A well known Sexual Health Clinic in London has started privately prescribing PrEP to those who can afford it, but it this ultimately the best way forward? 

Waiting for PrEP - photo by LewishamDreamer (Flickr)
Waiting for PrEP – photo by LewishamDreamer (Flickr)

This week Dean Street Clinic, part of Chelsea and Westminster Hospital NHS Foundation Trust, have opened their doors and started privately prescribing PrEP (Pre Exposure Prophylaxis) – to those who can afford it. Whilst circumnavigating the system at a cost may be good for a few, will it cause longer delays for those waiting for the NHS to start prescribing PrEP?

The NHS is holding off on prescribing PrEP (either free of charge, or with a prescription fee) whilst it conducts consultations and cost-analysis, the current soonest we can realistically expect it is late 2016 / early 2017.

The LGBT community is already community divided. As letters of rainbow we don’t always see eye-to-eye, and then within those letters we have our own factions – bears, twinks, cubs, daddies etc. Further still within those groupings you see divisions based on HIV status “Positive, Undetectable, Negative…” and now “on PrEP” – if you can afford it.

My fear is that what Dean Street has done here, which looks and feels like a great “stopgap solution” will, whilst people wait for PrEP on the NHS, be slowly replicated across the UK . Then before you know it we’ve got a network of clinics prescribing Truvada, albeit at a price, and it’s not a huge stretch of the imagination to see the NHS and/or Department of Health saying in 2016/17:

“In this current time of austerity prescribing an expensive HIV drug to those without HIV, when existing prevention methods such as condoms and PEP are available, isn’t something this government or NHS can justify. But for those who need it the third sector, and a number of clinics, have embraced the free-market and are prescribing PrEP privately.”

Those rich gay men who can can afford privately prescribed PrEP (current UK list price: £355.73) will go away happy and safe whilst those who need it, those who really need it (people who engage in sex work, people in violent relationships with no control over prevention, people in serodiscordant relationships, MSM on low (or no) income, those who have come here seeking political asylum, the trans* community) will continue to go away empty handed, and live a life with a high life-time risk of contracting HIV.

PrEP is an amazing thing. Trying to circumnavigate the system and help your population is an amazing thing. But be careful how you do it, because you may well simply make matters worse.

Tom Hayes (@PositiveLad on twitter)

What do you think? Please feel free to leave your thoughts and comments below…




  1. This news is, frankly, chilling. Chilling because although Dean Street have very correctly started prescribing truvada as PrEP, its being available only on private prescription sets a terrifying precedence for those of us who still believe in the original principles of the NHS, that it should be free at the point of delivery.

    Gilead have, in the USA, promoted truvada heavily and with such aggressive discounting that many Americans actually receive it free. What are their intentions here? And what are the government going to make of this? Drugs from a sexual health clinic have always been free, even when the prescription charge was first introduced as a “token payment”, in order to prevent the spread of what was then referred to as VD.

    Dean Street have set a dangerous precedent, one which I fear the government taking up elsewhere.

  2. Unless and until the NHS makes it free, the UK list price of £355.73 for 30 tabs means a daunting £4,328 a year. But that’s for those who intend to have risky sex more than once a week.

    Drop that rate to once a month and, with four tabs a go under the Ipergay regimen, it becomes an annual £569. Near-total protection for £1.56 a day? I’m in!

    I disagree with nothing in Tom’s piece. Yet there’s a whole cohort of older (*looks in mirror*) neg gay men out there who’ve now spent three of our prime adult decades inhibiting our lusts for the sake of our health.

    Are we now to be expected to retain that restraint until everyone has the same choice? Ditto for the legions of younger single guys who are in work and aren’t constant weekend party animals.

    To be fair, Tom doesn’t suggest as much. But unless they’re put in check right away, there are bound to be others who will soon cry loudly for the 56 Dean Street initiative to be scrapped.

  3. Steve Craftman: “Gilead have, in the USA, promoted truvada heavily and with such aggressive discounting that many Americans actually receive it free.”

    That’s nothing out of the ordinary. For drugs still in patent, pharma companies generally allow discounts to their big customers – among which the NHS is globally right up there.

    What’s instead swinging the scales in the US is that risk-driven private health insurers have each done their own actuarial sums… and largely concluded that funding Prep for those who want it is ultimately cheaper than refusing it.

    Guess what? Prevention is not only better but cheaper than cure.

  4. Tom – thank you for this, and I completely agree with you. It might look good, like a clinic that cares is stepping in to ‘provide’ something that’s needed, but fact is that it strikes hard at the ‘free at the point of care’ principle on which the NHS as we know it rests. And the spectacle of a relatively rich few benefitting because they have enough disposable income + are well-connected enough to know about this form of PrEP in the first place, while those who have far less social capital and far less financial capital go without is frankly disgusting and disgraceful.

    I think 56 Dean Street have been very badly advised. If they want to add to the pressure on the NHS to provide PrEP free to those who need it, they should simply do that in a targeted and very public way. But contributing to the increasing fragmentation of the (currently free) health service, which is what they are doing here, is beyond belief.

  5. Let’s reframe that DOH statement:
    “In this current time of austerity prescribing an expensive contraception drug to those who aren’t pregnant, when existing prevention methods such as condoms and the morning after pill are available, isn’t something this government of NHS can justify.”

  6. I find that the news that U.K. Government is looking towards the end of 2016, beginning of 2017 to legalize PrEP access to be interesting in the sense that it is when the Drug Patent to Truvada will end, and the generic version will become available (as it is already online) and driving the price seriously down for the original version. Gilled doesn’t promote PrEP with Truvada probably because they are already seeking approval of their Truvada replacement drug called TAF, that is in the pipeline in the U.S. IMHO, I think that the opening of the first PreP clinic to open in Europe is a milestone. Gilled should be contacted from the U.K. activists to demand free access to Truvada for middle to low income clients as they do in the U.S. Now is the time.

  7. There is a peculiar irony about all this.

    Given that the NHS WILL fund anti-retroviral drugs if you are HIV+, if one could choose sexual partners based upon how “risky” a proposition they might be, the best choice would be an HIV+ person who has had an undetectable viral load for, say, six months or more. Any other choice (apart from someone wealthy enough to afford their PrEP), is something of a gamble; but for the good old condom of course.

  8. I think that we should leave the choice as to what prevention tool someone prefers to choose for themselves. Not unlike a woman’s right to choose which birth control method she prefers. Something like “my body my choice” comes to mind.


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