The NHS in England has been told by the High Court it can fund a “game-changing” drug that can prevent HIV after health bosses argued it was not their responsibility.
NHS England had said it was up to councils to provide the pre-exposure prophylaxis (Prep) drug as they are in charge of preventative health.
But that stance was challenged by the National Aids Trust. The judge said there was nothing to stop the NHS paying for the drug.
NHS England has yet to respond.
Using Prep has been shown to reduce the risk of HIV infection by more than 90%. The once-a-day pill, which costs £400 a month per person, works by disabling the virus to stop it multiplying.
The idea is to give it to uninfected men who are having unprotected sex with other men.
It is currently used in the US, Canada, Australia and France to help protect the most at-risk gay men. NHS England had argued that because Prep was preventative it was not its responsibility.
In May, it said it had legal advice that said it did not have the “legal power to commission Prep” and that under 2013 regulations “local authorities are the responsible commissioner for HIV prevention services”.
NHS England has also warned that if it prioritised Prep, there was a risk of a legal challenge from people wanting similar access to other preventative treatments.
But the National Aids Trust said local authorities did not have sole responsibility for HIV prevention in England. The NHS in Wales, Scotland and Northern Ireland have not yet made a decision on Prep.
‘This is about saving lives’
Harry Dodd, 25, is one of about 500 gay men in England who are taking Prep as part of a trial called Proud.
He says: “I’ve seen the panic on the face of previous boyfriends when they are awaiting their [HIV test] results – it’s a huge fear and it affects everything you do.
“To be able to have sex without having that fear hanging over you all the time is huge.” Harry says taking Prep has still not become socially acceptable.
“Too many people seem to think it will encourage a hedonistic lifestyle, but for me this is about saving lives,” he says. “People reacted with cynicism when the contraceptive pill for women was first introduced.
“For me, taking Prep has helped me to trust again, have relationships and build bridges and that shouldn’t be taken away.”
Paul Steinberg, from the London HIV Prevention Programme, told BBC News the drug was a “very significant breakthrough”, but urged people to still wear condoms to stay safe.
He said one of the dangers of not having the drug available on the NHS was that people would try to obtain the pill online and self-medicate.
“Buying online is what people are being forced to do to get access to this drug, but that’s not a sustainable situation,” he added.
There could be side effects to taking the drug, which could affect the kidneys, and this needed to be monitored by a professional, he said.
Deborah Gold, chief executive of the National Aids Trust, said trials in San Francisco – where there is very high levels of Prep use – had had dramatic effects on reducing the HIV rate.
Asked on BBC Radio 4’s Today programme about the argument surrounding Prep on “personal individual responsibility”, Ms Gold said “there are lots of reasons why everybody sometimes, with the best will in the world, isn’t consistently able to use a condom”.
“Those at very high risk of HIV – particularly gay men – actually use condoms more consistently than the general public, and they are very good at doing that,” she added.