Funding PrEP for HIV prevention

Despite overwhelming evidence that pre-exposure prophylaxis (PrEP) against HIV infection is largely safe, effective,1 2 3 4 and cost effective,4 5 6 7 NHS England has declined to make it available on the NHS, arguing that HIV prevention is the responsibility of local government.8

NHS England’s apparent appetite for legalistic cost shunting,9 and its argument that it does not have the legal power to commission PrEP,8 is regrettable. Such an approach confounds its advocacy of a health and care system integrated around the best outcomes for the citizen and perpetuates an incoherent national approach to HIV prevention.

PrEP has undoubtedly attracted some moral panic.10 11 Yet the clinical principle is not dissimilar to that of antimalarials, used to prevent malaria when travelling in at-risk environments. In population health, PrEP’s role is comparable to the function of vaccinations and immunisations, which NHS England …