The end of year reviews of 2016 were pretty damning. Bowie, Prince and George Michael led a long list of musical heroes who left us. Brexit in the UK and Trump in the US upset the pollsters and divided both nations. Worldwide, there was a succession of murderous atrocities committed, not least a bloody attack on a gay nightclub in Miami. And Princess Leia died. And then her mum died too.
But just before Christmas there was one bit of good news. 56 Dean Street, the busiest sexual health clinic in Europe, announced that they had seen a 40% drop in new HIV diagnoses. Shortly afterwards other London clinics chimed in, reporting drops in new diagnoses among gay and bisexual men in 2016 of between 35% and 50%.
I found this hard to process. To hear the news I’d been hoping, fighting and campaigning for half of my adult life felt almost too good to be true.
The change couldn’t be explained away by a drop in testing, which remained roughly the same. Also, there was no significant change in the rate of other STIs, which suggested that there hadn’t been a sudden, dramatic increase in condom use or other changes in sexual behaviour.
Treatment as prevention (TasP) undoubtedly was a contributing factor. Over the last few years there has been progress in reducing the number of people living with undiagnosed infection. People with HIV now access treatment earlier and when we are undetectable on treatment we’re no longer a transmission risk. That change has been growing steadily over the last few years so it didn’t seem to explain the massive, game-changing drops that the clinics were reporting. This had to be the result of something new.
We haven’t got all the data in yet so we have to proceed with some caution but most signs suggest that it was PrEP that made the difference.
For years condoms, as a strategy, were barely able to keep the number of new HIV infections among gay men stable. Testing and treatment seemed to have some impact but only slowly. Something more needed to be added to the prevention armoury if we were going to successfully drive down new HIV infections.
The efforts of the PROUD study, activist websites like ‘IWantPrEPNow’ and ‘Prepster’ and support from clinical teams, mean that PrEP has now been taken up by a group of very sexually active gay and bisexual men. The figures suggest it’s having the impact that activists had hoped for. In fact, the figures exceed the expectations.
I’ve long argued that, just as combination therapy finally enabled us to treat HIV effectively, a combination approach to prevention is required. It is telling (and frustrating) that this vital tool, PrEP, is still not available on the NHS.
There’s still some distance to travel. The data that was hastily released at the end of the year needs greater analysis. I’m fairly certain we’ll see that the steep drop in diagnoses is not spread evenly amongst all groups. At the year’s end, we won’t be seeing total drops in new diagnoses within that 35-50% range, because that dramatic impact will likely be confined to a particular group of gay men, with high numbers of sexual partners, engagement in sexual health information and the will, and cash, to access PrEP outside of NHS provision.
What we can hope for is that the evidence for the effectiveness of PrEP will be conclusive enough that funds will be invested in getting it to all those who need it. We have the tools we need to end HIV infections. Let us not hesitate to use them.
Among all the hell that 2016 threw at us, it may just be that right at its end was the turning point in our battle to end new HIV infections.
This article by Matthew Hodson|@Matthew_Hodson previously appeared at FS Magazine, here.