Luke*, 27, has taken PEP—the emergency treatment that can prevent HIV infection after the virus has entered a person's body—thrice in the last year. "The first time I was on mephedrone and GHB and I was having sex with this guy at a party. I realized he wasn't wearing a condom and when I asked him if he was negative, he said, 'I think so.'"
Luke went to London's leading sexual health clinic, 56 Dean Street, and was prescribed an emergency course of PEP. "They were ridiculously professional and referred me for drug counseling, which I attended." Since then, Luke has been twice prescribed PEP on the National Health Service by physicians.
"The last time was really traumatic, actually. It was the Valentine's Day weekend and it was a very crazy weekend and I got depressed and went all out and didn't give a shit. I was dumb and I must have been with three or four guys, and then as I came down off the drugs I had an anxiety attack and went to the emergency room, where they gave me PEP."
Luke's experiences of needing emergency HIVmedication are not unique. According to figures released on Tuesday by the Department of Health, more gay men are accessing PEP on the NHS than ever before. In 2011, 2,388 gay men in England were prescribed PEP. By 2015, this figure had risen to 7,980, an increase of 234 percent. Public Health England told Broadly that the increase was "in line with the overall rise in the number of patients attending sexual health services in England."
The data paints a bleak outlook for the sexual health of queer men. Alongside the staggering increase in the numbers accessing emergency HIV medication, the figures show that gay and bisexual men are disproportionately affected by STIs: Syphilis and gonorrhoea cases have risen by 19 and 21 percent respectively. Despite widespread clinical evidence of its effectiveness, the UK government has also denied users access to PrEP, the life-changing HIV prevention medication that is the pre-exposure counterpart to PEP.
HIV/AIDS campaigners and sexual healthexperts believe that gay men may be resorting to desperate measures in their efforts to get their hands on PrEP. Under British guidelines, anyone telling doctors they've been potentially exposed to HIV is prescribed an emergency course of PEP. The prescription consists of two medications: Raltegravir and Truvada. Discount the Raltegravir, and you're left with Truvada—the brand name of PrEP. Figures don't exist for how many men tell doctors they have been exposed to infection solely to get PrEP, but the practice is known widely as "clinic-hopping". There are even online blogs that explain how to "get free PrEP on the NHS."
Although Luke has never clinic-hopped himself, he knows men who do. "I feel like morally I wouldn't do it, because it's wasteful. But I understand why people are doing it." After all, HIV infection rates are increasing in every part of the UK. According to spokesperson Dr Michael Brady, HIV charity Terrence Higgins Trust has been "concerned for a while that that men at risk of HIV will access PEP (which is available on the NHS) and use only some of the medication as PrEP. At the very least, these figures represent a significant rise in high risk groups accessing clinics in need of effective HIV prevention."
Activists such as Will Nutland from the organization Prepster are advocating for PrEP availability on the NHS. Does he think clinic-hopping is behind the huge spike in PEP figures. "We do know for sure that people are accessing PEP for PrEP, but we can't put a figure on it exactly," he replies. However, he points out that going from clinic to clinic to get your hands on PrEP isn't an option for many. "Going to hospital, or a sexual health clinic, can effectively take a day out of your month, so it's only really useful if you're not working or on a very low income." Instead, many men choose to buy generic PrEP online, from countries such as India—with no guarantee that the product they're getting is entirely safe.
Yusef Azad of the National Aids Trust believes that the "spike in demand for PEP is a sign of the immense need out there for further prevention tools in addition to condom use." It's a scandal that PrEP isn't being made available to those in need on the NHS, he says.
"Frequent repeat PEP prescriptions are an expensive and ineffective substitute for PrEP. The NHS is denying gay men access to PrEP, forcing them to rely on PEP which was not designed for on-going risk." When asked for comment, the Department of Health were unable to provide information on how much a course of PEP costs the NHS per individual.
Of course, it's possible that an increasing number of people now know about PEP, and this is driving the rise in figures. According to the 2014 Gay Men's Sex Survey, only 37 percent of men had never heard of PEP, a significant decrease on previous years. But while more gay men may be aware of PEP, the proportion of men who engage in risky sex and take PEP remains relatively small, making up around 7.2 percent of those who have sex without protection and are at risk of contracting HIV.
Azad speculates that other factors, such as the rise of drug-fueled sex parties (also known as chemsex parties) and hookup apps, may be driving the increased PEP uptake. Luke regularly attends chemsex parties. "Basically, whenever I find myself in a precarious situation it's usually because of drugs." For men like Luke, making PrEP available on the NHS would have life-changing consequences.
"I think it would be another way of taking control. I know people who are on PrEP who still use condoms. My best friend is on it. It would take the anxiety out of sex, like the pill. People who are on the pill, they don't go out and have more sex. It's just a way for people to take control over their life."
* Name has been changed