The report surveyed 1,120 people who had tried to access PrEP in the previous 12 months, and struggled to do so. Over half (65 per cent) of respondents were totally unable to access the drug via an NHS PrEP service. We know from data presented at BASHH in 2019 that in one clinic alone, nine gay men who were on a waiting list to access PrEP through the PrEP Impact trial, acquired HIV while waiting for a trial space. 

At the time, Dr Jewsbury from the Manchester clinic, said: “In summary, we found nine preventable infections in patients that were motivated to take PrEP. It’s quite possible that if they lived in a different part of the UK or if PrEP had been commissioned in England, then these infections may have been avoided.” 

So a year on, what has changed? 

As we approach the end of 2023, it’s abundantly clear the full potential of PrEP has been curtailed by a sexual health system under continued extreme strain.

We don’t know how many people are currently not able to access a sexual health clinic to start PrEP. But of those who can get a foot in the door of the clinic, we know 121,547 people could potentially benefit from it. Reassuringly, 71 per cent of these individuals started or continued to take PrEP. So, the system is still working for some people, if they can access it.

The number of people who had their PrEP need identified within a clinical consultation rose from 79 per cent in 2021 to 83 per cent in 2022. There has also been a significant rise in the proportion of straight women and men who have had their PrEP need identified. But this still means that two in fi e (41 per cent) of women with PrEP need have not been recognised. More health inequalities arise when we look at ethnicity. Among straight people, those of White ethnicity had their PrEP need identified at a higher rate than people of Black African ethnicity, despite rates of HIV being much higher within Black African communities.

There is a vast difference between those who could benefit from PrEP and those who actually take it – while 74 per cent of gay, bisexual and other men who have sex with men (GBMSM) started on PrEP, only 36 per cent of straight women and 39 per cent of straight men took up the drug. It is clear that many straight people either do not see oral PrEP as for them, or aren’t receptive to the way we currently offer PrEP.