7th August 2016
by Judith Duffy [Herald Scotland]
Campaigners have called on the Scottish Government to follow the example of France and introduce a drug that can prevent HIV without waiting for it to be licensed.
The drug, called Truvada, triggered headlines last week after the High Court told the NHS in England it should fund the treatment, despite health bosses arguing it was the responsibility of councils.
Critics argued the drug could lead to irresponsible sexual behaviour – with some describing it as a “lifestyle drug” – and would strain scarce NHS resources. The drug, which studies have found could reduce the risk of infection by nearly 90 per cent, is expected to be of most benefit for gay men who are at higher risk of contracting HIV.
Charity HIV Scotland said ministers north of the border should follow the example of France, which last year said it would make the drug available for free before it was fully licensed for prevention, as a pre-exposure prophylaxis medication (PrEP). Truvada was originally developed for the treatment of HIV.
George Valiotis, chief executive of HIV Scotland, said: “In France, the health minister said last year we are not going to wait for licensing, we are going to do this now as it can make a real difference to transmission rates.
“We would hope the Scottish Government would take the same approach and say we will act now.
“For the last 10 years, there have been between 350 and 370 new cases of HIV a year in Scotland – that is in spite of rigorous, well-organised behaviour change programmes for the last 30 years. In Scotland nearly one in four people who have HIV don’t know they have it.
“We need something else and the evidence for PrEP shows it works in particular cases.”
In a statement issued following the ruling, NHS England said it would appeal against the High Court ruling and warned that funding PrEP, which could cost £10-£20 million a year, would hit the money available for treatments for diseases.
Christian organisation CARE for Scotland, said it was “a lifestyle drug” that could increase the risk of sexually transmitted diseases.
But Valiotis said: “We have had a lot of people telling us they feel stigmatised about how this is being discussed,
“We were really shocked to see NHS England comparing it to other diseases – you don’t see that being done for other treatments.”
Some Scots are already using the drug. Gordon, who did not want his full name to be used, has been taking it on a daily basis since January. He obtains a generic form of PrEP online, which costs around £45 a month, but emphasises he still also has regular check-ups and monitoring at a sexual health clinic.
He said: “The difference it has made is it is a reassurance – I used to worry all the time. People can have the virus without knowing, so they may be unknowingly transmitting HIV and people are unknowingly being infected as they don’t know the status of their partners. I don’t feel so nervous now.
“I don’t use it on its own, I still use condoms, but it has given me reassurance so I don’t need to worry about it.
“I have always been cautious, but some of my friends have been cautious and ended up getting up HIV. This drug, if it is taken properly on a daily basis, can make a huge difference to people.”
He added: “I remember when the Aids epidemic was at its height and people were dying and it took a long time for drugs to be made available that were effective to treat HIV. Now they have something they can stop transmission – so why is there all this negativity about it?
“I am being responsible to myself, but I am also being responsible to my sexual partners.”
Dr Jamie Franks, a senior lecturer in the school of health and life sciences at Glasgow Caledonian University, who has carried out studies into PrEP, said research had estimated that treating HIV over a lifetime adds up to around £400,000 per person for the cost of the drugs alone. The cost of Truvada at the moment is around £400 a month.
He said: “PrEP is very cost-effective as long as we give it to the people who are most likely to become infected with HIV.”
On the issue of it being a “lifestyle” drug, Franks added: “If only we all heeded what all of the health psychologists tell us to do all of the time, we would all be a lot healthier.
“When it comes to HIV and sex, it is the same as alcohol and smoking, getting a suntan and eating too much.”
Ingrid Young, research fellow at the MRC/CSO Social and Public Health Sciences Unit at Glasgow University, said the drug had to be viewed as part of a comprehensive sexual health package.
“It is one of many options and will depend on the person and their circumstances and what suits them best,” she said.
“We offer a range of contraceptive options to women – and it is fantastic to finally be able to have a range of things to offer to people who may be at risk of HIV.”
The Scottish Medicines Consortium, which assesses if drugs should be made available on the NHS, said an application for Truvada as PrEP had yet to be submitted, but it would be assessed on the usual criteria, including cost-effectiveness.
Health Secretary Shona Robison said the European Medicines Agency recommended granting a marketing authorisation for Truvada’s use as PrEP on July 22, which has been sent to the European Commission for adoption.
She added: “We would urge the European Commission to do this quickly.
“As soon as Truvada is licenced for PrEP we will call on its manufacturer to submit an application to the Scottish Medicines Consortium, at a fair price, so its routine use in Scotland can be considered as quickly as possible.”