PrEP users in Scotland are almost all gay and bisexual men

Over 3000 gay and bisexual men have been prescribed PrEP in the first two years of Scotland’s PrEP programme, with fewer than 100 individuals from other groups taking PrEP, according to a report published this week by Health Protection Scotland.

There are differences in health policy between the four countries of the United Kingdom. In England, the HIV prevention medication PrEP is only available to limited numbers of people as part of a research study. In contrast, in July 2017, Scotland became the first country in the UK to implement an NHS-funded programme providing PrEP alongside comprehensive STI and HIV prevention services.

In the first two years of the programme (to June 2019), 3354 individuals received a total of 11,289 PrEP prescriptions. Since January, around 100 new patients have started PrEP each month. The report doesn’t include data on persistence (how long people have continued to take PrEP), although those figures do give a hint of this.

Glossary

cost-effective

Cost-effectiveness analyses compare the financial cost of providing health interventions with their health benefit in order to assess whether interventions provide value for money. As well as the cost of providing medical care now, analyses may take into account savings on future health spending (because a person’s health has improved) and the economic contribution a healthy person could make to society.

event based

In relation to pre-exposure prophylaxis (PrEP), this dosing schedule involves taking PrEP just before and after having sex. It is an alternative to daily dosing that is only recommended for people having anal sex, not vaginal sex. A double dose of PrEP should be taken 2-24 hours before anticipated sex, and then, if sex happens, additional pills 24 hours and 48 hours after the double dose. In the event of sex on several days in a row, one pill should be taken each day until 48 hours after the last sexual intercourse.

transgender

An umbrella term for people whose gender identity and/or gender expression differs from the sex they were assigned at birth.

Almost all people prescribed PrEP (3266 people, 98% of the total) were men who have sex with men. PrEP was also prescribed to 51 other men, 26 women and 11 people whose gender was ‘other’ or not recorded. Seventeen PrEP recipients self-identified as being transgender and were included in one of the previous figures.

In terms of age, 4% were in their teens, 41% in their twenties, 28% in their thirties, 15% in their forties and 28% in their fifties or older.

While two-thirds of people’s ethnicities were recorded as white Scottish or British, 12% were white other, Irish or Polish. Fewer people were of Asian (2.3%) or African (0.4%) ethnicities.

PrEP has been prescribed in all parts of mainland Scotland, with two-thirds of prescriptions being issued in services in the NHS boards covering Scotland’s two main cities (NHS Greater Glasgow & Clyde and NHS Lothian).

PrEP can be taken daily or in anticipation of specific risk events. Over half of people used PrEP daily, 17% for event-based dosing and 25% for a combination of the two.

PrEP has encouraged people who were not previously engaged with sexual health services to come forward – 1318 people (39%) had no sexual health service attendance recorded in the two years prior to the roll-out of the PrEP programme, including 910 people (27%) who had never previously attended.

“As Scotland was the first country in the UK to make PrEP available free at the point of use on the NHS, we have been leading the way in terms of HIV prevention,” commented Nathan Sparling, Chief Executive of HIV Scotland. Although he urged Scotland to do more to improve access beyond gay and bisexual men, he also had a recommendation for policy makers south of the border.

“We have all the evidence to show that PrEP is popular as a form of prevention, is cost-effective in terms of provision, and, most importantly, that it works to reduce rates of HIV transmission,” he said. “It’s high time NHS England and the UK Government followed Scotland’s lead and makes PrEP available on the NHS.”

References

Health Protection Scotland. Implementation of HIV PrEP in Scotland: Second Year Report, 17 December 2019.