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England and Wales PrEP warning: We’re running out of money

England and Wales PrEP warning: We’re running out of money

  • Local councils may not be able to afford to fund PrEP as UK government still hasn’t 2020 confirmed budgets.
Deborah Gold of National AIDS Trust.

English and Welsh local councils have warned they may not be able to afford to deliver PrEP from April onwards.

Experts have credited the drug with plummeting HIV infection rates in the UK, particularly among gay and bisexual men.

But the UK government still hasn’t announced how it will fund PrEP in the long term.

Who pays the cost of PrEP?

The cost is formed of two main elements.

Firstly, the cost of the drug itself. However, many patients are buying PrEP privately online. And NHS England is buying cheap, generic PrEP for others who are part of a trial to see how effective the drug is.

The more costly part is the services PrEP users need. This includes sexual health clinics testing them for HIV and other sexually transmitted infections every three months.

Clinics also provide regular kidney function tests. One of the PrEP drugs potential side-effects is kidney damage.

While the National Health Service provides the clinics, it is not NHS England that pays for them. In fact, local authorities across England and Wales are responsible for funding sexual health clinics.

Moreover, people buying PrEP privately typically rely on their local sexual health clinic to provide these services. So the real cost for local authorities is higher than simply screening those who are getting their PrEP on the NHS trial.

And strangely, the debate about who funds PrEP often overlooks the cost of these extra services. 

£700 million cut

However, that debate may change today, as the Local Government Association warns it may not be able to continue to fund its PrEP work.

It warns the UK has cut local councils’ public health budget by £700 million in real terms between 2015 and 2020. And this year the government still hasn’t told them what their budgets will be from April onwards.

Usually this happens in December. Indeed, the Local Government Association told GSN this is the latest the UK has announced the budgets.

Cllr Ian Hudspeth, chairman of the LGA’s Community Wellbeing Board, said:

‘PrEP is a game-changer in preventing new HIV infections and a vital weapon in our prevention armoury.

‘This is a potentially life-saving drug which can help us achieve the government’s ambition of getting us closer to zero transmission by 2030.

‘While councils share this ambition and want to see this drug available to everyone who needs it, they will struggle to afford to provide it while their existing public health services continue to be under such strain.’

PrEP saves money

In fact, PrEP actually saves the UK money. It is vastly cheaper for the country to fund PrEP than to treat someone with HIV. Official estimates say it costs almost £380,000 to treat one person with HIV across their lifetime.

So this is not about the overall cost – but which branch of government foots the bill.

And it directly relates to other sexual infections. While new HIV infection rates are dropping, other STIs are rising. And many are struggling to get appointments at clinics, even when they have symptoms.

That in turn is because the local government can’t fund enough places amid rising demand.

‘Not down to the wire, well past it’

Deborah Gold, chief executive at National AIDS Trust, called for the swift government action. 

She said: ‘The government’s continued silence on both the future of PrEP and the overdue local government funding settlement is inexcusable.

‘Without these announcements local authorities have neither the time nor the resources necessary to plan the HIV prevention and sexual health services that are needed from April.

‘It is no longer a case of being down to the wire, we are now well past it.’