A ground-breaking HIV drug could be made available on the NHS after a High Court ruling.

On Tuesday, Mr Justice Green ruled that NHS England was wrong to claim that providing PrEP — a drug which is highly effective at preventing at-risk individuals from contracting HIV — was not its responsibility.

But what exactly is this drug, and why does this ruling matter?

What is PrEP and how does it work?

Pre-Exposure Prophylaxis — or PrEP — is a once-a-day drug that has been shown to reduce the risk of HIV infection by more than 90%.

It can be used by people who are at high risk of contracting the virus — for instance, those with an HIV-positive partner, or people who often have multiple sexual partners who might be carrying HIV.

PrEP prevents the virus from entering a person’s cells and replicating, by filling the bloodstream with antiretrovirals, which are also used to control HIV in people who are already infected.

It cannot be used like a ‘morning after pill’ for people who think they may have been exposed, as it takes a full week’s does for it to build up to full effectiveness.

Professor of Music at Newcastle University, Paul Atinello
Professor of Music at Newcastle University, Paul Atinello

Why is this ruling important?

We spoke to Paul Atinello, a Newcastle University academic and trainee psychoanalyst who used to manage PTP, a support group for people living with HIV in the North East, about what the ruling means for HIV positive people like him and their loved ones.

He said one of the most important things was the knowledge that, if PrEP is made widely available, which this ruling makes more likely, fewer people in the area will contract the life-changing virus.

On top of that, he said there was a more political dimension to the question of whether the NHS should fund the drug and that the ruling might point to the changing of some attitudes towards HIV positive people.

He said: “Really, what this fight comes down to, is ‘do people have the right to have sex?’

“There are people who think ‘you people shouldn’t be having sex anyway, why should we be paying for it?’ but apart from anything else, it is actually cheaper this way, compared to treating people afterwards.

“I think the political is tied to some attitudes towards sex itself — something kind of puritanical, which has been around since the beginning of the AIDS crisis. Many institutions aren’t comfortable seeming to encourage or even condone sex — and of course we are going through a time when the government doesn’t want to spend money on anything, and there’s increasing resentment aimed between different groups of people.”

Dr Michael Brady, medical director at the HIV/Aids charity Terrence Higgins Trust, described the drug as “a game-changer”.

He said PrEP offered “another line of defence” against HIV, alongside condoms and regular testing.

Dr Brady said: “It is not a vaccine and it won’t be for everyone, but, once approved, we expect it to significantly increase the momentum in our fight against the virus.

“We urge the Government, NHS England and local authorities to make PrEP a key priority in the fight against HIV.”

Professor of Music at Newcastle University, Paul Atinello who is HIV positive and has set up a support group for the North East

Why didn’t NHS England offer the drug?

The body which commissions day-to-day NHS services had said that councils were the only ones allowed to fund the drug, because they are generally in charge of preventative health.

Cash-strapped councils said they could not afford to pay for the treatment.

NHS England’s stance was successfully challenged by the National Aids Trust (NAT), and the High Court has ruled that PrEP does fall within its remit.

In his judgement Mr Justice Green wrote: “No one doubts that preventative medicine makes powerful sense.



Will it now be available on the NHS?

The ruling doesn’t mean that PrEP will automatically become available on the NHS.

First of all, health bosses say they intend to appeal.

If the judgement is upheld, they will then have to assess the cost-effectiveness of the pill, which costs £400 per person a month, weighing this up against other services they are called on to provide.

However, NHS England has also said it will put aside money in case it does have to fund PrEP, and put pressure on the drug’s manufacturer to offer it at the best possible price.

Yusef Azad, Director of Strategy National Aids Trust, outside the Royal Courts of Justice

Shouldn’t people use a condom if they’re concerned about HIV?

PrEP can be used as an additional defence against HIV, along with condoms, and it can allow couples in which one partner has HIV to have sex without having to use a condom.

While condoms are effective if used, thousands of people are still infected every year, so campaigners say that PrEP could still stop huge numbers of people contracting HIV. The lifetime cost of treating someone who contracts HIV is thought to be around £360,000, so prevention can be far cheaper than managing the infection.

On top of that, for many HIV-positive people, the ability to have sex without worrying about infecting a partner is an incredibly important, emotional breakthrough.

Paul explained the impact that carrying an HIV diagnosis can have on a person’s ability to form sexual and romantic relationships — and how the availability of PrEP might change this.

He said: “I was on a train when I heard about this drug, and I actually started crying right there.

“I’m nearly 60, and I’ve lived alone for 14 years, and I find out that things I never thought were possible are.”

He added: “Some other members of the group have found it easier to have sexual relationships with HIV, but for most of us, including me, it becomes very difficult.”