HIV News from NAM aidsmap

Where do people get their PrEP from?

Each month in Boyz the team from NAM aidsmap report the latest news on HIV and sexual health. Keep up to date and read more on their website at

A third of PrEP (pre-exposure prophylaxis) users in the UK are still buying it from an online pharmacy or getting it from another private channel – purchasing it from a clinic such as 56 Dean Street’s PrEP Shop, getting spare pills from friends or getting it abroad.

While there are now more places available on the NHS’ PrEP IMPACT Trial in England, only half of PrEP users got their medication from the trial. Another 5% were getting PrEP from NHS programmes in Scotland, Wales and Northern Ireland. 

The information comes from a survey of 2389 people (mostly gay and bisexual men) this summer. Three-quarters were currently taking PrEP and quite a few others had taken it before but weren’t at the time they filled the survey in.

But 22% of all respondents had tried and failed to obtain PrEP in the previous year. Three-quarters of those mentioned being unable to enrol in the IMPACT trial. People living outside London had more problems getting PrEP than Londoners.  

If you’re taking PrEP, there are some tests that you need to have every few months: for HIV, kidney function and sexually transmitted infections (STIs). While most PrEP users did get these tests, people not getting PrEP through a clinic had fewer tests.

Of current PrEP users, only 58% of those buying PrEP online had had at least three HIV tests in the past year. And 48% had had at least three STI tests. This means that STIs are going undiagnosed in some people who have to get hold of PrEP themselves, outside of a clinic.


PrEP and U=U across Europe

How does the UK compare to other European countries? A massive online survey of close to 128,000 gay and bisexual men living in over 40 countries has just been published. Whereas the survey we talked about above mostly recruited people interested in PrEP, this one involves a much wider range of men who use dating and hook-up apps.

It shows a lack of access to PrEP across Europe. Across the continent, 63% know what PrEP is, 45% would like to use it, 7% have tried to get it and just 3% were using PrEP.

The situation is actually better in the UK than in other countries. Here, 87% know what PrEP is and 9% were using PrEP. 

Access to PrEP is poor in some countries including Germany, Sweden and Italy. Less surprisingly, it is very poor in countries in eastern Europe and the Balkans.

Similarly, knowledge that ‘undetectable = untransmittable’ (U=U) varies across the continent. Across Europe, 57% said they already knew that a person taking effective HIV treatment cannot pass their virus to someone else during sex, but 43% didn’t know or weren’t sure. Knowledge was highest in the UK, the Netherlands and Scandinavia.

Gaps in knowledge were especially common in men under the age of 25 and men who were ‘out’ to very few people.


How adherent do you need to be?

In recent years, anti-HIV medications have become more effective. Doctors often say that many of them are more ‘forgiving’, meaning that occasional missed doses won’t necessarily result in the treatment no longer working.

A group of researchers wanted to see what levels of adherence are needed to achieve and maintain undetectable viral loads with modern medications. An undetectable viral load shows that HIV treatment is working and that you can’t pass HIV on during sex.

The small study provides some interesting clues although larger studies would be needed to provide a more definitive answer. Looking at data for 570 adults living with HIV across the United States, the researchers compared adherence (specifically, the proportion of days for which a person had medication available during a given period of time) and undetectable viral loads. 

People who had medication for fewer than 80% of days did worse. But when researchers compared people with enough medication to cover 80% to 90% of days, and people with enough for 90% to 100% of days, they found no differences in the number with an undetectable viral load.

They also calculated the adherence rate required to achieve an undetectable viral load in 90% of viral load tests. They found that this was 82% – far below the ‘gold standard’ of 90 or 95% that is sometimes recommended. 

This varied between different types of anti-HIV drugs. For medications known as integrase inhibitors, it was as low as 75%. But before aiming for this level of adherence, it’s worth asking yourself whether you’d be happy with having an undetectable viral load for just 90% of the time. It would be interesting to see what adherence level is required to be undetectable for 95 or 99% of the time, but the researchers don’t report their data on that.

But the study does tell us that occasional missed doses are unlikely to have serious consequences for people taking HIV treatment.


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