The BMJ Awards 2017: Prevention

BMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j1364 (Published 22 March 2017) Cite this as: BMJ 2017;356:j1364
  1. Nigel Hawkes, freelance journalist, London, UK
  1. nigel.hawkes1{at}btinternet.com

Better understanding of patients underlies the success of this year’s shortlisted teams, finds Nigel Hawkes


Ignoring the long running argument over whether the NHS should pay for a drug to protect against HIV infection, many men have been paying for it themselves. Few pay the full price of £400 (€460; $490) a month for Truvada (emtricitabine-tenofovir), the branded HIV drug shown in trials to be extremely effective in preventing infection. Most go on the internet and buy a generic version, Tenvir-EM, for around an eighth as much.

When they found this was happening, doctors at a London clinic wondered if the men might be wasting their money, given the many warnings about fake or contaminated drugs sold online. “We didn’t know what to expect,” says Nneka Nwokolo, a consultant at Chelsea and Westminster Hospital, which runs a sexual health clinic in Soho. “We wouldn’t have been surprised if some of the drugs had been fake or ineffective.”

Between February and September last year the clinic identified 234 people taking generic prophylactic drugs, and tests of these drugs found no instance of counterfeiting. “Our results have so clearly shown that the Tenvir-EM bought online is genuine that we are no longer doing tests, unless they are buying from a website we haven’t previously heard of,” Nwokolo says.

Nobody knows how many men have taken this route, but Nwokolo believes those seen at the Soho clinic are the tip of the iceberg—and that do-it-yourself prophylaxis is already having an effect. “In 2015-16 we have seen a 40% drop in new HIV diagnoses,” she says. “We wondered if this was unique to our clinic, but from conversations we’ve had it seems all the clinics in London have seen the same.”

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