It sounds like a minor sensation: after years of stable or rising HIV diagnoses among gay men, their number fell significantly for the first time in 2016 at four major London sexual health clinics.
These are the clinics 56 Dean Streetthe largest of its kind in London (minus 40 %), Mortimer Market Centre (minus 50 %), Bart's Health Sexual Health (minus 36 %) and Homerton Sexual Health Services (minus 40 %).
This was reported by the HIV Treatment Bulletin At the end of December, after a 17 per cent drop in new HIV diagnoses had already been reported in San Francisco in September 2016; gay and bisexual men account for around 72 % of new diagnoses there.
As the number of HIV tests and diagnoses of other STIs at London clinics has remained roughly the same, experts suspect that the reason for this is not fewer tests or more condom use, but primarily the use of HIV pre-exposure prophylaxis (PrEP) by men in the gay community.
Several hundred men in London who have sex with men have had access to PrEP since October 2014. In addition, PrEP activists clarify with sites such as prepster.info and iwantprepnow.co.uk about PrEP and provide information on where to buy PrEP medication.
Many men apparently obtain these drugs themselves. In England, it is legal to order three months' supply of generics for personal use, for example in India - at around a tenth of the price of the original preparation (in England around 460 euros).
In addition, some sexual health clinics such as 56 Dean Street offer free preparatory and accompanying examinations for PrEP users (for example, the necessary tests for HIV and hepatitis B, checks on kidney and liver function and checks for other sexually transmitted diseases). Around 400 people take up this offer at 56 Dean Street alone. In addition, the team at 56 Dean Street checks the imported generics on request to see whether they contain the same active ingredients as the original. So far not a single counterfeit has been discovered.
"We should still be very cautious at this stage, but I don't know what else [apart from PrEP] it should be," said PrEP campaigner Will Nutland of the London Institute of Hygiene and Tropical Medicine, who is behind the prepster.info site.
Other possible factors for the decline in new HIV diagnoses could be, as apparently in San Francisco, earlier HIV diagnoses and an earlier start of treatment, as people with HIV whose viral load is stable below the so-called detection limit due to successful therapy are not sexually infectious ("protection through HIV therapy").
Information on PrEP
PrEP (HIV medication for HIV-negative people to protect against HIV) reliably protects gay men against HIV. It was introduced in England and France, among other countries, as part of the PROUD and the IPERGAY study.
In France, PrEP is now available free of charge if prescribed by a doctor. In England, the National Health Service (NHS) initially declared that it could not fund PrEP, but following a judgement to the contrary by the Supreme Court, it announced a further PrEP trial with at least 10,000 participants. This will cover the costs of medication, the necessary examinations and medical care.
In Germany, the PrEP drug Truvada® has also been available since autumn 2016 for the PrEP authorised and available on prescription. However, anyone who wants to protect themselves against HIV must bear the costs themselves (over 800 euros a month for the medication alone). Deutsche AIDS-Hilfe and other HIV/AIDS organisations are therefore calling for PrEP to be reliably reimbursed by health insurance companies. To this end, the Infection Protection Act or the G-BA's vaccination guidelines would have to be adapted. In the meantime, more and more people are using the "grey market", but also legal ways to obtain cheap generics - for example, bringing generics for their own use when travelling from the UK to Germany.
Further questions & answers about PrEP can be found here here.
