“We’re in a changing landscape of HIV”

David Rowlands explains PrEP, PEP, and stigma                   Published @GTVLondon


What are some of the biggest health challenges that gay men are currently facing?


Higher rates of smoking, alcohol consumption, poor mental health, and increased rates of HIV and Hepatitis C. Often people are unaware of what risks they may be facing and what impact this may have on their lives.


Chemsex is a dangerous sex trend that is having fatal consequences within the community. Users meet through social media apps and congregate at chemsex parties, where groups of people gather together and take drugs before getting intimate. The drugs used are mephedrone — also known as ‘meow meow’, GHB/GBL, and methamphetamine — also known as crystal meth.


Has the roll-out of PrEP in the UK been successful?


We think PrEP is a new way for people to reduce their risk of acquiring HIV, but we’ve known about PrEP for many years. It’s taken some time for the UK to better understand how PrEP can be used effectively within the prevention of HIV.


Sexual health clinic 56 Dean street have recently launched a ‘PrEP Shop’ to make it easier for you to buy generic HIV PrEP from someone you trust. By using the buying power of the NHS, they aim to keep prices affordable. Current price is £55 for 30 tablets.


If you’re taking PrEP, It’s really important to get the right advice, run some tests, check you don’t have Hepatitis B, make sure that any other drugs or supplements you take don’t interact with PrEP, and that you don’t have any other health problems that might be an issue. PrEP Shop keeps things safe by linking all these things with the doctors and pharmacists who write and check your prescriptions.


You’re also able to buy PrEP online at www.iwantprepnow.co.uk. People at very high risk of HIV may be eligible to get free NHS-funded PrEP by joining the PrEP Impact study.


How effective will PrEP be in halting HIV infections in the UK?


Over the past three years, one clinic in London has seen recent HIV infections among gay and bisexual men using its services fall by around 90 percent. The experience of the 56 Dean Street clinic, in the heart of London’s West End, illustrates how services may need to change to improve rates of HIV diagnosis, increase the numbers of people on treatment, and reduce new HIV infections among men who have sex with men.


Similar services are also emerging in other European cities, notably the Checkpoint clinic in Barcelona that is now being replicated in Portugal and Italy. But the London data is the first evidence that services offering new models of high throughput, community-based care that incorporate HIV treatment and PrEP can have a transformational effect on a city’s epidemic.


Does PrEP mean that the battle against HIV has been won?


The progress that we’re currently seeing in London will only continue to work if we keep our foot on the accelerator.


The Mayor of London, Sadiq Khan, has recently signed the Paris Declaration on ‘fast-track’ cities — aiming to end the AIDS epidemic. The ambition of this declaration is bold — firstly, to cut rates of new HIV infection in the capital, and secondly, to eliminate the discrimination and stigma associated with the condition.


For the British HIV Association, and many other campaigning organisations, this really is an incredibly important and courageous statement for the Mayor to make. It means that he’s putting the weight of City Hall behind the fight to halt the spread of HIV, and to end the discrimination and stigma associated with it.


Have the safer sex messages regarding condoms become superfluous?


Over many years, key messages around condom use have been promoted to the MSM community. It’s important that these messages are continued. Some people find that they’re unable to negotiate the use of condoms, therefore it’s important that PrEP is available to those who wish to use it in a period of their lives.


We must also not forget key messages around Post-exposure prophylaxis — PEP — which may stop you developing an HIV infection if you’ve been exposed to the virus. However, it doesn’t always works.


















What the likelihood that the HIV virus will mutate or develop a resistance to PrEP?


Resistance relates to HIV and not the person. So an HIV-negative person can’t be resistant. Secondly, resistance is only a risk if you become HIV positive. Even then the risk is low.


The risks of drug resistance are from:


•Starting PrEP without knowing that you are already HIV positive. This is why the HIV test before PrEP is essential.


•Becoming HIV-positive during a break from PrEP and then not having an HIV test before restarting.


•Missing too many PrEP doses, so that drug levels are too low to prevent HIV infection.


•Contact with drug-resistant HIV. This is very rare — globally, only two cases have been reported of PrEP not working because of drug-resistant HIV.


In PrEP studies, very few people became HIV-positive while taking PrEP. In those who did, less than 1 in 20 developed drug resistance.


Three cases have been reported of people who became HIV-positive even though they were taking PrEP correctly. Two of these cases were from partners whose HIV was already resistant to the drugs in PrEP. This is a very rare event but other cases might be reported in the future. Currently, less than one percent of people who are newly diagnosed in the UK have drug resistance.


In you’re unlucky and develop drug resistance on PrEP, there will be other HIV drugs that you can use for treatment.


Are we living in a post-HIV world?


We’re in a changing landscape of HIV and it’s important that people living with HIV are given a voice, and that stigma is broken down within the community. It’s important that campaigns such as ‘Undetectable Equals Untransmittable’ are shared.


People living with HIV on Antiretroviral Therapy with an undetectable viral load in their blood have a negligible risk of sexual transmission of HIV. Depending on the drugs employed, it may take as long as six months for the viral load to become undetectable. Continued and reliable HIV suppression requires selection of appropriate agents and excellent adherence to treatment. HIV viral suppression should be monitored to assure both personal health and public health benefits.


This fact is a testament to the preventive impact of effective HIV treatment and highlights the need to maximise access to treatment in order to minimise and ultimately eradicate HIV transmission. Spreading the ‘Undetectable Equals Untransmittable’ message is also an important way to help reduce the stigma experienced by people living with HIV, whose sexual partners may fear infection unnecessarily


Does the health service in the UK have sufficient resources to meet the needs of gay men?


Services in HIV prevention and treatment and care for people living with HV are changing within the UK, and it’s important that the NHS are developing these services to meet the needs of the MSM community.


We are now seeing social media platforms more engaged in helping meet the needs of gay men across the diverse community. While budgets are being cut, we need to be more creative in our approach to both HIV testing and prevention of HIV in the UK.