Protected by PrEP – Improving health through harm reduction

Chad Morgan, a PrEP promotion specialist at Brook, talks about the work Brook is doing with communities in Lewisham to reduce HIV transmissions, and about the importance of harm reduction tools such as PrEP in the prevention of HIV.

Tackling HIV is a global challenge, and each country has a part to play. Here in the UK, the government has committed to end new HIV transmissions in England by 2030.

If we are to succeed in that ambitious goal, it requires effort at both a regional and local level.

At Brook we’ve been working to help reduce transmissions in Lewisham, and to do that effectively we have to understand how HIV effects the local communities in the borough.

Throughout the UK, Black and Minority Ethnic (BME) communities are at a higher risk of HIV . This is due to complex mix of reasons, such as stigma or barriers to accessing sexual health provision. Lewisham is currently reported to have the 11th highest rate of HIV in the country, and as almost 50% of the borough’s population is Black and people of colour, it leaves these communities at increased risk of infection. Moreover, while men who have sex with men are disproportionality affected by HIV in the UK, in Lewisham 49% of new diagnoses are actually among heterosexual people.

This shows that we need to speak to a broad range of different communities in our HIV prevention work in the borough.

We also need to consider how HIV spreads. Globally, HIV is mainly transmitted through unprotected sex, and this is also the case in Lewisham. So why aren’t people using condoms? Again, there are a myriad of reasons. Some people may find it difficult to discuss condom use with their partners, some may face barriers to accessing sexual health services. Drug and alcohol use can also play a factor in affecting people’s judgement, while others may just prefer unprotected sex.

So, what can we do to stop this? As health care professionals our role is to improve the lives and wellbeing of people and to improve health outcomes. We don’t try to force people to stop or adopt particular behaviours, instead we explain the merits and empower them to make the decisions that are best for them. This where harm reduction comes into play.

Put simply, harm reduction is an approach to public health that aims to reduce the negative consequences of specific behaviours. An example of this would be the programmes that provide drug users with access to needles and syringes to help stop the spread of HIV. It is a humanising and pragmatic approach that aims to understand people’s needs and service them.

It also supports people to make small, incremental steps that have a very real, positive effect on their health.

One of the best harm reduction tools we have when it comes to HIV is Pre-Exposure Prophylaxis, or PrEP. PrEP is a pill you can take once a day to provide protection from HIV. It is up to 99% effective in preventing the person taking it from contracting the virus. This is especially useful for people who find it difficult to use condoms, for whatever reason. So while we absolutely continue to promote condoms, PrEP provides another way to prevent transmission of HIV – win!

PrEP is free on the NHS, provides protection to all people, and will protect against contracting HIV through other methods such as injecting drug use. In Lewisham, people can access PrEP from The Waldron Health Centre, or the Trafalgar Clinic at Queen Elizabeth Hospital. You can also use Brook’s Find a Service tool to locate where to access PrEP in other parts of the country.