WORDS BY CONOR CLARK
PHOTOGRAPHY BY YOSEF PHELAN
“The service isn’t just an NHS clinic, it’s like a community centre in the heart of Soho that serves and represents the needs of the community,” says Jon Clark, Clinic Manager of Dean Street Express, the LGBTQIA+ sexual health clinic he has worked at for the last decade. When it first opened its doors in February 2014, it did so to a different world: PrEP wasn’t yet available on the NHS, there was no home testing and ending new cases of HIV felt impossible. Things are still far from perfect today, but the team at Dean Street Express has played an undeniably fundamental role in improving how LGBTQIA+ people treat sexual health by providing a safe space where they can access support without fear or judgement. By the end of 2023, staff had seen approximately 695,650 patients and performed more than half a million (524,181) HIV tests, as well as dispensing 500,549 boxes of PrEP since just 2018.
“We’re not just about HIV and sexual health,” explains Clark, who is also a Registered Nurse. “We’re also about supporting our communities with issues from mental health to safeguarding, gender identity, relationship support and family problems. A typical day will require staff to do more than just hand you a swab…I simply do not believe there is another service in the NHS like it.” Now in its 10th year serving the community, Dean Street Express has hit an array of milestones over the years that GAY TIMES is celebrating by speaking with some of the clinic’s specialists about the significance of each one.
2014: Dean Street Express opens to the public
At a time when home testing was non-existent and PrEP (pre-exposure prophylaxis) was yet to be rolled out on the NHS, the launch of Dean Street Express in 2014 was revolutionary. The clinic introduced walk-in STI testing that saw patients get results in a matter of hours, with touchscreens at reception allowing people to check-in discretely and with ease. Video guides made self-sampling easier than ever, with patients able to put their samples into a tube that takes them directly to be tested without the need to pass them to someone in person. Dean Street Express is unique in that it has a lab onsite, which clinic consultant Dr Alan McOwan says has helped to make regular check-ups easier through the use of technology.
“The Infinity machine can process samples in 90 minutes and directly send an SMS result to patients. The crane that lifted the Infinity machine into position brought Soho to a standstill. I still can’t believe we managed to triple capacity and reduce the waiting time for results from one week to four hours,” he tells GAY TIMES. “The design of the space was really important. It needed to feel less clinical and more welcoming like a bar or club. We knew it would be a hit when within an hour of opening the doors, someone posted an Instagram video of the ‘magic pipe’ that took their samples to the lab!”
2016: PRIME service launches for those at highest risk of catching HIV
The team at Dean Street Express noticed that those who visited the clinic for PEP (post-exposure prophylaxis), as well as those with a rectal STI, had a one in 10 chance of becoming HIV-positive within the next 12 months. As such, they launched PRIME, a programme targeted at those individuals with the goal of making testing and treatment as accessible as possible to those at highest risk.
Miriam O’Connor, Lead Nurse at Dean Street Express, says patients signed up to PRIME in the clinic and “received monthly text messages with sexual health and HIV prevention advice, as well as general lifestyle advice.” Those who showed the text at the clinic’s reception were able to walk in for testing without having to book an appointment in advance, simplifying the process of being seen by staff. Members of PRIME were asked to choose from one of five options to reduce their risk of becoming HIV-positive, these were as follows:
- Take a break – Abstaining from sex and/or chems until you are back in control of your sexual health;
- Just Us – Maintaining a safe and monogamous relationship;
- Condoms Plus – Condoms and a safety net;
- PrEP – Using prep to prevent the spread of HIV;
- Total Bareback – Opting to have condomless sex and as such being given information around STI/HIV reduction, as well as a recommendation of being tested every three months.
2017: Dean Street Express enrols 10,000 patients onto the PrEP Impact Trial
PrEP has been hailed by sexual health experts as crucial in bringing the HIV epidemic to an end, which has been one of the key goals of Dean Street Express ever since it opened in 2014. So, when the government began to consider running a PrEP programme in England, Dean Street Express played a pivotal role in contributing to efforts proving its real-world effectiveness. From October 2017 to July 2020, the PrEP Impact Trial ran at 157 sexual health clinics, with more than 24,000 participants taking part – a staggering 10,000 of which were recruited by the team at Dean Street Express. The landmark study’s overwhelming success in reducing HIV acquisition in real-world settings ultimately confirmed the effectiveness of England’s approach to PrEP, which eventually resulted in the drug being made freely available on the NHS.
