Factsheet How to get PrEP in the UK

Roger Pebody, Published September 2017

Key points

  • In England, PrEP will be available to people taking part in the PrEP Impact trial.
  • In Wales and Scotland, PrEP is available through NHS sexual health clinics.
  • It is also possible to buy PrEP drugs online and import them for your personal use.

Decisions on health policy are made separately in England, Wales, Scotland and Northern Ireland. In the case of HIV prevention drug pre-exposure prophylaxis (PrEP), each country has taken a different approach.

In England, PrEP will be available soon at some sexual health clinics, as part of the Impact trial. In Wales and Scotland, PrEP is available at sexual health clinics. In Northern Ireland, there is no NHS provision of PrEP.

In addition, it is possible to import PrEP medications from overseas. This is legal and may be a good option if PrEP is not available in your local area or if you are assessed as not meeting the eligibility criteria for PrEP. If you choose to buy your own PrEP medications, it is important to also go to a clinic for some tests. These are the same tests as you would have if the clinic was providing the PrEP drugs – regular screening for HIV, sexually transmitted infections and kidney function. In this way, you can use PrEP as safely as possible. There is more information on this in the second half of this factsheet.

To find out more about what PrEP is, read NAM’s factsheet Pre-exposure prophylaxis (PrEP).

Is PrEP right for you?

If you are thinking about taking PrEP and attend a sexual health clinic, a doctor or nurse can help you think through whether you need PrEP and whether it is suitable for you. This will involve you being asked about the kind of sex you have been having and expect to have in the future. PrEP is only provided to people considered to be at risk of acquiring HIV and each country has its own eligibility criteria to check this.

The clinic will also need to do some tests. The most important is an HIV test, to check that you are still HIV negative. There will also be tests for sexually transmitted infections, hepatitis B and C, and kidney function.

While you are taking PrEP, you will need to come back to the clinic every three months to get a new prescription and repeat some of these tests.

England

People living in England who meet the eligibility criteria will soon be able to access PrEP from some sexual health clinics by taking part in a trial called Impact. The trial will provide PrEP to 10,000 people over three years. Each participating sexual health clinic will be allocated a limited number of places and it is possible that the trial will fill up quickly.

The trial will be conducted in sexual health clinics in England. Different clinics will open to recruitment in a phased approach over a few months, meaning that some clinics will begin recruiting before others. Clinics in London, Brighton, Manchester, Liverpool and Sheffield are expected to be amongst the first to start enrolling people, with more clinics joining subsequently.

The trial is open to English residents, over the age of 16, who meet one of the following criteria:

  • Men who have sex with men or trans women, who report sex without condoms in the past 3 months, and consider that they will do so again in the next 3 months.
  • The HIV-negative partner of an HIV-positive person when the positive partner does not have an undetectable viral load, and sex without condoms is anticipated.
  • Other people who are clinically assessed and considered to be at similarly high risk of HIV acquisition.

The trial will run for three years. If you are taking part in the trial, you will be able to stop and start PrEP, according to your needs. If you choose to take a break from PrEP you will still be able to go back to it later – your place on the trial will not be given to another person.

You can find out more about the trial here.

Wales

PrEP is available in sexual health clinics to Welsh residents, over the age of 18, who meet one of the following criteria:

  • Men who have sex with men (including transgender men who have sex with men).
  • Transgender women, who are HIV negative, report sex without condoms in the past three months and consider that they will do so again in the next three months.
  • The HIV-negative partner of an HIV-positive person when the positive partner does not have an undetectable viral load, and sex without condoms is anticipated.
  • Other people who are clinically assessed and considered to be at similar high risk of HIV acquisition.

You can find details of sexual health clinics offering PrEP in Wales here.

Scotland

PrEP is available in sexual health clinics to Scottish residents, over the age of 16, who meet one of the following criteria:

  • Men who have sex with men, transgender men who have sex with men or transgender women, who report anal sex without condoms with two or more partners in the past 12 months, and are likely to do so again in the next three months.
  • Men who have sex with men, transgender men who have sex with men or transgender women with a documented bacterial rectal sexually transmitted infection in the past 12 months.
  • The HIV-negative partner of an HIV-positive person when the positive partner does not have an undetectable viral load.
  • Other people who are clinically assessed and considered to be at similarly high risk of HIV acquisition.

You can find out more about PrEP in Scotland here.

Buying PrEP online

Several online pharmacies based overseas sell PrEP medications. It is legal to buy the drugs for personal use and have them delivered to you in the UK.

"Although you may be arranging to buy the medication yourself, it’s recommended you talk to a health adviser, nurse or doctor at a sexual health clinic as well."

The tablets you can buy are generic medicines. They have the same active ingredients as Truvada, but are manufactured by different companies and have different names. Some of the most widely used are Tenvir-EM (manufactured by Cipla), Ricovir-EM (manufactured by Mylan) and Tenof-EM (manufactured by Hetero).

It is important to check that the tablet you are buying is a combination pill, containing both tenofovir and emtricitabine. For example, Tenvir-EM contains these two drugs, whereas Tenvir only contains tenofovir and is not recommended for PrEP.

PrEP users and advocates have set up a website called www.iwantprepnow.co.uk.  The website includes direct links to online pharmacies selling PrEP drugs. The pharmacies are only listed when PrEP users have reported that the buying process went smoothly and that they received genuine pills.

