no one should be forced to pay over-the-odds for a treatment which they’re legally entitled to receive from the NHS."

Why are people having problems accessing PrEP?

The UK Government pledged to end new cases of HIV infection by 2030, by scaling up HIV testing and increasing access to PrEP among at-risk communities. However, researchers have warned this ambition may be under threat because access to PrEP in England is far lower than it should be.

Of 1,120 people who tried to get an appointment to get PrEP between October 2021 and July 2022, around two-thirds (68%) encountered problems. More than one third (35%) waited 12 weeks to be seen, and 57% waited more than 12 weeks⁴. Long waiting times, lack of appointments, and a training shortfall are all part of the problem, made worse by the COVID-19 pandemic and funding cuts⁵.

Further reading

1. WHO: WHO recommends the dapivirine vaginal ring as a new choice for HIV prevention for women at substantial risk of HIV infection.

2. UK Proud study: Examining the impact on gay men of Pre-exposure Prophylaxis.

3. NICE: NICE recommends offering PrEP to people at high risk of HIV for first time.

4. BMJ: HIV: Two in three people have trouble getting PrEP, finds survey.