“To plan a PrEP programme in England, NHS England and Local Authorities need to know how many people need PrEP, how many will want to take it and for how long. This was the purpose of the Impact Trial,” explains Tara Suchak, Consultant and Service Lead at Dean Street Express. “The success of the trial meant PrEP was fully commissioned on the NHS and is now available free of charge to all those at risk.”
2018: Dean Street reports an 80 per cent drop in HIV transmission
Just four years after opening, the real-world effects of Dean Street’s services began to be visible on an epic scale. The clinic reported an astonishing 80 per cent drop in new HIV diagnoses, something that Dr McOwan at the time said he had “been waiting 20 years to see”. The UK ultimately became one of the first countries to exceed the UNAIDS 90-90-90 targets in 2018, which called on nations to have 90 per cent of people living with HIV knowing their status, 90 per cent of people living with HIV who know their status being on antiretroviral therapy and 90 per cent of people living with HIV on antiretroviral therapy achieving viral suppression.
Franki Lander, Consultant at Dean Street Express, shares that “PRIME and PrEP, as well as HIV-positive patients being rapidly started on treatment, had a major impact on new HIV infections,” something which helped both London and the UK more generally see a decrease in new HIV infections while many other cities and countries were still struggling to do so.
2020: Dean Street Express remains open and converts to phone consultations for PrEP as UK enters COVID-19 lockdown
As the world grappled with the COVID-19 pandemic in 2020 and lockdowns began to be enforced, many sexual health services were forced to close or drastically reduce their services so staff could be redeployed to hospitals. However, Clark explains that he and his team recognised the ongoing need for these services – particularly for those who require regular access to medication. “We very quickly worked up a pathway where if the patient can’t come to us, we will come to them and contacted patients over the phone to perform a verbal assessment like at Dean Street Express and then send PrEP out to a patient via recorded delivery,” he tells GAY TIMES.
“We also utilised the online testing service Sexual Health London so patients could access testing from home whilst in lockdown. Dean Street Express became a hive of activity like a call centre with staff on phones and staff allocated to dispense and pack PrEP ready for postage.” Clark adds that one of his “standout memories” from the COVID-19 pandemic is “the sheer number of patients who were so grateful for a phone call from Dean Street.” He continues: “Many were isolating alone so to have a conversation with a patient during lockdown that was on such a human empathetic level given the times we were living under was just as important as the clinical elements of the call.”
2022: Dean Street Express converts part of its service into mpox vaccination hub
Two years ago, the UK outbreak of mpox began to disproportionately affect gay, bisexual and other men who have sex with men (GBMSM). Sexual health clinics were put under increasing strain by the surge in cases, with the smallpox vaccine eventually rolled out to those at highest risk of infection. Paul Burns, Nurse Practitioner at Dean Street Express, explains that the clinic always remains “flexible to change” and as such part of it was converted into a vaccination hub in August 2022 to meet the community’s needs.
“We contacted thousands eligible to come in and receive an mpox vaccine and to date have delivered nearly 10,000 vaccines at Dean Street Express and continue to offer dedicated clinics as well as offering routinely in sexual health appointments,” he says. “Patients should receive two vaccines in total and we urge anyone eligible who has not started a vaccine or are due a second vaccine to contact us, as it is not too late to receive it.”
2023: PrEP Impact Trial proves the drug’s real-world effectiveness
PrEP’s ability to reduce the risk of HIV transmission became undeniable when the Impact Trial’s results were released in November 2023. As the largest real-world study involving participants at sexual health clinics, it showed how the drug would be used in everyday life and paved the way for clinics like Dean Street to further increase access to PrEP. The team’s work in enrolling 10,000 patients onto the trial was undoubtedly pivotal in showing how it would benefit LGBTQIA+ people and ultimately making PrEP freely available on the NHS, something that 10 years ago would have seemed unimaginable.
“Once it was announced that PrEP would be freely available in England, we hugely increased our appointment capacity to help provide PrEP to everyone who needs it, with particular focus on MSM (men having sex with men), young people and the trans community,” says Hasan, Lead Pharmacist at the clinic. “At Dean Street, we look after over 30,000 patients who take PrEP. If you want to start PrEP with us, you can walk-in to Dean Street Express and talk to us.”
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