Factsheet How to get PrEP in the UK

Roger Pebody, Published December 2016

Key points

  • NHS services in the UK cannot currently provide PrEP.
  • But it is legal to buy PrEP drugs online and import them for your personal use.
  • To use PrEP safely, you also need to have regular kidney, HIV and STI tests.

Currently, the NHS does not provide PrEP (pre-exposure prophylaxis). But it is possible to import PrEP medications from overseas.

Arranging your own healthcare in this way may not be ideal, but an increasing number of people are doing so. It is the only way they can get PrEP and it is helping many people stay HIV negative. 

If you buy your own PrEP medications, it is important to also go to a clinic for some tests. You should have regular screening for HIV, sexually transmitted infections and kidney function. In this way, you can use PrEP as safely as possible.

To find out more about what PrEP is, read NAM’s factsheet Pre-exposure prophylaxis (PrEP).

Official policy on PrEP

The European Medicines Agency regulates all drugs sold in the UK and other European countries. It has approved Truvada for use as PrEP, in order to prevent HIV infection. Truvada is a single tablet containing two drugs, tenofovir and emtricitabine. It is manufactured by Gilead Sciences.

A large study of the best ways to implement PrEP is due to begin in the middle of 2017. It is expected that this will allow 10,000 people to access PrEP between 2017 and 2020. At the time of writing, very few details of the study have been finalised by Public Health England and NHS England.

Until this study begins, NHS clinics cannot provide PrEP medications for free.

"Although you may be arranging to buy the medication yourself, it’s recommended to talk to a health adviser, nurse or doctor at a sexual health clinic as well."

It does not mean that you cannot ask NHS doctors for advice and support about PrEP. Sexual health clinicians have an ethical obligation to inform you about all the ways you can reduce your risk of HIV, including methods they are unable to provide themselves. In particular, they should be able to help you with the tests and checks you need in order to take PrEP safely.

Buying PrEP online

Several online pharmacies based overseas sell PrEP medications. It is legal to buy the drugs for personal use and have them delivered to you in the UK.

The tablets you can buy are generic medicines. They have the same active ingredients as Truvada, but are manufactured by different companies and have different names. Some of the most widely used are Tenvir-EM (manufactured by Cipla), Ricovir-EM (manufactured by Mylan) and Tenof-EM (manufactured by Hetero).

It is important to check that the tablet you are buying is a combination pill, containing both tenofovir and emtricitabine. For example, Tenvir-EM contains these two drugs, whereas Tenvir only contains tenofovir and is not recommended for PrEP.

PrEP users and advocates have set up a website called www.iwantprepnow.co.uk.  The website includes direct links to online pharmacies selling PrEP drugs. The pharmacies are only listed when PrEP users have reported that the buying process went smoothly and that they received genuine pills.

A month’s supply of 30 pills, taken daily, usually costs around £45. On top of this, customs officials have occasionally asked people importing PrEP to pay a VAT charge.

Occasionally, online pharmacies have been out of stock of PrEP drugs, or there have been postal delays. It’s best to order at least one month in advance.

Is the drug genuine?

This is an understandable concern for people buying medication online. In fact, the overwhelming experience of people buying PrEP drugs through the websites listed on www.iwantprepnow.co.uk is that they have purchased genuine drugs.

This has been tested by a blood test known as Therapeutic Drug Monitoring (TDM). It shows whether someone who has taken a tablet has active levels of the drug in their blood. Although TDM is not routinely available in the NHS, your sexual health clinic might be able to tell you if someone using the same PrEP drug or supplier has already been tested with TDM. In the tests done so far, there have not been any problems.

It’s worth knowing that the tablets sold are also used for HIV treatment for millions of people in Africa and other parts of the world where patent protections do not apply. In many cases, the tablets have been approved by the American regulatory agency, the Food and Drug Administration (FDA) and by the World Health Organization (WHO) for this purpose. This is the case for Tenvir-EM, Ricovir-EM and Tenof-EM.

We would advise checking that the product you are buying has been approved by the FDA or WHO, and checking that the supplier is recommended by www.iwantprepnow.co.uk.