A month’s supply of 30 pills, taken daily, usually costs around £45. On top of this, customs officials have occasionally asked people importing PrEP to pay a VAT charge.

Occasionally, online pharmacies have been out of stock of PrEP drugs, or there have been postal delays. It’s best to order at least one month in advance.

Is the drug genuine?

This is an understandable concern for people buying medication online. In fact, the overwhelming experience of people buying PrEP drugs through the websites listed on www.iwantprepnow.co.uk is that they have purchased genuine drugs.

This has been tested by a blood test known as Therapeutic Drug Monitoring (TDM). It shows whether someone who has taken a tablet has active levels of the drug in their blood. Although TDM is not routinely available in the NHS, your sexual health clinic might be able to tell you if someone using the same PrEP drug or supplier has already been tested with TDM. In the tests done so far, there have not been any problems.

It’s worth knowing that the tablets sold are also used for HIV treatment for millions of people in Africa and other parts of the world where patent protections do not apply. In many cases, the tablets have been approved by the American regulatory agency, the Food and Drug Administration (FDA) and by the World Health Organization (WHO) for this purpose. This is the case for Tenvir-EM, Ricovir-EM and Tenof-EM.

We would advise checking that the product you are buying has been approved by the FDA or WHO, and checking that the supplier is recommended by www.iwantprepnow.co.uk.

The law on importing medications

People living in the UK can purchase and import drugs without breaking the law, provided that:

  • The medications are for personal use only.
  • The quantity purchased is for no more than three months’ use.
  • The drugs are not otherwise illegal in the UK (e.g. recreational drugs).

Truvada is currently protected by a patent in the UK. This mean that the NHS and UK pharmacies should normally use Truvada rather than generic versions of it that are cheaper. But it is lawful for individuals to import generic drugs.

Private prescriptions for PrEP

An alternative way to get PrEP is with a private prescription for Truvada, with you paying the full cost of the drug yourself (around £400 for month’s supply of 30 pills). This service is offered by some private healthcare clinics in London including 56 Dean Street (a private service within the NHS clinic) and Same Day Doctor.

Clinical support

Although you may be arranging to buy the medication yourself, it’s recommended you talk to a health adviser, nurse or doctor at a sexual health clinic as well. They can help you with the tests you need in order to take PrEP safely.

They can also give you advice on what to do if you miss a dose of PrEP and on different ways to take PrEP (every day, or before and after having sex). If you want to stop using PrEP, they can advise you on the right way to do this.

If the way you feel about yourself, pressure from other people, drugs, alcohol or other issues affect risk taking and your sexual health, they can help you with that too.

Tests to have before you start

You should have these tests done before starting PrEP or around the same time. If you’ve already started PrEP, get them done as soon as you can.

  • HIV: 4th-generation blood test, able to detect antibodies and p24 antigen
  • Kidney function: test for protein in urine
  • Kidney function: test for creatinine and eGFR in blood
  • Hepatitis B and C: blood tests
  • Sexually transmitted infections

It’s important to be sure that you don’t have HIV without realising it – if you did have HIV, taking PrEP could mean you develop resistance to drugs you may need for treatment.

Make sure you have a “4th-generation” blood test for HIV. This tells you your HIV status four weeks ago. Other tests, including ones which provide a result immediately and ones which you use at home, are not as good at picking up recent infections.

If you’ve taken any risks in the four weeks before taking the test, you can start PrEP but it’s a good idea to repeat the test four weeks later. This is just to check that a recent infection was not missed.

If you’ve recently taken a risk and have flu-like symptoms, don’t start PrEP. You need to rule out the possibility that these are the symptoms of recent HIV infection. Go to a sexual health clinic as soon as possible for advice and testing.

The hepatitis B test is essential because PrEP drugs are active against hepatitis B. You could still use PrEP, but you’d need a doctor’s advice on the safest way to do so.

Tests to have regularly while taking PrEP

Regular monitoring is important. Every three to four months you should have:

  • HIV: 4th-generation blood test, able to detect antibodies and p24 antigen
  • Kidney function: test for protein in urine
  • Sexually transmitted infections

Once a year you should have:

  • Kidney function: test for creatinine and eGFR in blood

Your sexual health clinic should be able to provide these tests. Sexual health clinics in some of the larger cities may have more experience of supporting people with PrEP.

If your clinic seems unwilling to help, you could try asking to see a consultant (senior doctor). It might be helpful to show staff the British HIV Association (BHIVA) and British Association for Sexual Health and HIV (BASHH)’s Position Statement on PrEP in the UK. This gives clinicians information on how they can support people using PrEP.

This factsheet is due for review in September 2020

Find out more

This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.
Community Consensus Statement on Access to HIV Treatment and its Use for Prevention

Together, we can make it happen

We can end HIV soon if people have equal access to HIV drugs as treatment and as PrEP, and have free choice over whether to take them.

Launched today, the Community Consensus Statement is a basic set of principles aimed at making sure that happens.

The Community Consensus Statement is a joint initiative of AVAC, EATG, MSMGF, GNP+, HIV i-Base, the International HIV/AIDS Alliance, ITPC and NAM/aidsmap
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This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.

NAM’s information is intended to support, rather than replace, consultation with a healthcare professional. Talk to your doctor or another member of your healthcare team for advice tailored to your situation.