New HIV diagnoses in gay and bisexual men fell by 20% after Scotland started to provide PrEP. This happened after 20% of men using sexual health clinics started to take PrEP.
Scotland was one of the first countries in the world to launch a publicly funded PrEP programme, in 2017. The HIV prevention medication is available through NHS Scotland’s network of sexual health clinics, free of charge.
In the first two years of the programme, over 3200 gay and bisexual men took PrEP at least once. This is around one in five of the men who attended Scottish sexual health clinics.
Researchers found that in the two years before PrEP, there had been 229 HIV diagnoses in the country. But in the two years after, the number fell by 20% to 184.
And in a group of gay and bisexual men who attended sexual health clinics regularly, the rate of new HIV infections fell by 43%. As expected, infections fell furthest in men who took PrEP. But they also fell by 32% among men who had never taken PrEP, suggesting that PrEP users remaining HIV negative had benefits for their sexual partners too.
While other factors could have contributed to the fall in new HIV infections, the researchers believe PrEP is the most important factor. The uptake of HIV testing and HIV treatment was already very high before PrEP was introduced and there’s no reason to think men were using condoms more than before.
Similar falls in HIV infections have also been recorded in New South Wales, Australia – another region where access to HIV testing and HIV treatment was already excellent. In places like this, making PrEP available in addition to condoms, testing and treatment can make a real difference.
In other countries, PrEP may not have the same impact. For example, in many places there are barriers to people accessing HIV treatment. This matters for HIV prevention, because when a person is taking fully effective HIV treatment, they cannot pass HIV on. Researchers in the United States recently found that allocating more money to make sure everyone living with HIV there is on effective treatment, rather than focusing on PrEP, could reduce new infections by as much as 94%.
Click here to read more about PrEP in Scotland.
Click here to read more about PrEP in Australia.
Click here to read more about HIV prevention priorities in the United States.