The law on importing medications

People living in the UK can purchase and import drugs without breaking the law, provided that:

  • The medications are for personal use only.
  • The quantity purchased is for no more than three months’ use.
  • The drugs are not otherwise illegal in the UK (e.g. recreational drugs).

Truvada is currently protected by a patent in the UK. This mean that the NHS and UK pharmacies must use Truvada rather than generic versions of it that are cheaper. But it is lawful for individuals to import generic drugs.

Private prescriptions for PrEP

An alternative way to get PrEP is with a private prescription for Truvada, with you paying the full cost of the drug yourself (around £400 for month’s supply of 30 pills). This service is offered by some private healthcare clinics in London including 56 Dean Street (a private service within the NHS clinic) and Same Day Doctor.

Clinical support

Although you may be arranging to buy the medication yourself, it’s recommended to talk to a health adviser, nurse or doctor at a sexual health clinic as well.

Although you may be arranging to buy the medication yourself, it’s recommended to talk to a health adviser, nurse or doctor at a sexual health clinic as well. They can help you with the tests you need in order to take PrEP safely.

They can also give you advice on what to do if you miss a dose of PrEP and on different ways to take PrEP (every day, or before and after having sex). If you want to stop using PrEP, they can advise you on the right way to do this.

If the way you feel about yourself, pressure from other people, drugs, alcohol or other issues affect risk taking and your sexual health, they can help you with that too.

Tests to have before you start

You should have these tests done before starting PrEP or around the same time. If you’ve already started PrEP, get them done as soon as you can.

  • HIV: 4th-generation blood test, able to detect antibodies and p24 antigen
  • Kidney function: test for protein in urine
  • Kidney function: test for creatinine and eGFR in blood
  • Hepatitis B: blood test
  • Sexually transmitted infections

It’s important to be sure that you don’t have HIV without realising it – if you did have HIV, taking PrEP could mean you develop resistance to drugs you may need for treatment.

Make sure you have a “4th-generation” blood test for HIV. This tells you your HIV status four weeks ago. Other tests, including ones which provide a result immediately and ones which you use at home, are not as good at picking up recent infections.

If you’ve taken any risks in the four weeks before taking the test, you can start PrEP but it’s a good idea to repeat the test four weeks later. This is just to check that a recent infection was not missed.

If you’ve recently taken a risk and have flu-like symptoms, don’t start PrEP. You need to rule out the possibility that these are the symptoms of recent HIV infection. Go to a sexual health clinic as soon as possible for advice and testing.

The hepatitis B test is essential because PrEP drugs are active against hepatitis B. You could still use PrEP, but you’d need a doctor’s advice on the safest way to do so.

Tests to have regularly while taking PrEP

Regular monitoring is important. Every three to four months you should have:

  • HIV: 4th-generation blood test, able to detect antibodies and p24 antigen
  • Kidney function: test for protein in urine
  • Sexually transmitted infections

Once a year you should have:

  • Kidney function: test for creatinine and eGFR in blood

Your sexual health clinic should be able to provide these tests. Sexual health clinics in some of the larger cities may have more experience of supporting people with PrEP.

If your clinic seems unwilling to help, you could try asking to see a consultant (senior doctor). It might be helpful to show staff the British HIV Association (BHIVA) and British Association for Sexual Health and HIV (BASHH)’s Position Statement on PrEP in the UK. This gives clinicians information on how they can support people using PrEP.

This factsheet is due for review in December 2019

Find out more

This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.
Community Consensus Statement on Access to HIV Treatment and its Use for Prevention

Together, we can make it happen

We can end HIV soon if people have equal access to HIV drugs as treatment and as PrEP, and have free choice over whether to take them.

Launched today, the Community Consensus Statement is a basic set of principles aimed at making sure that happens.

The Community Consensus Statement is a joint initiative of AVAC, EATG, MSMGF, GNP+, HIV i-Base, the International HIV/AIDS Alliance, ITPC and NAM/aidsmap
close

This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.

NAM’s information is intended to support, rather than replace, consultation with a healthcare professional. Talk to your doctor or another member of your healthcare team for advice tailored to your situation.