Be PrEP-ared: buying anti-HIV drugs online
The NHS will soon start trialling Truvada - the drug used in PrEP - on 10,000 people to see how might be best to roll out the PrEP programme. But, in the meantime, there are more than 655,000 gay and bisexual men in the UK - way more than the 10,000 places allotted. So, in the absence of a vaccine, men are taking matters into their own hands, as Graihagh Jackson found out...
Will - I’m Will Nutland and I’m the co-founder of PrEPster.info and I’m also a social researcher at the London School of Hygiene and Tropical Medicine.
For people like me who want to start using PrEP right now, I have a couple of options. One of those options is to try and get a private prescription, so get a doctor to write a prescription for me but that would cost me in the region of about £400 a month so about £5,000 per year. The other option is that I could buy a generic formulation of PreP online that’s nine times cheaper than it would be for me to buy a private prescription.
Graihagh - And when you say generic, what do you mean?
Will - By generic PrEP, I mean exactly the same formulation of PrEP that is provided and manufactured by the drug company Gilead. Gilead have an international patent on the drug Truvada but, under international laws, countries are allowed to produce a generic formulation of drugs if that country has a particular health emergency or a health crisis and can’t afford to buy the patented form of that drug. So places like India, there are drug companies there that are producing exactly the same formulation of drug but on a generic formulation. And it’s perfectly legal in the UK for someone like me to buy that generic formulation of PrEP so long as it’s for personal use.
Graihagh - So it may be legal but it does sound kind of shady the fact that it has to go through a different countries to get through customs. Why is that?
Will - Yes. Whenever we talk about people buying generic pills online of course it raises red flags for people. So that’s why PrEPster.info are working in coalition with our sibling website “I want PrEP now” have worked together to put some safeguards in place and, broadly, we’re looking at three sets of safeguards. The first is that we’ve done test purchases to make sure that my debit card or my credit card isn’t getting ripped off when I go onto those websites. The second safeguard is to make sure that the drugs actually arrive at the address that we’ve been given. The third safeguard, and probably the most important safeguard, is to make sure that the drug I’m putting in my body is actually what it says on the bottle. I want to make sure that I am taking PrEP and it’s going to protect me against HIV rather than taking something that is a fake drug.
So colleagues at 56 Dean Street have now done more than 250 tests on different people who have been taking generic PreP and there’s absolutely no evidence that from this half a dozen websites that we’ve looked at that there’s any fake drug. So we are fairly confident, as confident as we can that people who are buying drugs from these featured websites are buying the real thing.
Graihagh - That’s really promising and really reassuring to know. But I wonder why you would prefer to use something like PrEP over other methods, say condoms?
Will - I think the question is: why would somebody want to take PrEP is a very interesting question. I’m a public health doctor, I’ve worked in HIV prevention for more than twenty years. I’ve worked in some of the UK's leading HIV organisations and despite huge amounts of money and some fantastic work that’s been done to drive down HIV incidents in the UK, HIV incidence has been increasing for the last ten years or more. We know that condoms have been incredibly effective at reducing tens of thousands of HIV infections in the UK, but the strategies that have been used for the last five or ten or more years aren’t pushing HIV infections down across the whole of the population. I think what’s exciting about PrEP is that all the evidence is showing that if PrEP is highly targetted at those people who are most likely to be involved in HIV exposure, then not only will HIV be prevented in those individuals but if enough people start using PrEP, as a nation we can finally start to see HIV diagnosis going down. So, from my public health perspective, I think PrEP is hugely exciting in building up of the health of our nation.
Graihagh - But why do you personally prefer it?
Will - I’ve always lived with a sense of fear that I could become infected with HIV even when I am consistently using condoms. So for me, it allows me to have sex without fear, without anxiety and without stress and for lots of us we haven’t been able to do that for a very long time.
Graihagh - Do you think this is the ticket out?
Will - I don’t think PrEP on it’s own will be what leads to the eradication of HIV. I think PrEP, if it’s used in combination with continued condom use, with treatment as prevention. And by that I mean that people who are already infected with HIV are offered treatments to suppress their viral loads and, therefore, are unable to pass on HIV as soon as possible after diagnosis. If we make sure that there is good sexual health education across our nations, including good sex education in schools. If all of these things are combined together, then I think we have a really good chance of massively preventing new HIV infections.
But let us not forget that we already have about 100,000 people living with HIV across the Uk and it’s really important to make sure that their health is maintained and that those people are supported as people living with HIV.